Transcripts For CSPAN2 CDC Director Redfield Testifies On Coronavirus 20240713

[inaudible conversations] the cdc before the subcommittee this morning and has been several years march of 2016 since our last hearing on the budget of the nations leading Public Health agency. Before i do a formal welcome, i was made aware of this issue which is very troubling. And that is, that the administration is ordered the immigration courts to immediately remove coronavirus posters and it just says the immigration courts have been ordered nationwide by the administration to takedm down coronavirus posters from courtrooms and waiting areas. The executive office for immigration review under the department of justice mandated allex posters which explain in english and spanish how to prevent catching and spreading the virus had to be removed immediately. I just want to say that whatever your point of view on any issue that we face in this nation whatever your personal views are or your ideology , that we canno cannot, we cannot in this Public Health crisis play fast and loose with Peoples Health no matter what we believe it is a moral responsibility for us to make sure that everyone is protected. This just came to my attention. Doctor redfield we welcome you to have you here with your colleagues who are with you and the associated Deputy Director from science and surveillance, director of National Center for injury prevention and control, the chief Strategy Officer and chief operating officer. I might say i also want to acknowledge our doctor who is not here but did provide us with bipartisan briefing that we had for the subcommittee in february. In fact before we proceed, the cdc fy 21 budget request, let me start where we are all probably starting today with covid19 first i want to commend the thousands of Public Health experts at the state and federal level who are working so hard to keep us safe during the outbrea outbreak. That includes you doctor as well as all the cdc staff. We are in a crisis. There are questions about our preparedness and ongoing responses. I am very concerned about the nations testing capabilities other countries have been testing thousands of people per week but the us is behind the curve the low numbers of tests is likely a byproduct of under testing but the prevalence of coronavirus in the United States. Testing kits are now being distributed across the country and commercial firms are involved as well. But the delay was unacceptable while cdc properly developed a new test for the covid19 the majority of the initial test kit sat in laboratories and they were faulty with weeks of delays before the replacement kits went out. During this time cdc meantime on maintains a narrow testingin criteria if the health of the country was put at risk because of these actions. I suspect there will be a lot of questions today with those delays another concern is Emergency Funding. Congress came together last week with eight. 3 billiondollar emergency supplemental on the bicameral basis including two. 2 billion dollars for the cdc this funding will support cdc as well as state and local Health Departments who are critical to responding to this outbreak and saving lives. But when the crisis arose, the cdc only had 105 million available through the Infectious Disease Rapid Response. Upthe supplemental had 300 million. I have been a leader for years on the Public Health Emergency Fund and have repeatedly introduce legislation for Public Health emergency to provide 5 billion in Emergency Funding for Public Health Emergency Fund so you can act with alacrity and flexibility. We can only imagine where we would be if we had 5 million at the outset instead of 105 million and the Rapid Response fund the former Health Minister of south africa, global Public Health expert has set up Public Health infrastructure why do we lurch from crisis to ceisis and lapse into complacency between . And this is the reminder of the importance of a well trained, well trusted, wellfunded Public Health system. Beyond covid19 professionals at cdc day in and day out are working to combat foodborne illnesses and influenza and promote a Healthy Lifestyle to reduce the Tobacco Products and on and on it is important work and why we are proud of what we were able to do is an increasing the funding by li 636 million. 9 percent above the 2019 level on a bipartisan basis. Some of those highlights include for the first time in more than 20 years funding to specifically Mortality Prevention Research in the first year of a multiyear effort to support modernization the publicly held datas surveillance that local Health Departments in the first year a Multiyear Initiative of hiv 90 percent over the next ten years the establishment of the Suicide Prevention program and tobacco prevention given the ecigarette and vaping epidemic among the young people. Increases for global Disease Detection and Global Health security as you outlined in your remarksoutl, the Global Health security is critical to our National Security and the Infectious Disease Rapid Response reserve fund. Sp unfortunately the president 2021 Budget Proposal reverses the progress and the budget proposes to cut cdc by 693 million, 9 percent below the 2020 appropriation. Despite the presentation of the president s budget which claimed Infectious Disease, Global Health and preparedness and priorities of the cdc request key programs would be quite one cut Infectious Disease Rapid Responsere fund to allow cdc to quickly respond to covid19 this committee will not pursue icthe proposed cut during the outbreak is beyond consideration that we together intend to invest in the cdc in the nations Public Health. We will not lurch from crisis to crisis and lapse into complacency in between. Wenot. Cannot the coronavirus outbreak make that clear. I will stop here we look forward to your discussionson and other policy areas in your jurisdiction. The cbc and strategic stockpile and later on we added the Rapid Response Infectious Disease fund idea that the chair had been championing for many years and i think they are all good decisions if we are seeing the benefit of it now and i expect we will stay on that course. What you do and i think all of you for doing it and splendid professions believe are absolutely indefensible or excuse me, indispensable in defending the people of the United States. Wevee had this discussion before. I think of you as a biomedical equivalent of the pentagon and what we do protect the American People make these investments Going Forward. Good morning and thank you for coming to be with us this morning. Im going to do what i did with france is calling, how is your weekend, i think about you a lot. We know that this has been an extra in a stressful time for you and you are doing great work for the American People. Y i know the coronavirus is at the forefront of everyones mind this morning. Ththe publichealththe public hd cdc are front and center defending people and in addition to hearing about coronavirus this morning im hoping we can discuss other priority is. I know we all share which is producing opioid abuse and deaths addressing the threat of antibiotic resistance in preventing thein growing probles associated with chronic diseases, all critical Public Health issues foror the country. As the United States continues to monitor and respond to the virus i am encouraged to Work Together across party lines on resources with the days and weeks ahead. Ol such a highly polarized environment and i am encouraged we could set aside our differences and quickly deliver on such a high priority item for the health and safety of the American People. It took just nine days for the administration to submit information regarding a supplementalio appropriation ned and bipartisan bicameral congressional action. I suspect you can continue to count on bipartisan robust support in your efforts to keep the community i communities pred able to respond. Long before the Coronavirus Congress was already prepared for the Public Health emergency in a bipartisan way. Five years ago congress began shaping policies and prioritizing estimate including boosting funding year after year for the National Institutes of health and centers for Disease Control and prevention and Strategic National stockpile. Perhaps the greatest wife like these past few weeks as the prior establishment of an investment in the Infectious Diseased Rapid Response. Because congress had the tools in place the administration has been able to direct us with a response from day one. I want to associate myself with the chai chairman and i would le the phone to the larger. We proposed 300 million those in the budget realities we would have liked to do more. Im pleased that congress did te 300 million a supplemental and i hopebu that we can build on that given what we have towe work wih but again the outcome because was our creation of the reserve fund and while itsd unfortunae im glad that a the resources we available. I hope more available in the yfuture. Theres still a long road ahead and i am encouraged one of those is not whether the funding will be there for the publichealth defenders to continue their response. Along with providing the funding for the resources we need to prepare for and respond to the coronavirus the supplemental replenishes the disease Rapid Reserve fund 300 million to help us respond quickly to future threats. We are seeing and continuing to witness a deadly new disease is just a plain right away. Thats why the Global Health security is also such a critical component of preparedness and Public Health experts deployed all around the world an idea he first raised with me a number of years ago. To respond to new publichealth where they exist in the country of origin before they reach the shore is a good idea. They are likely to never know where the next threat may appear so ensuring the strategy for the region is necessary. I look forward to hearing more about the Global Health security. There are other topics i would like to address today addressing influenza, combating the opioid problem and they threaten the most vulnerable populations and reducing antibiotic resistance. A but as our time is limited i will make my statement and look forward to continuing our conversation and will yield back my time, not on the chair. Doctor redfield and distinguished panelists, thank you for joining us. I want to thank you for making withee us last week. We spent more than an hour together and i appreciate your commitment and expertise. Two weeks ago i planned to raise the budget continued neglect of the cbc. Its cutting Chronic Health resources an into the harsh impt on Health Outcome of america. After working for more than two decades to restart federal investment in gun violence Prevention Research, i was eager to discuss the type of research that may be funded. We would like to hear about progress on other important investments in the fiscal Year Spending bill including the Data Modernization Initiative Prevention Research and combating the epidemic. By the way thats an issue that is pervasive and i first learned about it from my 15yearold grandchil15 year oldgrandchild s was vaping and its not getting better, its getting worse. Today we have a new epidemic on our hands. One week ago my home county of westchester new york and its first confirmed coronavirus case today we have 98. Thertheres 26 deaths. The stunning increase requires every level of government to Work Together and aggressively to contain and stop the spread of covid19. With the recently enacted 3. 8 billion emergency supplemental, the federal government can aid state and locato state andlocal departmeng patients and medicaid the virus, however due to the administrations failure to treat thisri threat seriously, initial faulty test kits, slow distribution of working kids more people are likely to be infected and its fancy we are hearing those statistics. It is imperative that the federal government have a multiagency approach to am sure the tests are available for all who need one without delay. Cant goo backward. Unfortunately there was a real delay and that is why it was spreading. Earlier this week i sent a letter to secretary azar and your self urging you to urge powers at your disposal to quickly approve qualified labs in new york. Had a conversation with the governor of new york if they are ready to move. They need you to approve these including hospitals, private pe labs anclubs, other state facils and to permit both automated and manual. I want to stress that again if it is taking more time for the federal government to catch up state level, is Solid Movement and we need youyo to approve all these labs have facilities they could expand Testing Capacity by thousands per day. I dont know why they are waiting approval. Maybe you can address that in your comments that could expand capacity by thousands per day as may be throughout the country if only the federal government would get off the sidelines and approved the facilities. So in your remarks i would be most appreciated if you could tell me why its taking so long. Are there not enough people to check at the facilities . Are the facilities not adequate for up to your standard, we need to know. If the word im getting from i e governor is the people involved in this issue that they are ready to move, why arent they being approved. As covid19 comes closer to the pandemic status, we must do all we can to protect the public. I look forward to the discussion and again i thank you for the personal interaction we have and i appreciated the opportunity and i look forward to hearing from all of youou today. We look forward to the facts so that we can move as quickly as possible. This is an emergency. Thank you. Just a while ago the miami herald published a story right now the department of justice contacted the herald to say, and i quote, the signs shouldnt have been removed and its now been rectified. So the outcry against that really moves things around in. Your full testimony will be entered into the hearing and you are recognized for five minutes. Thank you very much, chairwoman and Ranking Member and obviously chairwoman thank you very much for letting us hear the distinguished members of the committee. The first thank you for your support inin the cbc. Your investment enables them to protect the health and safety of the American People and as we are seeing right now with covid19 and Infectious Diseases can emerge anywhere in the spread everywhere. We have slowed the spread of covid19 to the United States as a consequence of the impact of the investment in Public Health that has been there at the federal,an state, tribal level. Cdc has identified securing Global Health and ensuring domestic preparedness to eliminating the disease and ending epidemics as the top strategic priority is. We also identified the capabilities that support the entire agencyst programmatic efforts including the modern modernization, analytic systems and a stateoftheart laboratories. As well as building a Solid Foundation around the globe to address the Global Health security threats. Cdc has leveraged every one of these capabilities so far in the response to the covid19 outbreak. The president s fiscal year 21 budget provides 7 million to the cbc to support these and other publichealth priority is a. When it comes to Global Health threats i believe the cbc is the tip of the spiri spear house wie ddefense department. They are moving along in the sustainable regional footprint. This approach would increase the ability to meet the publichealth challenges wherever they occur. They depend otheyve dependablyd a stateoftheart s laboratory and the budget does include 10 million to help maintain these Laboratory Capacity equipment and specialized training. The budget also supports the Infectious Disease Rapid Response fund which has enabled the cbc to respond immediately to the covid19 outbreak and also helped us provide sustainable response to the drc. Like covid19 the new influenza virus strain can emerge from animals to spread very quickly. Today the surveillance is being leveraged to ramp up for covid19 surveillance. They threatened the lives and can disrupt the Health System and economy. It includes an additional 40 million to protect americans from f influenza. The president also concludes an increase of 13. 6 million to address the growing threat of kick borne disease. The ability to prevent disease depends on accurate, timely data in the Public Health workforce that can use the data to predict the next outbreak ended my time as the cbc we focused on bringing the reporting time to real time. This request supports the t publichealthst data modernization, strategic Multiyear Initiative that bringu publichealth data intoo the 21t century read the cdc relies on data for every important Public Health issue we attempt tol address. Pregnancy complications is another devastating burns and the budget includes 12 million to increase and improve the Maternal Health in america where ever the Maternal Death will trigger a publichealth response to understand what caused the death to try to identify idimportant interventions. Finally the cdc is committed to ending epidemics and includes an increase of 371 million to support the president initiati initiative. The cbc is deploying approaches to alter the projection in the overdose epidemics. Overdoses has declined into the budgetth includes 476 billion in an additional 48 million to address Infectious Disease related to drug use disorder. The cdc and Public Health partners are the nations first line of defense against these threats. We are committed to working with you to protect the health and wellbeing of all americans and i look forward to answering all of your questions including the question that you asked i will answewouldanswer that also. Thank you. The cbc has been working to respond to covid19 including utilizing Quarantine Authority that hasnt been used in a decade and over the last couple of weeks we moved from a strategy of quarantine to a strategy of medication. People are following the guidance according to their Healthcare Provider to get evaluated and Healthcare Providers are facing the reality that they cannot get their repatients tested. Others are testing thousands. South korea has been a 10,000 a day. We are behind the curve and my understanding is they continue to be distributed, commercial phone are involved as well. I want to try to keep within five minutes. Why iss the u. S. Behind other countries when it comes to ttesting availabilities, why ws it such a delay in the ability to replace the test kit sent to the publichealth labs and then i have a question after that. We got this new disease december and its occurring in china and the chinese fairly rapidly published genetic sequence the end of the first week of january. We actually worked based on that test is a fairly quickly we had a test of you running which is our job to get the Technology Available to the laboratory and wees let them know and they begn sending samples that had the first diagnosis in january i think it was 21st in the state of washington. Why are we eat high and other countries and by was there such a delay in the ability to place . We rapidly developed the test and have to expand it to go to the Public Health club whe publn it was scaled up by the contractor they then needed tohi validate it to make sure the testhe works. When they tried to verify that it works, some found one of their agents wasnt working correctly as part of the procedure. We then have to tell them to hold off on using the test and they should still send samples to the cdc. We worked to correct it. The most important points that i want to say is the cdc focus is to provide testing for the publicHealth System. As theres a whole mother systee need testing for a and im happy to sayfo now both as of yesterdy the availability to any dr. s office they can go to. The primary job was to get it to the publicHealth System in the nation. But nevertheless you have people asking for a test who cannot get a test. Your questions at the cb questiy producing these test kits and maintaining the definition for testing lead to an increased transmission in theg communiti. Thus the delay undermined the cdc traditional publichealth efforts of track and trace . Stimac im not willing to concede the second but im willing to say we went through a regulatory us to beginn the test in our test was approved from very specific clinical studies so when the test was approved, it was approved for use in highrisk individuals coming in at that time from china and later it was expanded to individuals with pneumonia and later expanded to any position that feelphysicianthat feels thr public old person to work up a teswith atest but it was a serit the test available. But i think the conclusion is that they are behind the curve in testing and south korea can test 10,000 people in a day so very quickly if you cant otherwise i will come back. L we got to part per billion per cdc. We want your assurance that funds will be allocated quickly and we are also going to need you to outline the plan for its share of the emergency supplemental and deal with what your top d priorities are. What should the American Public see in the coming week flex we will get that money out very quickly and much of it to the state and local Health Departments to operationalize that i would like you to comment more. Thank you very much for moving so quickly to provide us thee funding and the top prioriy is to get funding to the state and local jurisdictions using the language that they received the top priority is to get 90 of the preparedness antidote to the 62 current guarantees as quickly as we can and we are hoping to do that within the next two weeks. Do you have enough resources . Do you have enough resources . Stimac the most important thing is to make sure the cdc is over prepared for the response and not underprepared. Thank you very much. I appreciate those questions since we covered that was me ask you Something Different we are not going to cut by 700 billion. What this committee will wrestle with is the increase Going Forward and what other things we need to prepare you as best we can to deal with things like you are dealing with right now and the committee has seen this coming for a long time. In both of the last two administrations, so ive given tithat if you have as much money that they would like to the budget that you are assigned. Im hoping for the legacy that i get to meet cdc is one thing. I helped build a data fram probm for predictive analysis to be not just for the cdc put the entirto theentire Public Healthe in the country. I need laboratory to be so prepared the complexity weve gone through has lasted six weeks are not going to be an issue because we have invested heavily in Laboratory Capacity in the labs. I want to build a Public Health workforce that right now those of you know for a seattle where i was just visiting as part of the best Public Health of the nation. Thats not what we need. We need to be prepared. I need the Rapid Response fund tobu be robust so that it can really roll out and i need a Global Health Security Foundation across the globe that can protect the nation following. Thats what i need andie i want every program to helpcoming up with diabetes, cancer, smoking, Infectious Disease. I would suggest that the interim because building a takes time as everybody knows. If you work with us to put dollar figures the chair is going to have a difficult decision. The critical thing for us is to work with people who know what they are doing so we can get you those dollars an appropriate amount so we can go forward. Second,yo not to beat on a budgt i know you dont agree with what i was disappointed to see the good health and wellness in Indian Country with the only programone of the onlyprograms c health let me just assure you that isnt going to happen. I would like you to expand on what we ought to do because every set of statistics puts native americans lasted just about every Health Category at risk andak this is everything fm trying to make the Health Service more robust but also a unique population in some ways that has special challenges so what do you think we ought to try to do too and that disparity and my friend points this out appropriately. We need to try to raise. Thank you, congressman. I think you know my personal views on this. We are continuing to make progress and we think that the good health and wellness is extremely important. It supports organizations throughout the country. Obviously the key area is critical importance of environmental issues. Theres been a movement as you know in the block grant and Modernization Initiative both of these can help to support. We are trying to move away from disease specific interventions as opposed to allowing thehe communities to see what are the important Health Issues they need to address and appropriate the resources inrd that regard. It obviously is an important area that we also would like to see to continue to be effectively. Hopefully there will be morel flexibility rather than saying they have to do this or this. That was our attempt. Thank you very much, madam chair. As i mentioned in my home county, 98 cases have been confirmed in just one week. They are trying to take a step to combat by increasing testing capacities and approval to use with the hospital, private land, additional state facilities to process tests. How many test kits do they have the capacity to deliver on a daily basis and covers the cdc working to increase Testing Capacity and how long will it take for the facilities to be approved in how one does the cdc believe that it will take for the Rapid Response test is available for Health Providers . I got the impression that cbc was a stumbling block and because they didnt get approval i wont tell you the other things i heard. Thank you for that. Ive probably hear heard the old times ten. Let me tell you ive worked very closely with your Health Commissioner in albany. February 29 c he requested he could bring up the lab and they approved at the same day, february 29. Actually, we were onth the phone last night because he is one of the first state labs to go to a more Automated System and im hopeful that the verification len that should have been completed last night will be the first lab to be able to use the very high throughput system. Second, i want to say the same day, february 29, the administration gave g regulatory relief to any lab that wants to develop the test to develop the test and use it. Major medical centers for example the state of washington all they have to do is be preapproved to the clinical testing and then they have to verify themselves that it works and that they have 15 days afterwards so they can actually go forward. February 29 if they chose to go forward and develop test. Third is weve worked there are three new york labs that have requested testing for the cdc, and we have provided them and we will continue to provide with a e request. They make a request to how many they want shipped out and they are shipped out. At the meeting we had with the vice presidenVice President ande leaders they didnt comede together as independent companies. It came together altogether. The i have a minute and a half. A patient was being treated for several days in a hospital before he received the correct diagnosis. We now know that Healthcare Professionals working in that hospital as well as to area physicians have tested positive. Im very concerned about the work force and whetheworkforce y helped the system what guidance is the cdc providing to the Healthcare Providers i think its gone up today. They ar were told not to worry about thehe other stuff and they worry about Infection Control. This is a critical issue. There 600 exposed. We dont have that much redundancy to have that many so it is critical. One thing that i think is important this epidemic started in china. It was kind of hopeful for us because we knew that was the risk. 99 of the cases occurred outside of china and they are not starting to see the communities that we are moving quickly to understand how to address here up to a industry have coronavirus that is what the Hospital System has to do into the diagnostics now have penetrated tode the degree they would get a timely diagnosis. They seem so basic because it would shock some of the stories that we heard i joined the entire delegation to come out and i appreciate your willingness and readiness to be available to the Public Health workers overtime. We are very grateful for that to the publict health workers. I do think that the Public Health system is best in the country and as you said, we are struggling. I wanted to bring up a couple of questions to clarify. I know the cdc partnered with the private manufacturing test kit and be available is increasing exponentially. Its h happening now. That being said i find it interesting that when my colleagues in contact with someone that tested positive were able to get tested almost immediately and quickly received assults while focusing on my district and across Washington State are unable to get their testing results back. So people are now getting tested in the Public Health agencies yesterday but what im being told is if we are trying to get people into the university of washington but people who go locally and it goes to the state lab is still a delay. Weve been waiting for about five tests like everyin day the headline is still waiting for the test results. Can you quickly speak to the . I open the time i get i accomplish. They need redundancy. They dont have it. This is when i go back about the capability of theab data, peopl, response on Global Health, the truth is weve not invested. Theres the search capacity. There is capacity as the clinicians that he spoke to be validated by the state they had to develop their own past one thing thats important, the Public Health labs we built technology in those labs to monitor the flu. That equipment may be a good lab to do 300 tests a day. They used these throughput machines like new york is about to do. Those can do thousands and thousands of. They never had the equipment. I have to reclaim because i dont have a lot of time left. They were not able to get samples back and had to resort from israel. I know that there are smaller challenges basically their own tests. I know the administration has been working to get them going for capacity purposes. I wouldte be grateful if they could also be responsive to the rural areas we need more people into the labs are willing to do it h if you give me specifics im happy to look into it. I know that they have a new focus on protocols what im hearing on the ground level is that things are on the website and i dont have the capacity to go into that and make sure you. How can we make sure the Nursing Homes in the communities right now today are getting the information and communicating what they are going to need or will be . We put together specific guidance and we will continue to try to make sure. They tried to aggressively make sure each of the Nursing Homes are up. I think 23 of them have been in your state and many of them have been enough nursing home so this is a priority to get that up and running and provide Technical Assistance. This is our number one vulnerability right now. During that time ive been on the subcommittee we have justifiably doubled the nih budget and they are on a trajectory to do so again. However, during the same time perco the cdc budget has remained relatively flat despite the Fact Research has shown every dollar invested in Public Health results and 67 to 88 in benefits to the society. Over the last decade our failure to fund the cdc has resulted in the local and state Health Department losing 25 of their staff since 2008. It has been a failure in the coronavirus response, i do not believe that it reflects on the competency and effectiveness of the cdc thats why i strongly support the 22 initiative to increase the cdc budget. Id like to take this opportunity to give you a chance to share your professional judgment about the Public Health funding. What do you consider to be the greatest funding needs for the cdc right now and is the current level of investment enough to ensure the best federal, state andde local response not only to the coronavirus but also responding to the Public Health emergency such as covid19 do you have the capacity to maintain responses to the ongoing Substance Abuse epidemic thank you very much congress while in. Gives me a chance to sort of reinforced once again what my goal is and that is to rebuild the infrastructure not just at the cdc that the whole nation. As you know 70 of the funding that is appropriate at the cdc is used to go out to the state and local Health Departments. We provide the funding for the backbone across the nation. The state and local territory departments aree underfunded and i want to rebuild the capabilities we have the data modernization would be nice if we had a system every department in the country right now that we see in real time so we could predict whats going on and we dont have to. We need to basically get more people into Public Health. We need a Rapid Response to not only make priority choices in how we are going to use the money that we do have. Finally, we need to build a robust Global Health Security Network throughout the world. We have a plan to do. Fullstop after they so we can detect, respond and prevent infections at their source rather than have to deal with them at home. If we have to go all the departments are to go up. I guarantee if you talk to them they are underfunded. Just a. Followup to what you said by the end of 2020 is estimated the percentage of Agency Employees eligible for the retirement will reach 25 so what level of investment do we need to train and hire the next generation of Public Health professionals . That is one of the critical capabilities and i would like to get back to a more specific than that arena as we were challenged to come up with a specific budgetary requirement, but it is critical. There is one i mentioned briefly that my predecessor started which is an importantmp program. It took young people out of college and gave them two years and then put them in Health Departments all across the country that wanted y them. Now you get young energetic people not quite sure what they the to do and they see gift, but it is to do Public Health. It doesnt necessarily come out of that way when you read a magazine but they get out and practice publichealth and a number of them say i want to go on to medical school and a number of them are working at the cdc today. So expanding the programs to see the value of the courier and publicourier andpublichealth t important. The program is a really important thing for the nation. Thank you very much, m madam chair. When china denies the presence of the disease. Owthe bottom line is we know its probably higher than it is ever going to be a. With protections to be half against a bad actor like that . I just think if we have these strong teams is going to get more eyes on the ground of whats actually going on. Nothing is going to be perfect. This particular outbreak started in a certain area of china. I know i direct contact either new years eve or the day after with my counterpart and head of the cdc. I dont think he was in the light so cant really comment. They arrested the physicians who tried to talk about this new disease and how bad it was so if we think were ever going to get into that kind of systemt and somehow affect it, no, they are going tog continue the system if we just have to live with it. Whats interesting though is one of the things i hope you do is that you advocate the kind of innovation we are going to need to deal with other vaccine front i know your background is in biology. They produced abased vaccine and got it to the delivery in six weeks from conception. An American Company that hasnt had a profitt for ten years developing this platform if it works we will owe it to the American Innovation and bills like hr three destroy the innovation so how important is the process both for this and antiviral and for treatment when it comes to these kind of publichealth threats. We are never going to winin that. For us to be able to rapidly respond and in six weeks if we lose innovation we are going to lose the inability to maintain the advances they have for antibiotic resistance and they are going to go aside. We made a point when it was being considered and they agreed there were probably dozens of his is we wouldnt be able to develop treatment for if we publish innovators in this country. Let me talk about one to bring it back to testing issue. Now they are geared up to do this. The other system which sounds like. Is that a model we should be looking at a. The point i want to make clear is what the responsibility was the publichealth side. A i guess i anticipated the private sector would have engaged in. The test we did develop is to commercialize it. I think those decisions on the commercial is the section we have groups that can fill the gaps in that they can try to promote the. That i can tell you having lived throughth the last eight weeks i would love them to be engaged eight weeks ago. I think we have the wrong agency to ask that question here. Thank you, madam chair. Thank you all for being here these are very challenged times. Let me ask you first of all with regards to Hand Sanitizer, and im not sure but im trying to unpack how we move forward on this. We all know that one of the pretensions strategies is to wash hands for 20 seconds. Its part of the directive now unfortunately you cant find Hand Sanitizers. Fortunately i had another one at home and ive been in three cities in the last ten days people dont have a lot of money and vulnerable populations if they were around they probably couldnt even by Hand Sanitizer. And in fact our Health Care Workers and medical professionals on the frontlines, so what in the world is going on and how do we wrap our hands around this so we can make sure the direction we receive in the mefederal government can be adhered to thank you, congresswoman. Obviously important this isnt an area that we drive that i can telbut i cantell you the interag group is looking at a variety of Different Things to figure out the shortages and where they can be done and whether it is respiratory maskrs or medicine r Hand Sanitizer and i can get back to you exactly. But from the publichealth point of view i do remind people 20 seconds of washing with warm water or hot water and soap is going to work. There are people working to track where the supply issue is and i can get back to you. Can you, please because a lot of people dont have access to warm water and soap. First thank you for your assistance with regards to very challenging Public Health emergency ipublichealthemergeng place in myd district can you tell us what role they have in this entire operation and what they think in terms of time thinking how long it is going to last and what have we learned in the last 24 hours since people have been disembarked. The assistant secretary is in charge of the response. We provide Technical Assistance support under his direction to the response and we are also going a to provide some technicl assistance support to these individuals moving into housing either travis or lackland were georgia at the observation is really under control. Probably most importantly, we make sure Infection Control issues are done right and we are agency that gives the federal quarantine orders. Are you the agency that monitors the whole publichealth criteria and protocol as it relates to the health and safety of the workers, the crew of the passengers, the community . Because where it is being involved in the aredropped in ty district where historically we have had to deal with environmental grace any of the racism and injustice as casae naturally want to make sure that this isnt another one of those instances where we will unfortunately. We provide Technical Assistance to the Technical Assistance of highly respected within thees department but ultimately in charge. On th the publichealth and safety. We go back up to the assistant secretarys office. I will ask my next question madam chair, go ahead. Thank you very much madam chair. I have a lot of questions. I did a Facebook Live on sunday and a lot ofn people were askig questions. First of all we are not cutting your budget thats why we brought you here and i just want to say that. Are we past containment is this strictly mitigation at this point . In different areas we are in a containment in certain areas i would say in general a containment and mitigation. When you say Nursing Homes does that include assisted livingng o and other areas . On to ask is that anyone that wants to get tested can get tested. Isis that true right now . Yes or no, you dont have to give a long answer. Can anyone get tested . Ld through a physician. Is that a yes . I wrote a letter last week you quit keeping track of how many were tested on the website and i think that is a bad idea from the number of conversations. We had secretary azar this morning said he doesnt know how many people have been tested as an article on cnn why are we not keeping track of that and we are we updating the cdc website three days a week. We are doing it every day now and got a new reporting system that includes publichealth labs you will get a direct from lab course of people can see all the tests done where they are done and if the Surveillance System does that. So the answer is already old news. Thank you very much. Teappreciate that. Others are proactively testing at doctor fauci agreed as well as healthcare personnel. Are we now actively or proactively testing folks like that that have a policy . We are recommending physicians for anyone that has a variety of clinical scenarios to be tested we are proactively testing and it does. I community. We have significant communities spread. The recommendation is proactively. We have increased awareness of how to approach the patient, so you do not get exposed. How about a question on the test going back, other countries use the World Health Organization test, why do we not use that question who made the decision. As they tried to sayy, our tt is created as fast as anybodys in the world. I get that. W. H. O. Does not make a test, they have the germans, one of the germans universities, again, they had to go through regulatory review, our test is much quicker and i would differ that question to the fda. I will ask him that, thinking romance. Another question, there was an article over the weekend and i dont mean to be rude, saying cdc recommended seniors not travel and it was not part of the White House Task force recommendation Vice President said it was never a recommendation of the task force. Deed the cdc recommend that Older Americans not trouble . Did they recommend at this point. Not at this point at that point, did you recommend. I dont know exactly when that was. Over the weekend when there was reports that did notot say t in your saying cdc do notot recommend, what point did they recommend seniors not travel. Probably in the last in the last 72 hours. I would really love to know when it was recommended by cdc because there is a real dish trust, they dont know who the distrust is, because we are not getting this information and right now im trying to convince my inlaws to not to travel to las vegas are both in their 70s and one has Health Issues. This is what were getting asked on Facebook Live town hall, someone said it was not a request and i you recommending it. I would like to know when it was requested and if i need to we will get the information back. Thank you very much. I apologize thank you very much. Thank you all for your work, i agree with my colleagues, we should not cut yourr budget. I want to say, amateur you would agree with this, you said the virus is expansive in italy, south korea and now in this country, it is absolutely wrong tand inappropriate to call th e chinese coronavirus preet i assume you would agree with that. Yes, china was the first phase, korea and iran was a second phase with italy and now all of europe, if you looked at just last night, i think if you have a second, over the last 24 hours there was almost 1500 newn cases in italy, 1500 in germany. Thank you, you answer the question. There has been some other real misleading statements that are wrong, i am going to read some, if you agree with the statements let me know. Our test have been perfect that this is like the coronavirus is like the regular flu is like a hoax, anybody that wants to be tested can be tested, the number of cases will be down to 0,l magically disappear, you can still go to work and its okay to shake hands. This can be misleading since im not hearing, do you want to correct that, im assuming you would agree there misleading statements. I dont think i heard any that i would say is not other than the i do believe the availability of testing in the last two days tested in law court is finally getting us where we need to be. Thank you. The you familiar with the public charge role . The new Public Storage role . I am concerned that it might lead people not to go to get the care that they need, can you respond to that . I would concur, i talked to your colleagues when we were in the trip and state of washington, we brought this and were looking at it to see the Public Health implication. Thank you very much. Would you say were at the beginning, middle or the end of this coronavirus in the United States. I was sad cannot predict. Can you say what percentage of americans you are predicting will get the coronavirus. I think it depends how effective our Public Health responses. I went to state one thing, well have a role to play. It is really serious when we say the practice, washing hands, coughing and elbows, try not to touch your face, i know though count how many times i did on this, but its hard but you tried not to. If youre sick, please stayy h home. Did any Health Agency recommend to the white house that people over 60 should not fly on planes . I dont know the exact days, i will get back to you, we did recommend that the elderly and vulnerable including children with chemotherapy and others should really considers at this point to not travel. What of the age of elderly estimate. [laughter] i did not divine but in the discussions that we had the individual broughtht it up and said a year older than they we were. What is that age. Right now the data weve been looking at, if you look at theyo data the average age in italy is 82, 83 and 84 years ofy age, the data that we have gotten from china, italy, korea and our own nation it looks like 65 and above is most of the people dying. One especially the Nursing Homes including the care providers, what is the level of concern about having enough care providers take care of people as the disease spreads . This is the important of what we talked about before, being over prepared, if you are over prepared, the ability to take the Healthcare Professionals, not just the Healthcare Professionals, i think the congresswoman knows and washington one of the places, they dont have firefighters. There firefighters are allrs quarantine. During self isolation. We have to be over prepared, not to try to catch up, u time matts in Infectious Disease, we have more time in environmental disasters like hurricane and flooding then we do when it comes to Infectious Disease. Infectious disease, if youre a week late as summer you criticized about the fasting or whatever, it matters. Im running out of time, we have another round coming, okay one more question. I have some friends or people who are self courting team themselves, we read about in the paper and so forth. You get exposed in yourself , thatine for 14 days, is right is not how long you have the disease for 14 days. The average incubation period from infection to symptoms is fivepoint to days. How long does the disease last one to get it. It varies if you do get it, but if you get exposed you will develop symptoms within the 14 days and be able to be diagnosed ifif you say asymptomatic we hae no evidence that you said virus longer than that. If you self quarantine for 14 days, you come to work and then you meet somebody, you might have to self quarantines yourself again which means we may all be in the process of self quarantining. you sound like what my wife said this morning. I do believe, and for all in this together, from individual citizens all the way up, we have a great Public Health department, we still want to stay with early diagnosis, public isolation and aggressive use of litigation strategies proved were in a fight to contain basically and stop this outbreak at least many of us are hoping not knowing, hoping that this will follow the pattern of flu and other respiratory viruses, the transmissibility in our environment must change. Its interesting when i look at the changes around a the world d i sent throughout all the experts cases and all of the contacts of experts and you look in the Southern Hemisphere, there is veryse few cases in the Southern Hemisphere right now. Its a great possibility that might change just like the flu changes. I think we need to stay the course, be aggressive, this is again by being over prepared is where we want to be, this is why the stuff you did in a fast rate in a bipartisan way is soo important, and gave us resources to scale up. I think youre getting gavels or. Thank you for your willingness o to hop on the phoe yesterday, i know the white house called you awake and i appreciate your willingness to take the time. I will start the questions i wag going to ask yesterday obvious in the white house was calling so i got bunk. Thats array. Is this a pandemic . I thinkpa the word is not really important. Usually the w. H. O. And jurisdiction that makes that call. This is clearly a massive global outbreak. Okay. I know that chairwoman started out focusing on where shes from, new york city, im from a different part of the country, a very rural district that i represent in the northwestern corner and 11 of the 14 counties in my district are entirely rural, if you can imagine my office is taken the necessary steps to prepare for cases and doing what we can to make sure refilling and people with what we know. So we have been in communication with all of our hospitals, Community Health centers, our county Health Departments et cetera. One concern that has been shared through the outreach is how the virus could increase provider shortages especially in rural areas. Let me just give you an example to back up, one of the counties in my congressional district, we have a ratio of 7000 1, if you want to compare that to cook county, thats 1200 1. You can imagine if rural doctors need to isolate themselves due to a coronavirus exposure, the limited options for people i wondering if you could offer and anybody at your table will give folks and other folks opportunity toth answer, but wht steps do Rural Communities take to continue treatment and do their providers get sick and cannot see patients, do you have any advice for specific more rural parts of the country. Im happy to make a comment. This is why we tightened the area of infectious control. We have seen in washington and california we have 600 Healthcare Providers working in those environment and is causing strain. For most communities, if this is going to happen is probably going to be in a nursing home. And they go into the hospital and you dont have diagnosis, someone gets sick from the nursing home and they just came back from italy, they visited their sick mother in the nursing home and then they got sick in the hospital and boom. I think we have to be aggressive in the infectious control and work hard because this is what happened in wuhan and thats when the mortality was so high, they had 130 infection bed was started in over 20000 in about four weeks, but they did not have doctors or nurses or equipment to staff the 20000 beds. Their Health System fell apart. Thats why mortality was so hi high. Are rural areas more risk for Something Like this. You may have the benefit of being more isolated from morey populations. If you. The virus does not get into a Community Transmission and if it does it will come through a nursing home that would be my best. Is there anybody at the table stat would have anything to add that doctor redfield just shar shared. Thank you for the question, rural health has been an ongoing issue for a long time. And we have been talking about here, the coronavirus and covid19 is just shining a light on a number of deficits that we have had in the systems and Public Health system for a a while. We have been involved in havee some resources that are very small in terms of how the Rural Community is generally, not in the generation specifically but can have resources that they would not normally have that they would be helpful and we can follow up and send you thee information and talk to staff about whats available and what we have supported generally that may come for covid19 as well. We would appreciate that, anybody else have anything else to offer . Something else that we heard from nearly everybody ntthat we contacted as far as Health Providers, the respirators, latex gloves, eye shields, they express a need for more of this equipment. And i dont think anybody is a plan to make sure the protective gear is out there for the healthcare. Providers. Thank you for the question, this is thent important role, im sure you have a hearing there for aspirin to look at the manager stockpile, they manage the inner agency group has been critical analysis as i mentioned before, all the Different Things that we need. Masks, protective gear i went out to 3m to visit them with masks and they are making about 35 Million Masks a day but unfortunately only 4 million are for medical use in about 31 million are for industrial use, youll probably hear more about that because aspirin others will come up with a plan to try to seewi if, that can be we will make sure they get in touchti with you. Are you back. Congresswoman. Thank you doctor redfield in the information youre sharing, i associate myself with all my colleagues and theyre not getting a budget anyway shape or form. I have some questions, do you have any idea how many people have been tested . Were going to collect the data inputted out every day as i mentioned. Can you tell me how many. As of yesterday we have 4856 from Public Health labs only. So that does not include the Clinical Labs or the private labs, were trying to get altogether so you will have a single point and that should be out soon. Do the individuals who get their test of the private labs still have to have the diagnosis confirmed by the cdc . If their lab is not independently approved by the fda, we still do a confirmation of those state labs. So the Clinical Labs have been reporting their test as is. I have a new jersey specific question. Unfortunately we only have ten presumptive cases but theres only ten people that have yet to be tested by the cdc, so new jersey thats preliminary and whatever it does and i understand this is a rapidly evolving situation but can you confirm why theres been a delay in the confirmation from the cdc on the six cases, our staff has confirmed that its not currently any delay due to volume on previous it takes about a day and we have confirmation within 48 hours and the cdc does have a secondary test for product. Why is it now taking more than one week for verification, why do we have this delay as it relates to presumptive cases in new jersey. I will have to lookew into tt but if they have confirmed to new jersey and i have 11 confirmed cases in new jersey as of now, they are considered a case. And then we followup. Do they know that . Yes. I got the impression that theyre waiting for confirmation which suggest that they dont necessarily know. We will clarify for sure and get back to you so you know exactly what reality is. Thank you. I have h a question about what happens if you are confirmed to have this virus in your isolated in the hospital and whatever, what is the treatment . That is very importantne for everyone to hear this very clearly, the majority of people who get infected with this virus, particularly those under the age of 60 are quite relatively healthy and they would go to home isolation, we would ask them to restrict their movement, stayed home for 14 days. And do what . Basically do everything that they can to not infect anybody else that lives around them. Theres nothing that they can do. Theres nothing that they need to d do other than what we used to say when i was a doctor, rest, drink a lot of fluid, drink orange juice and please, please, please honor the home isolation. But i will tell you people that are very sick and we have a number that are very sick, there is an experimental drug that is available right now in compassionate use, this country has used it in a number of people in washington have been treated with it and there is clinical protocols by tony fauci comparing that to placebo over here and asia, we will no probably by april whether that drug works or not. That is important because thats a drug that can save lives if it works. Should we expect the cdc to not confirm state health lab results . I think we are moving inti tt direction. Why is it primarily what to do in this situation . What will happen, a number of these laboratories will come out with their own Regulatory Approval to do test. Are we going to be sure that all states have the same standard, apples to apples across the country, not apples to oranges and peaches and pears. We put out our standards for the Public Health labs and obviously you knowte each state has their own but wew put out r standards, all the state labs are working under our Emergency Operation and our emergency authority, were in the process of getting each lab to get their own when the fda. Thank you, i yield back. Thank you. Congresswoman clark. Thank you, madam chair and thank you all for being here today. As you we have been warned about moving from containment to mitigation and i think the lack of testing that was done has put our move out of containment from mitigation would you say thats true across the country. I would say that one of the biggest drivers of what were going through right now is the movement of the outbreak risk from travel from china to travel from europe. Individuals are coming back from europe and their seeding communities. We will have to determine and we will know quickly how much is driving it or how much the Community Transmission before that was not recognized because of the testing. We will figure out the answer because were going back and looking at blood samples so we can go back a month ago and do surveillance to see what was there but i will say my own personal opinion right now, the new cases we are seeing in the United States are probably disproportionally driven from people that have returned from europe and gotten into a community and then we see secondary cases, that is my own personal opinion but i will not die on mysore, am open to data to know that is true and theres more transmission that we missed. We want to make sure that we remainar datadriven so i appreciate that. As we look at whatpp is happenig i think we will continue to see totalsls doubling and more of te move to broad scale actions that we need to take to mitigate this because our testing is behind where the virus and infection rate really are, how are you working with the frontline on this which will be the local publicpu health official, managd by the state and hopefully supported by the federal government. How are you working with them to give opinions on large scale gatherings, should they beed canceled, is there a rule for the cdc in that work . Thank you very much, we initially deployed a team into california and to seattle over the last several weeks just on this issue. I will tell you today the Vice President s office will be releasing a Mitigation Strategy for all territories in this country, the guidance we have worked on for the last couple weeks. Can you give me a preview. It is a framework for each of the states to look at a number of different areas and we put into low risk, moderate risk and high risk and different examples of what they need to do, i willt reach out to massachusetts in the light of the cases they have had, the one of the top fives. We had a long call with the help leaders of the top four and we asked them to take the template and edit it very carefully which you are supposed to have completed and we will go global and then we want them to fill it out specifically with the questions you just asked, what will h they do about the marines game, what about working from home, what about the schools, all of that is in play as an example so not only able give them the framework but will have a couple of the groups that have been dealing with this transmission for the last four weeks to see how theyre going to do this and i think this is critical and were here to give Technical Advice to all of the groups i will be reaching out to massachusetts in light of the last couple of days to see if they want to engage with cdc and we send people to new york, seattle into california importer to help them and i think massachusetts is the next one. Are you making recommendations that people dont have gatherings over 100 people or have you set the criteria. We are currently working in partnership with the state Health Department to come up with what we believe is an effective Mitigation Strategy. Is out with the Vice President is releasing . He will release the framework this, wethem how to do will be following up with specific jurisdictions like i f d last night and the day before and the last couple of weeks to work in partnership to see how they operationalize that framework in their community. They will all be different but were very involved, rather than cdc give a blanket recommendation, community by community, were working with the local Health Department to come up and express our recommendation. Im almost out of time and i dont want you to interpret this as a flip question but is there anything in the recommendations that say structural barriers outer border would be of any use in mitigating the outbreak of the virus. Not that i have seen. Thank you. Thank you. Doctor i have a couple of questions this is about Public Health data. I think what we have heard this morning is that the coronavirus outbreak has a need for modernizing our Public Health data system. But i understand you work directly on the Public Health let me ask you a couple of questions. If it had been complemented over the last five years in cdc how to help dataha system, how would the current Public Health respond be different . In the spirit of conjecture, it wouldve been different in two ways, in two different ways possibly, one is we would have detected much, much sooner and been able to contain further and more effectively, the other is even before detecting, depending on relying on different sourcesw of data which we do not know and want to do more of in analyzing the information along with help data to see there mightve been a problem either before getting scared about the number of cases being detected, its detection and prediction. Theres an example of things you cannot do right now and you will be able to, what can youms not o now. What we cannot do is twofold, one is the delay in finding out what actually is happening and a lot of that has to do with unfortunate barriers that the current systems have with getting the information from Healthcare Providers in getting it so we can use it to engage in the response earlier. In that regard what we do is to provide a supplemental to hprove surveillance and reporting. Our cdc Public Health data system up to the task of handling all the data local jurisdictions in such an emergency, i make the reference of the 4800 number that you gave us doctor redfield. Not 100 not what we would like and not what we know is possible. Theres an initiative 75 and that would get a 400 and not only get is 200 but allow us to maintain that over time and be able to keep up and the difficulty were running into that you can m appreciate his methods are changing significantly faster than they ever have, tools are showing up faster than they ever have been in if we cannot keep up we will fall back even more, if we talk five years from now and do not make those changes it may be 50 instead of 55. I want to add one quick thing, its fundamentally critical that every Health Department has the capacity to do. We heard from them and we talked about Electronic Medical records, they were talking about fax machines, individual excel worksheets and data entry et cetera were total the process. Im making your point, we need to invest in this effort. Then we just moved to you for second, the first time in 20 years, 2020 upper creation including funny for cdc and Mortality Prevention Research. Enthusiasm for researchers everywhere to move forward, what steps did cdc take with the new funding and what steps are promising opportunities to address the Public Health emergency. Cdc appreciates the appropriation and we move very quickly on the funding, fiber 21st we issued the first funding announcement for the grant and were pleased to let you know we had a informational call for potential applicants yesterday and had a Record Number for entry center of interested applicants, letters of intent are due next week and we hope to issue the grant by september to look at areas like mass violence, how are some prevented and why are others not, self defensive use of firearms, when is it used against a person or help sort of crime, and school programs, are they effective in preventing with firearms and violence. Safe storage, one of the best circumstances. Are there any applicants l looking on homicide versus suicide. We do not know yet, our hope is we get a wide variety of applicants, we have really greatly disseminated this information to a devic diverse. We look at primary prevention and Community Level intervention for that. Thank you. Let me yield to my colleague. Thank you very much madam chair, you anticipated one of the questions that i had for doctor res on the importance of healthcare information. I would just ask you this, could you work with our committee because we always have a very substantial supplemental that we hope will be helpful and you mentioned what you had requested might get you to 100 where you need, what we also need is a look forward as you mentioned yourself, i know you cannot estimate every piece of technology but when you think through these things, you really have to have a multiyear plan onleven though we only budget oe year at a time and really helps particular on technology because we tend to invest once in the speed of change is much faster than we anticipate and you end up out of date pretty quickly if we dont haveha some way of thinking proactively of what you might need Going Forward. Thank you for the invitation and were working on a longterm plan and building as we go along the way and part of that plan is doing what we have not done as much report and working with the private sector in introducing those to Public Health so we dont fall behind. This is to you doctor redfield, i dont ask you to make a judgment, we have a system that we have and its one of the things i learned when i was chairman about locality is absolutely dependent on cdc, i want a Robust Partnership but i dont want people to think there is notpl a role for state to stp up and do more in locality to do a little bitat more. My own state, the lack of investment i will just pick my own home, you are providing 60 of healthcare budget excuse me. For state and local, that is something we ought to be worried about as well. And we should not be l waiting around for the best equipment fand best ideas. We need to move this across the board dont we. I agree, i also want to add because were all impacted by the degree of preparedness of any state. So if we have one state thats underprepared, we are all underprepared, if anything i wouldve loved in new york, its great and theyve had a great lab and theyre actually doing their own, they have their lab test and the cdc at the state level in the state developed their own. I would like all the jurisdictions to bring up their own tests, we could have a race who gets to teste this quick, it goes back to foreign health. Point well made. Let me ask you this, i want to be careful for two reasons, two related questions, the first one does relate to china and you have to recognize the delegates he and you have to work with china, this was not the best result but it was better than what we seen in the past. But hopefully there is some candy discussion going on, not letting our folks in as rapid as they should have, i think we couldve been helpful to them and wouldve been helpful to us. And this system does put one out of five people on the planet and they cannot put everybody, and got it coming down and going up everyplace now, the more Rapid Response with have made a big response. They are superpower. They havee worldclass science and they have very capable people. What are you doing to invite tem to integrate m themselves were fully into the World Health Organization. We have had more than a 30 Year Cooperative relationship, its called cdc china and built by cdc america, i have a small group of individuals and you will see my global footprint and expanding that as part of it at least in china, we did offer directly to provide and amplify the distance foror the outbreak back in early january and are cdc colleague and counterpart actually requested having to go through higher channels and that was not done until the w. H. O. Did a report where we did have one cdc individual and one individual in the United States. I will make this plea and then im out of time. This is not directly you or your counterparts, i suspect they wanted to do it. This is a discussion that needs to happen between our political leaders and their political leaders, its an area we should be able to cooperate with another in the relationship, i just hope its on the radar screen of her state department and our president as well, they need to have this kind of conversation, we are not trained embers or friends or anything else. They are a big part of the solution or big part of the problem, they can choose to be one of the other but i know all of you have urged your counterparts to do that and i suspect they would want to dore that. They are professionals and dedicate their lives defending people just like you do. But this is the political needs to get involved read that is my sermon. Congresswoman. Thank you very much. The vaping epidemic as we know is a Public Health crisis that must be met with every level of government, the cdc office in smoking and health is so crucial and why congress provided an increase in 20 million in the fy 20 built to all levels of government can have the resources to combat vaping before we lose a generation of children to the harm of nicotine in addiction. Last year the illness resulted in 60 florida deaths, nearly 3000 hospitalizations in many but not all the cases could be because vitamin e acetate. Why cant the cdc say with certainty what caused the illnesses, do you consider vaping o regarding the differens to be a Public Health, are you concerned that compromise lung health is also great risk to those who contact coronavirus . The last question is yes, i learned about this from my grandson, who told me i was a cdc director and of cystic fibrosis, i would like them to tell you more in answer if you need to codify. Thank you for the question. Anything that can actually go into longs for vaping, vitamin e acetate as part of that, we are concerned that we shine a light on that but other things will take its place. One of the things that has become very, very important is to make sure although the response has been theis activatn has been ended, the activities continue especially the surveillance activities looking at what symptoms people are presenting an Emergency Room Department and what is that they are using in those substances that may be related to that. Like we were talking about before, to catch it before it gets to the point where we were with vitamin e acetate. In addition to that we are continuing to work to make sure we understand how adolescents and how it is you thinking about these, its very different and make sure that we reach out to them and make them understand the choices that they are making and try to redirect their choices so they can make more healthy choices. So that not only continuing the progress that we made but the combustibles or that were replicating not for vaping as well. But you know it is not working. And we know because even the college campuses, not only with my own grandkids but even met with the president and as you and i discussed, i learned from my grandchild that told me this was before she was in college, that was five years ago and she was upset because she was saying 65 of fifth and sixth graders, these are crazy statistics, do you think perhaps now that we know it can c be convicted with coronavirus, do you think that will shake themp . Up. This is a very important priority for us doctor areas in the team are the Bigger Picture of adolescent teen addiction. , when the decision was to take flavor products, mental was not taken off at that point in time. We are tracking very carefully to see if now if underage is shifting and we will see the data, we have the commitment and evidence that adolescents are shifting out of mental, we will put the Public Health evidence backup for action and from a regulatory perspective of the fda. My biggest concern, mine were actually in middle school and telling me 50 of the cross was using ecigarettes on a regular basis. Since i have 40 seconds left, you know it and i know in our grandkids know it, and so far they havee been reporting about the impact themselves in reporting what is happening to their friends, are we making any progress, is anything that we are doing working, i hear the statistics are the same whether junior high or now in college, they are all vaping. In the end its all the same. What are we doing, anything . Is increasing and as you know things are increasing and its hard to turn them around, it will be a while before that happens. However, were focusing on things that have been affected in terms of communicating and adolescents understand the communications in order to understand that dont just look at the pretty colors on the package with a respond to, think about whats inside. The package even if the packaging does not change, and then theres other sister agencies in terms of regulation that will make it easier to control the environment so they basically are protected from the outside as well. A lot of it has to do with finding out why they are using it, how they are using it and how it is we can get them to stop. We have showed progress but id like to pursue this madam chair because we are talking about everyones concern, your concern, im concerned, we field, but were trying to do something but were not successful. Thank you. Hi congresswoman. The fy 25 no procreation included 10 million for the first ever dedicated funding prevention at the cdc, as you know there is unique populations that are at higher risk for suicide such as latina, veterans and nurses. Im cochair for Maternity Care caucus for my colleague jamie for errors, i am particularly interested that indicate suicide might be a contributor to an unacceptably high incident of mortality in this country. Can you speak to the connection between postpartum connection and ideology, what are they doing to track this problem. Certainly i can start and turn it over to my panel so if anybody wants to add to it, in regards to the suicide, the 10 million a procreation we are going to Fund Applicants to look at data within the communities and identify who the most vulnerable and who has the most highest risk rate and work with them to focus effective on those areas. It might be real populations, and might be veterans, it might be young mothers. And to really look at the evidencebased Community Level strategies that drive that. In regard of mortality of suicide, i believe about 6 of Maternal Deaths due to suicide, we do new the age 10 44 i believe the fifth leading cause of death due to suicide in that group so we do see it the increased age for suicide death but were focused on primary prevention of suicide death, things like making sure there is good programs in school around social Emotional Learning and were improving connectedness and for suicide in our vital signs found more than 50 of people that died by suicide do not have a known Mental Health diagnosis. Can you show savior correlating efforts to other agencies,ot this problem with te veterans administration. Very much so we work closely with the va in organizations to look at why veterans are not accessing va when they are having suicidal thoughts and moat we can do the community and work closely for the mayors challenge, we went out and talked about our technical package in the strategies that were done at cdc to help cities implement this strategy. Over the last decades weve seen significant gains in the Life Expectancy with adult living into their 60s and 70s. This creates new challenges because when young adult patient at a pediatric care and on the registry, there is no system in place to follow and care for them. But the program has been flat funded of 6 million for the last six years and is currently down to staff members, do you have concerns that progress an investigation into critical lifesaving issues such as the cause of sudden death in midlife and prevention of related morbidity are possible within the current staffing structure. We are working within the confines of the resources that we have to address these issues. It has been significantly difficult. I think that we need support in order to branch out and address the problem in its full complexity. Right now it has been very limited in the kinds of things that need to be done, its not just spina bifida its also alzheimers, multiple sclerosis and other kinds of things that have been very difficult for us to make as most of an impact that we think we can in the resourcing and weve had to work with what it is that we have. A lot of that means is under measuring and getting information to the extent that we can but in most cases managing and a lot of information and more request with the Caregiving Community in each of the situations. What funding level would you need to ensure that the National Spina Bifida Program Covers the lifespan of individuals living leth ali disability and what are your plans to attract people at the pediatric system. We have worked on a plan Going Forward to get information about what the plan would look like and what would be necessary to support the implementation. Thank you. Congresswoman. Thank you again for being here. You would agree this is not a time to cut any of our Global Health budget. I think its one of the most important things that we need to do is build a robust longterm foundation of Global Health, i think cdc has the tip of the a spear and i think this is the time to get the foundation built. The answer is yes, we should not cut or no weon should not. The answer is yes we should not cut the Global Health budget. I am not telling answers but theres enough masks for First Responders and healthcare workers, if not we can get them. This is something that esper is in charge of, and looking through, and making those calculations so we can get back to you that i refer that to esper. I have a couple of practical questions, my mom is older than obvious. Is [laughter] shes healthy, knock on wood. She was supposed to go to the doctor for a checkup but now shes afraid, she does not want to go for a checkup because theres a room of sick people, of course its a room of sick people, what do you say to that . What do you say to that . I think your mother has a lot of wisdom, she really has the requirement to do things right now, we are supposed to get the elderly and vulnerable to step back andsh try to avoid being in credit places, a avoid trouble, this is where we are right now. Another practical question, were told to wash her hands and all that, dont touch her t fac, people are coming in contact, even ourselves with our clothing, furniture and allse of that is spread that way. Congresswoman, thats a very important question, this virus clearly can live in the Environmental Services for some period of t time. With the ship in japan, very aggressive studies are being done to see how much virus they find on railings in different places. Finding the virus does not mean its infectious but we can detect the virus for a prolonged period of time and the role that we call transmission is still unknown, thats whites important when you put your hand on the handrail walking down, you probably need to wash her hands after. What about if you put he touched the handrail and then touch her clothing and then you wash your hands but you cannot watch her closing. Its more touching the rail and putting your hands to your face. Allll right. Is the information coming from the World Health Organization reliable questionin . Its a very well respected Public Health organization. So right now can anyone go to the doctor and get tested for coronavirus or do we still have a delay in having enough test for that. As of is today monday . Yeah, tuesday, as of monday labs in lab core labs have made this test available in doctors offices, when you go to the doctor and get your blood drawn, the test is not done there its done by the lab and the same thing can happen if your doctorh wants to order a coronavirus test. This is another common sense question. It seems to me that some of the reasons not shaking hands, not washing hands, self quarantining, it is not just about not getting the coronavirus, its about that but the fact is we dont want everyone to get at the same time because we cannot take the stress off the system or the economy. Is that right . Yes, and we do not want them to get at the same time forgetting flu. This is unfortunately a virus that is on similar and a respiratory virus. If you look at hospital capacity, much of it is full up to 95 96, 97 , we dont have a lot of resilience in our Health System. Are there test shortages and any other part of the world, do we know. Are there test shortages in any other part of the world . I dont know exactly but i can tell you obviously in areas like africa where they have underdeveloped Health Systems, clearly they have been scared and the reason is unclear if it is seasonal obviously we will have challenges and more importantly the most important is medical intervention before. The one medical intervention that you need going into the hospital is oxygen. There are many Health Systems that dont have the capacity to deliver oxygen too those people. Is that in our country. Not in our country. Thank you i yield back. Congresswoman lee. Thank you very much. I apologize, if this is redundant i will ask after words in terms of pandemic versus academic, has anybody asked that question and where are we in terms of describing the word is not that important, its major global outbreak, the w. H. O. Is usually the organization that is formally declared a pandemic, its a wide scale global outbreak. Let me also ask you about sicklecell, it is been estimated in cdc estimated over 4 million americans have the sicklecell trait in the incidence of sickle cell trait in newborn screening was found to be about 7 or overall a black person or hispanic. Are there any standard method that im trying to get to the bottom for 20 years. Standard methodee of protocol or Healthcare Providers to the presence of sickle cell trait educating them about the potential Health Outcomes that might be associated withsifo the trait or counseling them aboutut the impact of the trait status that it might have on family future reproductive decisionmaking. I asked this because a child tested at birth, by the tender 18 or 19, who knows if they know or not whether they have the trait in a personal examples of that with regard to the interaction between the a1c test in the sickle cell trait, if you dont know the trait, they are not required to test if you are fromst the specific target population, how in the world do we deal with this, it is really a problem. We can send you information about the sicklecell program as cdc, a lot of that work is conjunction with providers and with the Healthcare Community to make sure that they get the information to families and to point out Resources Available to tothem. As you can see, we operationalize this analysis, for the whole nation, we can actually have data that could be in a system in the nation could have access to it. Why when an adult if the blood test if this adult is a specific population, why isnt part of that panel a test for sicklecell trait, if i had the trait at birth, if im getting married or at 25, there is an issue there. Either leaving or have it. Sure, i get back to and find out about that happening, a lot of it i would imagine has to do with the fact that is known at birth, the assumption being its known to the individual and theres no point. How isin it known if its known at birth how do i know 18 or 20 or 30 that i have the sickle cell trait. The assumption if its part of the birth record then its an assumption. Theres nobody in this country, i guarantee you whos anba africanamerican who knows that they have the sickle cell traito based on birth record. We will definitely get back to you. Its something we need to address. Thank you very much. Let me ask you, going back to the Reach Program and the whole issue of Health Disparity which my friend of the budget. The Reach Program has been a really Critical Program and eliminating disparities. Its been eliminated from the budget and i heard your response and how youre going to make the move for the cdc but with this budget eliminating in us being eliminated in the president s budget, i dont think you can compensate forul addressing racl and Health Disparities. You indicated some kind of mov move the aspects of the program, not to the specific but community specific or whatever, this is unacceptable, when you look at people of color, when you look at the native American Community and when you look at every community in this country, the exhibit Health Disparities based on race or ethnicity, that eliminate this program and to be unethical in terms of health and medical standard and its a shame. Are you weighing in on this, is cdc saying this is not a good healthcare decision . A good decision to make . What i say i thank you all know that we are constrained right now in this environment, that is why ive tried to put so much focus one court capabilit, it will helpro all programs, all programs including the Health Disparity program by building the Public Health capacity, i do believe that the flexibility will give local communities to be able to invest the money that they want, but we are we are not turning our eyes off to thec nation. And we will continue to try to navigate while we continue to address those and again, im going to come back, ive done it multiple times, i think the court capability that goes beyond cdc but all of Public Health structures that we have, the state, local, tribal, territorial, gives us a normal ability for us to function on multiple areas. The key very much for that response but unless directed by the federal government with major protocols in place, the Major Research and place with the major investment by our government in terms of the Reach Program we will be sent back. Thank you doctor. And i know the Ranking Member does and then well hear from the Ranking Member to close and then i will close up. This is about Global Health security, dr. Redfield. And you just mentioned africa and i just got an email again for my dear friend who was the former Health Director Health Commissioner in south africa, the shadow commissioner just said they now have the first cases in south africa. So these are my questions, because the viruses dont have borders. And africa can easily be overrun. What is cdc and Global Partners doing to assess the risk for immune suppressed clients for the immune suppressed clients with hiv and other Infectious Diseases what resources are available to support the diagnosis and Clinical Care and can this be scaled up withth other partners. Are they able to send both specialists to support the regional collaborating centers. We provided 600 million in the past and the supplemental and included a 300 million for Global Health. You could just enter those questions. Thank you very much, chairwoman. Clearly this hit on one of the concerns in Subsaharan Africa in general obviously healthy immune compromised individuals will react to this virus. Onone will be more likely to cae severe o illness and that obviously causes the other problem as more severe illness needs greater dependency on oxygen and many of these nations dont have that capacity and they needed. As the program has Country Office is okay for Subsaharan Africa we have been providing Technical Assistance to their counterparts in the countries and weve worked with the cdc that has been hired by the African Union and is one ofri te best testing capacities. Africa is a great durability. Its been one of my biggest concerns on a global scale because if this gets into africa like italy, theres going to be a lot of casualties. Litanies yield to my Ranking Member. Obviously talked of a great deal about the pope care security and i will get to that. But i want to shift to another area and this would be addressed to you. But i hear more about Drug Overdose deaths than any other. More family, more people affected obviously and i suspect theil death toll this year wille worse than anything weve seen in the corona virus. Finally we saw it come down a little bit for the first time congratulations for the great work of the cdc to help us in that area. Going forward, what can we do and where do you need additional help . Its not always opioids are different substances that seem to be more common. What should we be doing as a congress to try to provide resources to help our fellow americans in this area . The resources that we have received from congress have helped us build that infrastructure. We are able to collect Surveillance Data and with the current grant we added a category to look at other psychostimulants because we didnt want to be three years later saying whats going on in the trend so we are able to pick that upp in more realtime. We also realize the linkage to care is important so we dont attend the program and what we can do to help Healthcare Providers. Ive watched this evil and that is one of the reasons i came to the cdc because i knew the population level. I worked to see the integration of the success with things like Electronic Health w records and now as you mentioned we are seeing a surge of methamphetamine and other substances. What i think is important is not how we got here. They are wrestling with cocaine use but also with heroin and we can treat that so having the linkagewe to care is still important and then looking at the vulnerable populations like tribespo we are working with may organizationsln getting funding and groups have been able to integrate the programs now to identify highrisk patients to prevent them from having overdoses. Add one point. This is a chronic recurrent medical disease. It should engender the same aggressive research we are doing to get new cures for cancer and heart disease. This is going to be a medical disorder that will have effective therapy. We have them now that are a little different opioids but we need effective therapies to recognize this is the disease that it is a. Its a medical condition that needs research. Private sector. I would addga to that looking at the misuse in the first place place. It can lead to suicide and Overdose Deaths of looking at the linkage of the whole spectrum is the key. Thank you madam chair. In the search for a cure and defending people its a noble profession you are in and we appreciate what you do. I would say to my friends and i mean this with no disrespect but when somebody in Congress Tells you on a bipartisan basis we are going to help figure it out by letting the people work with us and where does the money to make the most difference or not. Ive had that discussion. I wasve the chair is a Something Congress has decided to do any substantial way over multiple agencies and for the strategic stockpile mechanisms that help you sort of get into the fight as quickly as you possibly can for all of the benefits we all agree very much with the chair of and we made that collective decision medicinea collectivedey this particular event. We want to work with our best people that we think are indies agencies in a very collaborative way so that we dont make mistakes. For the record in the and administration would be better off if we would all be collectively better off and i hope theyl that we learn a lesm that. This area more than anyone on the range of activities that we are talking about the health and wellbeing of people in a very immediate way that can come out of nowhere it. I think it has been sort of unelecteneglected. I have had the opportunity to visit on a couple of locations and getting an idea of the capabilities and we reflect that over time so i want to thank the chairman for the hearing. Certainly timely, madam chair, but more importantly, i want to thank the chair for the bipartisan commitment because this isnt something that is likely to go away, and i think that is something again i hope the executive branch realizes overtime regardless if its in there. This is the kind of commitment is theres no sense in sending us a budget. It cut things we are not going to cut and doesnt work in areas that we want to make investmen investments. There is expertise that we ought to be listening toe as we fashn with those investments, so we look forward to working with you and continue to wish you a very good luck in dealing with the corona virus and things get worse before they get better but at some point they will get better and we will turn the corner, but i hope the Lessons Learned here are adorning lessons. I hope they are for the American People as well. Well. We take a bath of things for granted around here. These are investments that battery if they are not made for years ahead of time and pp are issued in the last minute. We cant make a difference without a sustainable plan for investing in a. That im chair, you have that commitment your entire career. They are veryrt fortunate to be led by you at this particular time. I think the gentleman is unfortunate this iunfortunate te been able to produce i think quite remarkable labor hhs polls over the last several years there is compatibility here that i think at the outset someone say it isnt going to work. Because of the competency and cd professionalism and deep compassion and care and values of the Ranking Member and the ability to Work Together but the differences dont cloud the goals and theu challenges that e see and its been in the past history in the country. They crafted the responses to the challenges that weve had. They were not naive, but they understood that for whatever you cometh from, our obligation in r responsibility isti to see thate address this issue andnd thats the kind of cooperative relationship thatat i find in te committee with a Ranking Memberr and i think it is true with the subcommittee as well. So i thank you for being here. I did look up and its been cut in half. We will address that issue as well. On the vaping issue, the fact is that the ecigarrettes never had a legal issue. Stop it until they figure out whether or not into. I would ask you what i heard yesterday is 35 million in terms of hospitals and Public Health workers. We need the strength of the administration to say get more insurance and lets move forward with what we need for the Public Health. That is something im asking you to do. Its wrong to stop at 4 million because we cant get there and theres no answer to this. I dont know for the life of me who is monitoring the self monitor if you want to Say Something about that goahead. We did this a number of years ago and its heartening to see the cooperation of thee americn public when they understand what youre asking to do. I think about 90 of them basically did what they were asked to do. Not everybody that its heartening to know the American Public when they understand that they will abide these clear instructions. Thank you very much. You heard the concerns of there are serious concerns. We will keep asking the questions. We want to make sure the statement is accurate and anyone that needs to test kit the teste test immediately and we can relay the fears. The crisis is here. We are all dependent on strength of our Public Health infrastructure. If we are not strong in all 50 states, we are not strong. Let us help you with the core capabilities. And a roof goes down, predictive analysis indicated a that modernization, local Health Security and Public Health workforce that is second to none. And please, let us know because they have listening ears to what you need and we want to get you where the country needs to go in this crisis. Thank you all very much for being here. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] is is