Transcripts For CSPAN2 CDC Director Redfield Testifies On Coronavirus 20240713

It has been several year, before the subcommittee since the last Public Health agency. And to be made aware of this issue that is very troubling and that is and then to immediately remove the coronavirus posters that it has been ordered by the administration to take down coronavirus posters from courtrooms and waiting areas. The executive office for grimmigration review mandated the coronavirus posters in english and spanish on how not to spread the virus had to be removed immediately. I just want to say that whatever your point of view on the issue that we face in this nation whatever your personal views are or ideology is, that week not with this Public Health crisis play fast and loose with peoples health. No matter what we believe have a moral responsibility to make sure everyone is protected. It just came to my attention. Doctor we welcome you to have you and your colleagues here in the associate Deputy Director for surveillance. And the chief Strategy Officer and chief operating officer. I also want to acknowledge one doctor who is not here and to help to provide us with a bipartisan briefing for the subcommittee sorry not to see her here as well. With the budget request let me start with where we are at today with covid19. I first want to commend the thousands of Public Health experts from the state and federal level who were working safe duringeep a this outbreak. Athat includes you doctor redfield. As well as all cdcri staff. Im very concerned, i think we all are, abour nations testing capabilities for coronavirus. Other country have been testing thousands of people for weeks but the u. S. Is behind the curve. The low number of positive tests in the u. S. Is likely a byproduct of undertesting as opposed to an accurate count of the prevalence of coronavirus in the United States. My understanding is that the testing kits are being distributed across the country. But the delay is unacceptable. Why the c. D. C. Develops a new test for covid19, the the majority of the initial test kits were faulty and there were weeks of delays before replacement kits were sent out. During this time, c. D. C. Maintained a narrow testing criteria that makes us ask if the health of our country was further put at risk because of the actions. I expect therell be a lot of questions today about testing and those delays. Another concern is Emergency Funding. The congress came together last week and we passed an 8. 3 billion emergency supplemental on a bipartisan and bicameral basis. It includes 2. 2 billion for the centers for Disease Control and prevention. This funding will support c. D. C. As well as state and local Health Departments who are critical to responding to this outbreak and to saving lives. But when this crisis arose, the c. D. C. Had only 105 million available in the Infectious Diseases rapt response reserve fund. The supplemental added 300 million. Ive been a leader for years on a Public Health Emergency Fund and have repeatedly introduced legislation, the Public Health emergency act, to provide 5 billion in Emergency Funding for the Public Health Emergency Fund. So that you can act with alack rahity and flexibility. We can only imagine where wed be if we had had 5 billion at the outset instead of 105 million in the Rapid Response reserve fund. The former Shadow Health minister of south africa who is a global Public Health expert has said of Public Health infrastructure and i quote, why do we lurch from crisis to crisis and lapse into complacency in between . This outbreak is a reminder of the importance of a wellprepared, welltrained, welltrusted, wellfunded Public Health system. It goes beyond covid19. Professionals at c. D. C. Day in and day out are working to combat foodborne illnesses, influenza, to promote healthy lifestyles, to reduce and prevent the use of Tobacco Products and on and on. Its important work. An its why we are proud of what we were able to do and this committee in increasing c. D. C. s funding in 2020 by 636 million, 9 above the 2019 level and was done on a bipartisan basis. Some of those highlights include for the first time in more than 20 years funding specifically to support firearm injury and mortality Prevention Research. The first year of a multiyear effort to support modernization of Public Health data surveillance an analytics at c. D. C. s state and local Health Departments. And the first year of a Multiyear Initiative to reduce transmission of h. I. V. By 90 of over the next 0 years. The establishment of a Suicide Prevention program, tobacco prevention, specifically given the ecigarettes and vaping among young people. Increases for global disease detection, thats Global Health security, as you outlined in your remarks dr. Redfield, the Global Health security is critical to our national security. And the Infectious Disease Rapid Response reserve fund. Unfortunately the president s 2021 Budget Proposal reverses its progress. The budget proposes to cut c. D. C. By 693 million, 9 below the 2020 appropriations. Despite the presentation the president s budget which claims that Infectious Disease, Global Health and preparedness were prioritied in c. D. C. s request key programs would be cut, the Public Health Data Initiative, the Public Health work force program, the Infectious Disease Rapid Response reserve fund that allowed c. D. C. To quickly respond to covid19. This subcommittee will not be sur suing the administrations proposed cuts. The cut from our Public Health infrastructure in an outbreak is beyond consideration. Instead we, together, intend to invest in the c. D. C. And our nations Public Health system. We will not lurch from crisis to crisis and lapse into complacency in between. We cannot. This coronavirus outbreak makes that clear. I will step there. We look forward to your discussions of budget and other policy areas around your jurisdiction and preept your being all being here today. Before we before we turn to you, let me turn to my colleague, the Ranking Member of the subcommitteing, my colleague from oklahoma, congressman tom cole. Mr. Cole thank you, madam chair. Ill make a few remarks off the cuff before i get to my prepared statement. This is an area that i think my chair and i certainly strongly gree on. Im never critical of somebody who presents the president s budget, its your job. I call it the o. M. B. s budget to be fair. Ill state for the record that im quite sure we wont be cutting the c. D. C. Any time soon. I suspect quite the opposite well be building on the thing this is committee has done over the last few years. We had a discussion within o. M. B. , director mulvaney, and made the point whatever budget you send up here were going to increase spend on n. I. H. And strategic stockpile and we added Rapid Response strategic fund. I think overall they were good decisions. I think were seeing the benefit of them now. I suspect well stay on that course. What you do, and i thank all of ou for doing it and theres and the professionals you lead. Re indispensable dr. Red feed and i have had this discussion before, i think of you as the biomedical equivalent of the pentagon. What woe we do there protects the American People one way, what we do here protects them another way and frankly on a daytoday basis a more immediate and impactful way. We are more likely to have the problem were dealing with now than to have the kind of threat to the lives of americans. So again thank you for what you do. I suspect this committee on a bipartisan basis will continue to make these investments Going Forward. Good morning, dr. Redfield. Thank you for womanning to be with us this morning. I almost was going to do what i did with frances collings, how was your week, i think about you guys a lot, we know this has been a stressful time for you. I know coronavirus is at the forefront of everyones mind this morning. You and the Public Health experts at c. D. C. Are front and center in defending our people. In addition to hearing about coronavirus this morning im hoping we can also discuss other priorities. I know we all share. Such as reducing opioid abuse and overdose deaths, addressing the threat of antibiotic resistance and preventing the growing problems soshed with chronic diseases, all critical Public Health issues for our country. As the United States continues to monitor and respond to coronavirus, im encouraged that congress and the Administration Work together across party lines to deliver Critical Resources for the days and weeks ahead. Such a highly polarized and partisan environment, im very encourages that we could set aside differences and quickly deliver on such a high priority item for the health an safe i have to the American People. It took just nine days, the ad for the administration to submit information regarding a supplemental appropriation need and bipartisan, bicameral congressional action. The vote in the house was overwhelming as it was in the senate. And i hope you can continue, and i suspect you can continue to count on bipartisan, robust support to aid in your efforts to keep your our communities prepared and able to respond. Fortunately, long before the coronavirus ever infected its first patient, congress was already preparing for this sort of Public Health emergency in a bipartisan way. Five years ago, congress began shaping policies and prioritizing investment in our readiness, including boosting funding year after year for the National Institute of health, center for Disease Control an prevention and Strategic National stockpile. Perhaps our greatest lifeline these past few weeks was the prior establishment of and investment in the Infectious Disease rapid respond reserve fund which was immediately visible to you, the c. D. C. , our number one Public Health defender. Indeed, because congress had the tools in place ready to deploy at a moments notice, the administration has been able to direct a swift and decisive response from day one, not lose anything time protecting our citizens. Ill associate myself with the chairman. Ill like this fund to be larger, we originally proposed 300 million. I know we both living within budget realities would have liked to have done more. Im please congress did the 300 million in the supplemental and Going Forward i hope we can build on that given what weve got to work with. We have many priorities here. But again, the jut come we cot was the aim in our creation of the reserve fund. While its unfortunate we had to use the fund, im glad the resources were available. I hope more are available in the future. While theres still a long road ahead with many unknowns, im encouraged that one of those unknowns is not whether the funding will be there for our Public Health defenders to continue in their response. Along with providing generous funding for the resources we need to prepare for, prevent and respond to coronavirus, im proud that the supplemental responsibly replenishing the Infectious Disease Rapid Reserve fund 300 million to help us respond quickly to future threats. As we have unfortunately seen and are continuing to witness, a deadly new disease is just a plane ride away. Thats why the Global Health security is also such a critical component of preparedness. Having our Public Health experts deployed all around the world, an idea you first raised with me its a f years ago, to respond to new Public Health threats where they exist in the country of origin before they reach our shores is a really good idea. Were likely to never know where the next threat may appear. So ensuring a strategy covering all regions is necessary. I look forward to hear manager about your plans for Global Health security. There are many other topics id like to address today, among them work addressing influenza, combating the open yode epidemic, progress toward treating chronic diseases that threaten our most vulnerable populations and reducing antibiotic resistance. As our time is limited i end my statement here and look forward to continuing our conversation. I yield back my time, madam chair. Ms. Delauro thank you, i yield to the chair of the full appropriations committee, congresswoman lowey of new york. Mrs. Lowey i thank chair delauro and Ranking Member cole for holding this hearing. Dr. Redfield and the distinguished panelist, we welcome you. Thank you for joining us. First, dr. Redfield, i want to thank you for meeting with me last week. We spent more than an hour together and i appreciate your commitment aened your expertise. Two short weeks ago, i planned to raise the trump budgets continued neglect of c. D. C. Its backward and misguided its backward and misguided recommendations to cut Health Resources and the harsh impact on the health of americans. After working more than two decades to restart federal investments in gun violence pretchings research i was eager to discuss the types of research that may be funded. We would like to hear about progress on other important investments in the fiscal year 2020 spending bill, including the new data maryland earnization initiative, child stwall abuse Prevention Research an combating the epidemic of youth vaping. By the way, thats an issue that is pervasive. I first learned about it from my 15yearold grandchild, that 60 of the class is vaping. And its not getting better, its getting worse. But unfortunately, today, we have a new epidemic on our hands. One week ago, my home county of westchester, new york, had its first con filmed coronavirus case. Today we have 98, with a total of 142 throughout new york state, more than 700 nationwide ncluding tragically 26 deaths. This stunning increase requires every level of government to Work Together and aggressively to contain and stop the spread of covid19. With the recently enacted 8. 3 billion emergency supplemental, the federal government can aid state and local Health Departments in assisting patients and mitigate the extent of the virus. However, due to the administrations failure to treat this threat seriously, initial faulty test kits, the administration slow approvals for laboratories, slow distribution of working kits, more people are likely to be infected and sadly were hearing those statistics. It is imperative that the federal government have a multiagency approach to ensure tests are available for all who may need one without delay. Cant go backwards. Unfortunately, there was a real delay. Thats why it was spreading. Earlier this week, i sent a letter to secretary azar, commissioner hahn and yourself urging you to use all powers at your disposal to quickly approve qualified labs in new york. Had a conversation with the governor of new york, that theyre ready to move. They need you to approve these labs including hospitals, private labs, other state facilities and to permit both automated and manual processing. I want to stress that again. If its taking more time for the federal government to catch up on the state level, theres real, Solid Movement and we need you to approve obviously all these labs and facilities have to go through a process. But as quickly as possible. There are labs in new york awaiting aprufle that could greatly expand Testing Capacity by thousands per day. I dont know why theyre waiting approval. Maybe you can address that in your comments but that could expand capacity by thousands per day. As may be the case throughout the country. If only the federal government would get off the sidelines and approve these facilities. So in your remarks id be most appreciative if you could tell me why its taking so long. Do you not have enough people to check the facilities . I dont get it. Are the facilities not adequate, not up to your standards . We need to know. The word im getting from the governor and his staff and the people involved in this issue that theyre ready to move, why rent they being approved. As covid19 comes closer to pandemic status, we must do all we canism look forward to our discussion and i thank you for the personal interaction we had. I preeshed the opportunity. I look forward to hearing from you, all of you today. We look forward to the facts. So that we can move as quickly as possible. His is an emergency. Thank you. Ms. Delauro thank you. I want to be accurate, just a ile ago the miami herald published a story, right now the department of justice spokeman contacted the herald to say the signs shouldnt have been removed, its now been rectified. So the outcry against that really moved things around. I wanted to, you know, make sure that the record is accurate. Dr. Redfield, your full written testimony will be entered into the record and youre recognized or five minutes. Dr. Redfield thank you very much, chair delauro and Ranking Member cole. All the members of the committee. Let me first thank you for your support of the c. D. C. Your investment enables c. D. C. To protect the health and safety of the American People. As were seeing now with covid9 Infectious Diseases can emerge anywhere and spread everywhere. We have slowed the spread of covid19 to the United States. As a consequence of the positive impact of the investment in Public Health that has been there at the federal, state, local and tribal level. C. D. C. Has identified securing Global Health, ensuring domestic preparedness, eliminating disease and ending epidemic as our top strategic priorities. Weve also identified the core capabilities that support the entire agencys programmatic efforts including the modernization surveillance and data analytic systems, the state of the art of laboratories, the building of maintaining a premiere Public Health work force, the Rapid Response fund you mentioned as well as building a Solid Foundation around the globe to address our Global Health security threats. C. D. C. Has leveraged every one of these capabilities so far in our response to the covid19 outbreak. The president s fiscal year 2021 budget provides 7 billion to c. D. C. To support these and other important Public Health priorities. When it comes to Global Health threats, though, i believe c. D. C. Is the tip of the spear. As with the defense department, having forward deployments in strategic regions across the globe, c. D. C. Will build a longstand, sustainable reeg that will footprint. This will increase c. D. C. s ability to meet Public Health challenges wherever they occur. The world depends on c. D. C. s expertise and the state of the art laboratories. The budget does include 10 million to help maintain Laboratory Capacity equipment and specialized training. The budget also supports Infectious Disease Rapid Response fund which enabled c. D. C. To respond immediately to covid19 outbreak and helps us provide a sustainable response to ebola and the d. R. C. Like covid19, the influne new influenza virus strains can emerge from animals and spread quickly among humans. Today its being leveraged to ramp up for covid19 surveillance. Severe influenza pandemics threaten lives and candice rupt military operations and the economy. The budget includes an additional 40 million to protect americans from insune zha. Influenza. It also includes money to address the growing threat of tickborne diseases. Our ability to fight disease depends on accurate, timely data and the work force to use that day to to preticket the next outbreak. We have focus odd bringing reporting time to realtime. This request supports the Public Health data modernization Multiyear Initiative that brings Public Health data into the 21st century. C. D. C. Reliance data for every public hell issue we attempt to address. The loss of a young mother due to pregnancy complications is another devastating occurrence in a family. The budget includes 12 million to increase and improve our ma tern health in america where every ma tern death will trig aeroPublic Health response to understand what caused that death, try to identify important interventions. Finally, c. D. C. Is committed to ending epidemics. The budget includes an increase of 371 million to support the president s initiative to end the h. I. V. Epidemic. C. D. C. Is deploying proven approaches to alter the direction of h. I. V. Infection rates in the United States as we are doing with the opioid and rug overdose epidemic. Overdose deaths have declined. The bunnell includes 476 billion for Overdose Prevention and an additional 48 billion to address Infectious Diseases related to drug disorder. C. D. C. And Public Health partners are the nations first line of defense against disease threats. We are committed to working with you to protect the health and well being of all americans and i look forward to answering all your questions including chairwoman, the question you asked. I will answer that also. Thank you. Ms. Delauro c. D. C. Has been working to respond to covid19 including utilizing Quarantine Authority that hasnt been used n decades. Over the last couple of weeks we health a care providers are facing the reality they cant get their patients tested. South korea is testing 10,000 people a day. We are behind the curve. My understanding is that testing kits continue to be distbued. Commercial firms are involved as well. Im going to try to keep within five minutes for all of us. Why is the u. S. Behind other countries when it comes to testing availability . Why was there such a delay in c. D. C. s ability to replace the test kits sent to Public Health labs . Then i have a question after that. Dr. Redfield thank you very much, madam chairwoman. We first got notification of this new disease on new years eve, december 31. It was occurring in china. The chinese fairly rapidly published the je metic sequence and at the end of the first week of january. We actually worked at c. D. C. Based on that and created a diagnostic test that really, i think, tested the first person in january on january 17. Quickly we had a diagnostic test up and running which is our job, to get that Technology Available for the Public Health laboratories of the country. With let them know and they began sending in samples, i think we had our first diagnosed in january, i think 21st, from the state of washington. Obviously at that time there was it took time to fly the samples to c. D. C. And run them. Sometime it was a threeday turn around, fourday turn around, occasionally a fiveday turn around. Ms. Delauro why are we behind other countries . Why was there such a delay in the ability to replace the test kits sent to Public Health labs . Dr. Redfield i think we rapidly developed test and then had to expand the test to go to the Public Health labs. When it was scaled bullpen think contractor the Public Health labs need to validate it to make sure the test works. When they did try to verify it works some of the labs found that one of the reagents wasnt working correctly, past of our Quality Control procedure. We had to tell them to hold off using those tests for Public Health, should still send the samples to c. D. C. We worked to correct it with the f. D. A. , it was corrected in a short time and that was replaced. I think the most important point about the availability of testing is c. D. C. s focus was to provide testing for Public Health. Theres another system we need testing. Or, clinical theres Laboratory Testing availability to any Doctors Office that can go through labcorp and qwest. Ms. Delauro nevertheless youve got people asking far test who cannot get a test. The overarching question is did c. D. C. s delay in producing producing functioning test kits and its insistence on a narrow definition of testing lead to ncreased sfred spread in our communities. Dr. Redfield im not willing to concede the second. I will say we had to go through a reag laer to process to get our test out. Our test was approved for very specific clinical settings. So when the test was approved by the f. D. A. It was approved for use in high risk individuals that were coming at that time from china. Then later it was expanded to individuals with pneumonia and then later as you know weve expanded now to any physician that feels theres a need or Public Health person can order that test. But it was a series of going through that reag laer to process to get that test available. Ms. Delauro i think the conclusion is we are behind the curve in testing when south korea can test 10,000 people in a day. If i can very, very quickly, if you condition, otherwise ill come back, youve got 2. 2 billion for c. D. C. We want your assurance that these funds will be allocated quickly and we are going to need you to jut line c. D. C. s plan for its share of the emergency supplemental and deal with what your Top Priorities are. What should the American Public see in the next coming weeks . Dr. Redfield i can assure ms. Delauro we have a lot of folks here. Thank you very much for the opportunity and thank you for moving so quickly to provide us with the funding. Our top priority is to get funding out to the state and local jurisdictions. Using the congressional language that we received, our top priority is to get 90 of the preparedness grant amount out to the 62 current grantees. As quickly as we can. We plan to do that in the next two weeks. Ms. Delauro do you have enough resources . Do you have enough resources . Dr. Redfield i think the most important thing that you all realize is to make sure that c. D. C. Is overprepared for a response, not underprepared. Ms. Delauro ok. That means resources. Thank you very much. Thank you very much, madam chair. I appreciate those questions on the testing. They were very much mine as well. Let me ask you something very different that will probably be a more pleasant question in some ways. Were not going to cut c. D. C. By 700 million. What this committee will wrestle with is what is the appropriate increase Going Forward and what are the things we need to prepare you as best we possibly can to deal with the things like youre dealing with right now. Mr. Cole again, this committee has seen this coming for a very long time. Its been a bipartisan con sent us. Congress has been consensus. Congress has been ahead than both of the last two administrations. So, given that, you know, what are the things because were going to have to ask you this question at some point. What are the things you really need if you had as much money as you would like, as opposed to the budget that youre assigned . Dr. Redfield thank you very much, congressman cole. Im hoping that the legacy for the time i get to lead c. D. C. Is really one thing. Help build the core capabilities of this country. That is data. Not data when i get presented something i know what happened two years ago. But i want predictive analysis, to be the name of the game, not just for c. D. C. , but for the entire Public Health structure of this country. I need laboratories that we were just talking about to be so prepared that the complexities that weve gone through these last six weeks are not going to be an issue because weve invested heavily in Laboratory Capacity in the Public Health labs of these things. I want to build a Public Health work force that right now those of who you know, like, for example, seattle, where i was ust out visiting, probably one of the best Public Health in the nation. Theyre struggling right now. Thats not what we need. We need to be prepared. I need the Rapid Response fund to be robust so that it can really roll out. And finally i need a Global Health Security Foundation across the globe that can protect this nation following the regional strategy. Thats what i need. Core capabilities. And it will help every program. It will help diabetes, cancer, smoking, Infectious Disease, thats what i need. Mr. Cole i would suggest in the interim, because, again, building a budget takes time, as everybody up here knows, that you work with us to put dollar figures to those kind of so we can the chairs going to have a difficult decision. Our counterparts in the senate will. But ill make a bet, the budget for this agencys going up. Not down. So the critical thing for us is to work with people that really know what theyre doing. So we can get you those dollars and the appropriate amount. So we can go forward. Second area. Not to beat on you for a budget that i know you dont agree with, but i was disappointed to see the good health and wellness in Indian Country program, one of the only programs that funds Public Health in native areas, once again proposed for elimination. Let me assure you, that isnt going to happen. I know your own commitment in this area. So i suspect i know where that proposal came from. But i would like you to expand on what you think we ought to do. Because every set of statistics we have, you know, puts native Americans Last in just about every Health Category and risk. This is everything from trying to make the Indian Health service more robust, but also this is a unique population in some ways that has some special challenges. So what do you think we ought to do to try and end that disparity . An area we have lots of minority population, my good friend, ms. Lee, always points this out, appropriately so. With africanamericans too. But these we need to try and erase these disparities. Dr. Redfield thank you, congressman cole. I think you know my personal views on this. You know, were continuing to make progress. We think that the good health and wellness Indian Country program is obviously extremely important. It supports 27 tribes, urban indian organizations, and throughout our country. Obviously theres key areas of critical importance in chronic disease, opiate, injury, environmental Health Issues. Theres been a movement, as you know, the American Health block grant, and the Public Health data modernization initiative, both of these, i think, can really help to support. I think were trying to move away from diseasespecific interventions as opposed to allowing the community, the travel community, to look and see what are really important Health Issues they need to address and then appropriate to resources in that regard. But it obviously is an important area that we also would like to see continue to be effectively hopefully there will be more flexibility and maybe some gain in efficiency, allowing the local groups to decide exactly how to invest the money in chronic disease rather than saying they have to do it this for this and this for or this for this. That was our attempt. Sir. Mr. Cole thank you very much. Thank you, madam chair. Ms. Delauro congresswoman lowey. Mrs. Lowey dr. Redfield, as i mentioned, as you know, in my home county of westchester, new york, 98 cases have been confirmed in just one week. New york is trying to take aggressive steps to combat the virus by increasing Testing Capacity, has asked the federal government for approval to use qualified hospital, private labs, additional state facilities to process tests. How many tests kits does the c. D. C. Have the capacity to deliver on a daily basis . And how is c. D. C. And f. D. A. Working to increase Testing Capacity in state . How long will it take for these facilities to be approved . And how long does c. D. C. Believe it will take until a Rapid Response test is vailable for Health Providers . I got the impression that c. D. C. Was a stumbling block and new york was raring to go in producing these kits and they didnt get approval. I wont tell you the other things i heard. Dr. Redfield thank you for that. Ive probably heard them all times 10. First, let me tell you that ive worked very closely with howard zucker, your Health Commissioner in albany. February 29 he requested that e could couse our e. O. A. To bring up the wadsworth lab. F. D. A. Approved it the same day. February 29. Actually were on the phone last night because hes one of the first state labs now to try to go to a much more automated, what we call high throughput system. Im hopeful that the because we cant just do it. They have to verify and im hopeful that the verification run that should have been completed last night and theyll be the first Public Health lab to be able to use the very high through put system. Secondly, i want to say the same day, february 29, the administration gave regulatory relief to any preapproved lab that wants to develop the test, to develop the test and use it. So theres no delay from the United States federal government perspective. Some Major Medical centers, for example, in the state of washington, and others, are up and running and doing their test. All they have to do is be approved to do clinical testing and then they have to verify themselves that the test works. They have 15 days afterwards to file the e. O. A. They can go forward on february 29, if they chose to go forward, and develop that test. Third is, weve worked there are three new york labs that have requested testing from c. D. C. And we have provided it and we will continue to provide what they request. They make a request to i. R. R. , how many kits they want shipped out, theyre shipped out to them. Fourth and most importantly, was the decision of the diagnostic industry, in a meeting we had with the Vice President and all the leaders, they didnt come together as independent companies. They came together altogether. And said, how do we help get diagnostics throughout this country . And i know the two big ones, major labcorp and qwest, are operational as of yesterday. In Doctors Offices throughout this country. Mrs. Lowey oh, i have a minute and a half. Ill talk quickly. Dr. Redfield they tell me to speak shorter. Its hard for me but im trying for you. Mrs. Lowey i know its hard. One of the reasons covid19 has seemed to spread so substantially in new york is a patient wag being treated for several days in a hospital before he received the correct diagnosis. We now know that Health Care Professionals working in that hospital, as well as two areas, have tested positive. Were already facing a nursing shortage. Im very concerned about our Health Work Force and whether the Health Care System will collapse under its own weight of nurses, doctors and other Health Professionals are now protected. What guidance is c. D. C. Providing to Health Care Providers, in particular emergency departments, to minimize the number of personnel exposed to covid19 . I guess we have 55. Dr. Redfield we have guidance and i think directly our updated guidance is going out today oin fection control procedures. I will say one of the greatest vulnerabilities of this nation right now is Nursing Homes. And you know that they c. M. S. Recently upped the resources. They have all their inspectors now told not to worry about all the other stuff they inspect for. All they want to do is Infection Control. Thanks critical issue this is a critical issue. In the state of washington theres 600 Health Care Professionals that have been exposed. In the state of california, 600 have been exposed. We dont have that much redundancy to have that many. It is critical. I will say one thing i want to say that i think is important. This epidemic started in china. That was kind of helpful for us because we knew that was the risk. 99 of the cases that occurred last night occurred outside of china. This isnt china. Right now the epicenter, the new china is europe. And theres a lot of people coming back and forth from europe that are not starting to see these communities, and we are moving quickly to understand how to address europe, but thats why youre seeing more in new york, thats why were seeing more again, were going to try to really reinforce that early consideration of coronavirus and treating individuals as if they have coronavirus is what the Hospital System has to do and i think the diagnostics now have penetrated to the degree that clinicians will get a very timely diagnosis. Mrs. Lowey let me just say quickly in conclusion, i would hope, based upon these particular incidents, that all those in the emergency room seem, seems so basic, are tested before they see a patient. Some of the stories weve heard are really shocking. Thank you. Ms. Delauro congresswoman herrera beutler. Ms. Herrera beutler thank you so much for coming out to Washington State. I joined with you and Vice President pence and almost our entire delegation to come out and i appreciate your willingness and readiness to be available to our Public Health workers all the time. All the time. Im sure youre enjoying the time delay we experience. Were very grateful for that and a shoutout to our Public Health workers. I do think Washington States Public Health system is, i think its the best in the country. And as you said, we are struggling. I wanted to bring up a couple of questions to clarify. So i know c. D. C. s partnered with the private manufacturers to make test kits available and the amount of test kits is increasing exponentially. Its happening now. That being said, i find it interesting that when my colleagues who are in contact with someone who later tested positive were able to get tested almost immediately and quickly receive their results while folks in my district and across Washington State are unable to get their testing results back. So i do find that people are now guesting tested. I was on the phone with one of my local Public Health agencies yesterday. But what im being told is, if they go were trying to get people into the university of washington. But people who go locally and it goes to the state lab, theres still a delay. Weve been waiting for about five tests for a number of like every day the headline is still waiting for the test results. Could you speak to that . Dr. Redfield its why i hope in the time i get i accomplish what i want in building core capability. These Public Health labs need redundancy. They dont have it. This is when i go back about the core capability of data, lab, people, Rapid Response fund and the Global Health. Weve not invested weve underincested in the Public Health lab. There theres not enough equipment, theres not enough people, theres not enough internal capacity, theres no surge capacity. Ms. Herrera beutler were being told that they also even the u. W. They can process about 1,000 a day and theres capacity there if the clinicians will send it there versus Public Health. But does u. W. Then also have to be validated by the state . Were being told that. Dr. Redfield all u. W. , which theyve done, had to do was on the 29th when the regulatory relief was done, and they just had to develop their own test, didnt have to use c. D. C. s. We published exactly how to do it. So anybody can replicate it. All they have to do is run to make sure their controls work. They dont have to send it to us. They go. In 15 days they have to file to the f. D. A. But i want to say one thing about that. Why are they different . The Public Health labs, weve built the technology in those labs to modder to flu. That uses monitor flu. That uses a certain equipment which we call thermo cycler. That equipment may be a good lab could do maybe a good lab could do 300 tests a day. The university of washington can use these high through put machines like new york is about to do. Those machines can do thousands and thousands and thousands. So they are converting to those high throughputs. But the Public Health systems never had the equipment ms. Herrera beutler i have to reclaim because we dont have a lot of time left. There is a lab in my district, im grateful that qwest and labcorp are coming online. Thats important. I have a lab in my district who has worked with c. D. C. On h. I. V. Well. And they have found it impossible to get in contact with c. D. C. On covid19 testing. And due to the fact that they werent able to get sample its back from c. D. C. , they had to resort to getting their samples from israel. I know there are smaller and u. W. Had some of this challenge. They had to develop their own tests. They went through it all themselves. I know that the administration has been working with the big guys to get them going for capacity purposes. I would be grateful if they could also be responsive to some of the smaller guys. Because in the rural areas, we just need more people and if these labs are willing to do it, go ahead. Dr. Redfield if you give me the specifics, im happy to look into it. Ms. Herrera beutler i will do that. The one last question i had, im sorry im breezing through this. Has to do with nursing home guidance. I know that the administration as new focus on enforced protocols. Had people followed protocols, wed be in a better place today. What im hearing on the ground level is things go up on a website, but my local Public Health said, i dont have the capacity to go into every single home and make sure everybodys doing im paraphrasing. How can we help make sure that the Nursing Homes in our communities right now today are getting the information and are at least communicating about what theyre going to need or what they will need . And how can you help with that . Dr. Redfield weve put together specific guidance and well continue to make sure, i know c. M. S. Is going to be aggressively making sure each of the Nursing Homes are up. Because this is our vulnerability. When you see tragically the 27 people that weve lost, i think 23 of them have been in your state. And many of them had been in that nursing home. So this is really a priority to get that up and running, Infection Control up and running. Provide the Technical Assistance. This is our number one vulnerability right now. Ms. Herrera beutler thank you. Ms. Delauro thank you. Congresswoman roybalallard. Ms. Roybalallard welcome and thank you for being here. During the time that ive been on this subcommittee, we have justifiably doubled the n. I. H. Budget once and are in the trajectory to do so again. However, during this same time period, the c. D. C. Budget has remained relatively flat, despite the fact that Credible Research has shown that every dollar invested in Public Health results in 67 to 8 in benefits to our society 88 in benefits to our society. C. D. C. Fund something critical to maintaining infrastructure at state and local Health Departments. Over the last decade, our failure to robustly fund the c. D. C. Has resulted in our local and state Health Departments losing 25 of their staff since 2008. If theres been a failure in our coronavirus response, i do not believe that it reflects on the competency and effectiveness of c. D. C. But rather on our chronic underinvestment in the Public Health system. That is why i strongly support the 22 times 22 initiative, to increase the c. D. C. Budget 22 by the year 2022. Id like to take this opportunity to give you another chance to share your professional judgment about our Public Health funding. What do you consider to be the greatest funding needs for the c. D. C. Right now and is our current level of investment enough to ensure the best federal, state and local response, not only to the coronavirus, but also while responding to a Public Health do ency such as covid19, you have the capacity to maintain responses to the ongoing Substance Abuse epidemic, Maternal Mortality health crisis, hepatitis outbreaks, and of course addressing chronic disease such as asthma and diabetes . Dr. Redfield thank you very much. It gives me a chance to sort of reinforce once again what my goal is as c. D. C. Director. And that is to rebuild the Public Health infrastructure not just of c. D. C. But of the whole nation. As you know, about 70 of the funding that is appropriated to c. D. C. Is used to go out to the state, local, tribal Health Departments. We provide the funding really for the backbone of Public Health across this nation. Like c. D. C. , the state and local and territory Health Departments are underfunded and i want to rebuild the core capabilities so that we have data and data modernization. Wouldnt it be nice if we had a data system that every Health Department in this country right now could see in realtime so that kyo predict whats going on . And where to go and where to put assets . We dont have that. Wouldnt it be great if we had the redawn dansy in our labs so were not arguing whether they can use a high throughput system because they dont have the technology to do it . These labs need to be equipped. Not at cdbgr and new york and california, but the c. D. C. And new york and california, but the whole country. We need to basically get more people into Public Health and get programs there. We need that Rapid Response fund at an area we can robustly respond and not try to make priority choices how were going to use the money that we do have. Finally, we need to build a robust Global Health Security Network throughout the world. Ive got a plan to do eight to 12 regional sents that are have full capacity so that we can detect, respond and prevent infections at their source rather than have to deal with them at home. That to me is the most important. Because if we have that, all the Health Departments are going to go up. All the Health Departments and all of your own jurisdictions, i guarantee you, if you go talk o them, theyre underfunded. Ms. Roybalallard just to follow up to what you just said. By the end of 2020, it is estimated that the percentage of Health Agency employees eligible for retirement will reach 25 . What level of investment do we need to train and hire the next generation of Public Health professionals . Dr. Redfield that is one of the critical core capabilities and i would like to get back to you with more specifics in that exact arena. As we were challenged to come up with a very specific budgetary requirement to deal with this. It is critical. We have one program i just mentioned briefly that my predecessor started which i think is really an important program. It took young people out of college and gave them two years, called the Public Health Associates Program, and then put them into Health Departments all across the country that wanted them. So now you get young, energetic people at the beginning of their career, not quite sure what they want to do. And they see the gift, what it is to do Public Health. It doesnt necessarily come out that way, probably when you read career magazine. But they get out there and they practice Public Health and a number of them then say, you know, i want to go on to medical school or Public Health school and a number of them are actually working at c. D. C. Today. So expanding those programs to get young people to see the value of a career in Public Health i think is critically important. And then obviously to be able to continue to retain the individuals that we have. But i think the Public Health sorks Associates Program is a really important thing for our nation. Ms. Delauro congressman harris. Mr. Harris thank you very much, madam chair. And thanks for taking time to appear here, because youre probably like a onearmed paper hanger right now, running around doing things. Let me just ask, let me follow up just on that Global Health Security Network issue. We could have all the Global Health security we want, but when china denies the presence of the disease for a month, a month and a half, what affect does that have . How you know, the bottom line is that we know that the fatality rate in china is probably higher than its going to ever be here in the United States. What protections do we have against a bad actor like that . Dr. Redfield you know, i just think if we have these regional presence, of strong teams, its going to give us more eyes on the ground of whats actually going on. Nothings going to be perfect. This particular outbreak started in a certain area of china. I know ive had direct contact on either new years eve or the day after with my counterpart, head of chinese c. D. C. I dont think he was in the light, that he had a problem, in early december. So i cant really comment of how the local Health Department in wuhan and how that was shared. I know that as soon as he knew, i knew. Ill stop you there. They arrested the physicians who tried to talk about this new disease and how bad it was. We just need to be protective here. But if we think were ever going to get into that kind of closed system and somehow affect it, no. Mr. Harris the communist chinese are going to continue that system and were just going to have to live with it. Whats interesting, though, is one of the things that i hope you do is youre advocates for the kind of innovation that were going to need to deal with these kind of new vie viruses, both on the vaccine front and the antirival front. A s idea that we produce vaccine and got it delivered to the n. I. H. In six weeks from conception is phenomenal. But its an American Company that has not had a profit for 10 years. Developing this platform. And if this vaccine works, we will owe it to American Innovation and yet, you know, bills like h. R. 3 i think will destroy American Innovation. So im going to ask you, how important is the private sector, innovative process, both for this and for antivirals, and for treatment, when it comes to these kind of Public Health threats . Dr. Redfield thank you, congressman. Its obviously fundamental and critical. Im going to give you the biggest chample for me where example for me, where its antibiotic resistance. We have programs that look at surveillance and containment. But were never going to win that. Its a containment strategy. The only way were going to win it is new innovation. So innovations fundamental for us to stay ahead of antimicrobial resistance, for us to rapidly response. What n. I. H. Is able to do now in six weeks, which normally would have taken them 12 months or more so innovation has to drive and if we lose innovation, were going to lose our ability to maintain the advances we have in clinical medicine, for antibiotic resistance. Theyre going to go aside. Mr. Harris sure much we made that point when h. R. 3 was being considered and even the c. B. O. Agreed that there were probably a dozen diseases that we would not be able to develop treatments for if we punish innovators in this country. Let me talk about one last and bring it around back to the testing issue. Because one thing that you said and im curious about this, just from a Public Health perspective, is that qwest and labcorp now are geared up to do this. Could they have geared up sooner . I mean, because you imply that we have to have a parallel track. We have to have this one system that is for Public Health bodies and then this other system for the private sector which it sounds like was ready to go and probably, because there is a profit motive, theyre ready to go much quicker. Is that a model we should be looking at in the future . To do Publicprivate Partnership with some of these companies that have the ability for rapidly gearing up and then make these available to the Public Health sector . Dr. Redfield my point that i wanted to make clear first is what c. D. C. s responsibility was. The Public Health side. That said, as a clinician, like yourself, i guess i anticipated that the private sector would have engaged and helped develop it for the clinical side. C. D. C. Has tried to help because the test that we did develop, i. D. T. , asked the f. D. A. If they could now actually commercialize it and we said, its fine by us. They can do it. But i think those decisions on the commercialized section, i mean, we do have groups that can fill gaps, barda, for example, if they see a gap they can begin to try to promote that. But i think i can tell you, having lived through the last eight weeks, i would have loved the private sector to be fully engaged eight weeks ago. Mr. Harris i think we have the wrong agency i guess to ask that question here. Thank you, madam chair. Ms. Delauro congresswoman lee. Mrs. Lee thank you very much. Good morning. I thank ms. Lee thank you very much. Good morning. I thank all of you for being here. Thank you, dr. Redfield, for being here and your tremendous leadership and all of you. These are very challenging times but you all have stepped up. In so many ways. Let me ask you, first of all, with regard to hand sanitizers. Im not sure im trying to unpack how we move forward on this. But i know that and we all prevention e of the strategies is to wash hands for 20 seconds and if in fact we dont get to wash our hands, we use hand sanitizers, right . Thats part of the directive. Now, unfortunately you cant find hand sanitizer. The small one i have, fortunately i had another one at home so i just fill it every day. Ive been in three cities in the last 10 days. Nowhere can i find hand sanitizer. So, what in the world is going on and how do we make sure that hand sanitizers are available . I mean, unhoused people need them. There may or may not be water around. People who just dont have a lot of money, vulnerable populations, if they were around they probably couldnt even abide buy hand sanitizers and our Health Care Workers and medical professionals on the front lines. So what in the world is going on . And how do we wrap our hands around this so that we can make sure that the directions we receive from our federal overnment can be adhered to . Dr. Redfield thank you, congresswoman lee. Obviously important. Weve seen the shelves. This isnt an area that we drive. But i can tell you the Interagency Working Group is looking at a variety of Different Things to figure out where the shortage is and what can be done. Whether the masks or medicine or hand sanitizers. I can get back to you exactly. But i do, from the Public Health point of view, at least remind people that 20 secretaries of vigorous washing with warm hart, hot wart and soap, is going to work. There are people looking to track, where is the supply issue here and i can get back to you. Ms. Lee could you, please. Because a lot of people dont have access to warm water and soap. Dr. Redfield i understand that. Ms. Lee and need to know. That dr. Redfield ill get the information from the Interagency Group and make sure it gets back to you. Ms. Lee thank you very much. The second question i have is, on the grand princess, first, thank you for your assistance with regard to this very challenging Public Health emergency and operation thats taking place in my district. I know c. D. C. And h. H. S. , i think h. H. S. Has been in the lead with our governors office. Could you clarify what role c. D. C. Has in this entire operation and what do you think in terms of time frame, how long its going to last, and what have you learned in the last 24 hours since people have been disembarked . Dr. Redfield the operational lead, the Mission Leader is aspr. Sistant secretary robert kadlac. Hes in charge of the response. We provide Technical Assistance and support under his direction to the response. We obviously are also going to provide some Technical Assistance support as these individuals to move housing, either at travis or lackland or in georgia. But the operation is really under control. Probably most importantly, we make sure Infection Control issues are done right. And we do we are the agency that gives the federal quarantine orders. Ms. Lee are you the agency that monitors the whole Public Health criteria and protocols as it relates to the health and safety of the dock workers, Health Care Workers, the crew, the passengers, the community . Because where the ship is being docked is in an area in my district where historically weve had to deal with environmental racism and injustice. We want to make sure this is not another one of those instances where we will, you know, unfortunately feel the impact. Dr. Redfield we provide the Technical Assistance, to the assistant secretary, for responsive preparedness. And our Technical Assistance is highly respected within the department. But theyre ultimately in charge. Were there to provide that ms. Lee who signs off on the health and safety, Public Health and safety . Dr. Redfield we go back up to the assistant secretarys office. Ms. Lee assistant secretary does. Ok. Ll ask my next question next goaround. Thank you. Mr. Pocan thank you very much, madam chair. Thank you for being here. I got a lot of questions. If we can be is you stint, that would be great. I did a succinct, that would be great. I did a facebook town hall, we had several thousand reviews in the first hour. A lot of questions. Were not cutting your budget. Thats why we brought you here. Now lets go to what everyones asking about. Are we past containment, is this strictly mitigation at this point . Dr. Redfield in different areas, were in a containment in certain areas. I would say in general were in a containment blended mitigation, in some areas were in high mitigation. Mr. Pocan ok. When you say Nursing Homes, does that include assisted living and other Senior Living housing area . Thats a question that people asked. Dr. Redfield yes. Mr. Pocan succinct is great. Yes is a great answer. I want to ask the friday press conference. The president interrupted you and said anyone who wants to get tested can get tested. Is that true right now . Dr. Redfield you can go to your Doctors Office mr. Pocan you dont have to give me a long answer. Dr. Redfield through a physician. Mr. Pocan is that a yes through a physician . Dr. Redfield yes. Mr. Pocan i wrote you a letter last week. You quit keeping track of how many people were tested on the c. D. C. Website. I think thats a bad idea. From a number of conversations, what you dont you dont know you what dont know. Which is why we wanted to keep track of those tests. We had secretary azar as of this morning say he doesnt know how many people have been tested in this country. That was an article on cnn. Why are we not keeping track of that and why are we only updating the c. D. C. Website now three days a week . World Health Organization does it daily and this is information people really want to know. Dr. Redfield were doing it every day now and weve got a new reporting system that includes c. D. C. Public health labs, were going to get direct dumps from labcorp and qwest so people can see all the tests done, where theyre done, and well have Surveillance System that does that. Mr. Pocan the yes from answer from yesterday is already old news . Appreciate that. Some have said we should be proactively testing. Dr. Fauci agreed. Anyone in a hospital with pneumonialike symptoms, as well as health care personnel. Are we now proactively testing folks like that and have a policy of proactive testing . Dr. Redfield we are recommending to physicians that anyone that has a variety of clinical scenarios to be tested. Mr. Pocan how aggressively . Dr. Redfield were aggressive now. Mr. Pocan were proactively testing . Dr. Redfield yes. And individuals with pneumonia or respiratory illness. It does vary by community. Where we have Significant Community spread mr. Pocan the recommendation is proactively testing Health Professionals . Dr. Redfield not all. If theyve had an exposure in a hospital where weve known cases, yes. Mr. Pocan how about Police Officers . Dr. Redfield as weve seen in washington, thats one of the things on my trip that really surprised me. How many firefighters were no longer available because they were in 14day quarantine. So it goes with exposure. Were trying to we have increased awareness of how to approach a patient so you dont get exposed. Mr. Pocan how about a question on the tests going back, other countries use the world Health Organization test. Why did we not use that test and who made that decision . Dr. Redfield as i tried to say, our test was probably created as fast as anybodys test in the world. W. H. O. Doesnt actually make a test. One of the german universities made a test. So that test had to come here and go through regulatory review. I think our test was much quicker than they would. I defer that question to the f. D. A. And [talking simultaneously] mr. Pocan i have them in committee tomorrow. Ill ask them. Thank you. Another question. There was an article over the weekend, im going to pull it up, saying that c. D. C. Recommended seniors not travel and then it wasnt part of the White House Task force recommendations. Vice president pence said it was never a recommendation to the task force and the story was completely fiction. Did the c. D. C. Recommend that Older Americans not travel . Dr. Redfield yeah. C. D. C. Now recommends at this point he mr. Pocan not at this point, at that point. Did you recommend to the task force dr. Redfield i dont know exactly when that was. Mr. Pocan over the weekend. When there was a report that did not say it and theyre saying that c. D. C. Recommended it. At what point did c. D. C. Recommend seniors not travel . Dr. Redfield probably in the last 72 hours that we recommended. I can get back to you with the exact date and time. We do [talking simultaneously] mr. Pocan i dont want to have to do a freedom of information act request. I want to know when it was recommended by c. D. C. Because theres a real distrust out there right now and they dont know who to distrust because were not getting information. This is one where right now im trying to convince my inlaws not to travel to las vegas tonight. Theyre both in their 70s and one has Health Issues. These are the questions were getting asked on town halls. So when someone says it wasnt a request and now you are recommending it, i would like to know when it was requested and if i need to dr. Redfield well get the information back to you. Mr. Pocan thank you very much. Is that my time . Im sorry. It went that quick. Thank you very much. Ms. Delauro congresswoman frankel. Ms. Frankel thank you for your work. I agree with my colleagues about we should not cut your budget. First of all, i want to just say, and im sure you would agree with this. You said that the virus is expansive in italy and south korea, now in this country. It is absolutely wrong and inappropriate to call this the chinese coronavirus. I assume you would agree with that. Dr. Redfield yes. China was the first phase. Korea and iran was the second phase. With itsly. Now all of europe with itsly. Now all of youre. Italy. Now all of europe. If you just look over the last 24 hours, there was almost 1500 new cases in italy, 1500 in germany. Ms. Frankel thank you. Theres been some other real misleading statements that are wrong. Im going to read some. If you agree with these statements, just let me know. Our tests have been perfect. That this is like the coronavirus is like the regular flu. That its a hoax. That anyone who wants to be tested can be tested. That the number of cases will soon be down to zero. Theyll magically disappear. You can still go to work and its ok to shake hands. Since im not hearing, anyone want to correct that . Im assuming you would agree that those are misleading statements. Dr. Redfield i dont think i heard nin any that i would say is not. Other than i do believe that availability of testing in the last two days through qwest and labcorp is getting us to where we need to be. Ms. Frankel thank you. Are you familiar with the public charge rule . The new public charge rule . Dr. Redfield yes. Ms. Frankel im concerned that it might lead people not to go to get the care they need. Could you respond to that . Dr. Redfield i would concur with you. Ive talked to some of your colleagues when we were on the trip in the state of washington. They brought this and we are looking at it to see its Public Health implications. Ms. Frankel thank you very much. Would you say were at the beginning, middle or end of this Coronavirus Fight in the United States . Dr. Redfield i cant predict. Ms. Frankel ok. Can you say what percentage of americans you think youre predicting will get the coronavirus . Dr. Redfield i think it depends how effective our Public Health response is right now. I want to state one thing. We all have a role to play. Its really serious when we say to practice the washing of the hands, coughing into your elbow, try not to touch your face. I know theyre going to count how many times did i on this, its very hard but you have to try not to. Then i think if youre sick, stay home. Please stay home. Ms. Frankel did any Health Agency recommend to the white house that people over 60 should not fly on planes . Dr. Redfield i dont know the exact age. Ill get back to you. But we have recommended that the elderly and vulnerable, including children with chemotherapy and others, should really reconsider at this point travel. Ms. Frankel what is the age of elderly [indiscernible] leave the room . [laughter] dr. Redfield i didnt define. It but i will tell you that in the discussions we had, the individual brought it up did say it was a year older than they were. Ms. Frankel what is that age . Dr. Redfield right now weve been looking at the data, if you look at the data, the average age in italy of death is like 82, 83, 84. Its really the data that ambassador burks has goten from china, italy, korea and our own nation. Looks like 65 and above is where most of the people are that are dying. Ms. Frankel all right. One of the concerns i know we have, especially in these Nursing Homes where everybodys getting sick and including the care providers, what is the level of your concern about us having enough care providers to take care of people as this disease spreads . Dr. Redfield this is the importance of what we talked about before. Being overprepared. If youre overprepared, the ability to protect the Health Care Professionals, and not just the Health Care Professionals, i think the congresswoman knows that in washington, one of the places they dont have firefighters. Their firefighters are all in quarantine. We have to be overprepared to response to these outbreaks. Not try to catch up. Time matters and Infectious Disease. We have more time in environmental disasters like hurricanes and flooding than we do when it comes to an Infectious Disease. Infectious disease, if youre a week late, as some of you have criticized about the testing or whatever, it matters. Ms. Frankel we have another round coming . One more question on this round. I have some friends or people who are selfquarantining themselves. Weve read about it the in the paper. You get exposed. You selfquarantine for 14 days, is that right . Is thaws but a is that how long you have the disease for . 14 days . Dr. Redfield right now the average incubation period from infection to symptoms is 5. 2 days. Ms. Frankel how long does the disease last once you get it . Dr. Redfield it varies, if you do get it. If you get exposed, you will develop symptoms within those 14 days. And be able to then either be diagnosed. If you stay asymptomatic, we have no evidence that you shed virus longer than that. Ms. Frankel if you selfquarantine for 14 days, you come to work and then you meet somebody who and you get exposed again, you might have to selfguarantee yourself again, which means that we may all be in a process of selfguaranteing. Dr. Redfield you sound like what my wife said this morning. We fully intend i do believe, if were all in this together, from individual citizens all the way up, we have a great Public Health department, we still want to stay with our early diagnosis, Public Health isolation, and then aggressive use of mitigation strategies. Were in a fight to contain to basically stop this outbreak. At least for now. Many of us are hoping, not knowing, hoping that this will follow the pattern of flu. And other respiratory viruses. That means the transmissability in our environment might change. It is interesting that when i look at the cases around the world and i sensor out all the exports cases and i sensor out all of the contacts of exports and you look in the certain hemisphere, theres very few cases in the Southern Hemisphere right now. Its a great possibility that might change. Just like as flu changes. I think we need to stay the course, be aggressive. This is, again, why i think being overprepared is where the posture we want to be in. This is why the supplemental you did in such a fast way, in a bipartisan way, is so important to us. It gave us resources now to cale up. Thank you for your willingness to hop on the phone with me yesterday. Ill start with some of the questions that i was ask going to ask you yesterday. Obviously the white house was calling. I got bumped. Its all right. Buftbuft is this a pan democrat buss buss is this a pan mr. Boustany is this a pandemic . Mrs. Bustos is this a pandemic . Dr. Redfield the word isnt important. This is clearly a massive global outbreak. Mrs. Bustos i know chairwoman lowey started out focusing on where shes from, new york city. Im from a very, very different part of the country, very rural district that i represent in the northwestern corner of illinois. In fact, 11 of the 14 counties in my district are almost ntirely rural. My office is taking the necessary steps to prepare for cases. So we have been in communication with all of our hospitals, our Community Health centers, our public our county Health Departments, etc. One of the concerns that has been shared with us through this outreach is how the virus could increase provider shortages, especially in rural areas. Let me just give you an example to back up a little bit. One of the counties in my Congressional District is called henderson county. We have a patientphysician ratio of nearly 7,0001. If you want to compare that to cook county, thats 12001. You can imagine if rural doctors need to isolate themselves due to coronavirus exposure, there are limited options for people. So im just wondering, if you could offer, and anybody at your table there, maybe give folks other folks an opportunity to answer this as well, but what steps can Rural Communities take to continue treatment if their providers get sick and cannot see patients . If you have any advice specific to more rural parts of ouryy of our country. Dr. Redfield any of you want to make a comment . Im happy to make a comment. This is an issue. And this again is why weve heightened the area of Infection Control. Because, as weve seen now in washington, weve seen now in california, we got 600 Health Care Providers that are working both of those environments and thats causing strain. The source for most communities, if this is going to happen, is probably going to be in nursing home. Then they go into the hospital and then the hospital dont have diagnosis, someone gets sick from the us ining home bay because someone who nursing home because someone visited their sick mother and then they got sick and went into the hospital and boom. We have to be aggressive in the Infection Control and really work hard. Because this is what happened in wuhan. Thats why the mortality was so high. They had 130 infection beds when they started. They had over 20,000 within about four weeks. You know what they didnt have . Doctors and nurses and equipment to staff those 20,000 beds. Their Health System fell apart. Thats why the mortality was so high. Mrs. Bustos are rural areas more at risk for Something Like this . Dr. Redfield you may have the benefit of being more isolated from a large population. So you pray that the virus doesnt really get into a Community Transmission zone. If it does, its going to come through a nursing home, i would bet. Mrs. Bustos is there anything from anybody else at the table who would have anything to add to it what dr. Redfield just shared . Thank you for the question. Rural health has been an ongoing issue for a long time. Like with a lot of other things weve been talking about here, the coronavirus and the covid19 issue is just sort of shining a light on a number of deficits that weve had in our Health Care System and in our Public Health system for a while. We have been involved and have some resources, theyre very small in terms of how it is that Rural Communities generally, not in this situation specifically, can have resources that they normally wouldnt have. Ms. Arias that might be helpful and we can follow up and send that you information and talk to your staff about whats available and things we have supported generally that may come to bear for covid19 as well. Mrs. Bustos wed appreciate that. Anybody else . Have anything else to offer . Ok. Something else that weve heard from nearly everybody that weve contacted as far as Health Providers is thes remain operators, latex s remain pir aters, latex gloves, the shields they all express a need for more of this equipment. I dont think anybodys asked this yet, but the plan to make sure that this protective gear is out there for our Health Care Providers. Dr. Redfield thank you for the question. This really is the Important Role im sure youll have a hearing here or there, for aspr, to really look they manage the stockpile. I will say that the Interagency Group has done critical analysis of all the Different Things we need. Masks, protective gear, i know the Vice President went out at 3 00 a. M. The other day to visit them with mask and tried to see theyre making about 35 Million Masks a day. But unfortunately only four million of those are for medical use. About 31 million are for industrial use. Youll probably hear more about that because i think aspr and others will be coming up with a plan to try to see how maybe some of that could be modulated. But its an aspr issue and we can make sure they get in touch with you so they answer that question. Mrs. Bustos that will be great. Thank you very much. I yield back. Ms. Delauro congresswoman watson coleman. Mrs. Watson coleman thank you for the information youre sharing. I associate myself with all of my colleagues who say were not cutting your budget any way, shape or form. I do have some questions. Do you have any idea how many people have been tested . Dr. Redfield [indiscernible] i have an idea. Ere now [indiscernible] to collect the data. We are going to put it out every day, as i mentioned, to congressman pocan. Mrs. Watson coleman can you tell me how many . Dr. Redfield as of yesterday, 4,856. From Public Health labs only. So that doesnt include the Clinical Labs, that doesnt include the private labs. Were trying to get it all together so youll have a single point and that surveillance should be out soon. Mrs. Watson coleman do the individuals who get their tests at the private labs still have to have the diagnose confirmed by the diagnoses i confirmed by the c. D. C. . Dr. Redfield if their lab is not independently approved by the f. D. A. , we do still do a confirmation of those state labs. So the Clinical Labs have been reporting their test as is. Mrs. Watson coleman i have a new jerseyspecific question. Fortunately we only have i think 10 is the number today. Presumptive cases. But there are six people with presumptive positive cases that have yet to be tested by the c. D. C. Preliminary, whatever it does, this is a rapidly evolving situation. But can you confirm with us why there has been a delay in the confirmation from the c. D. C. On these six cases . Our staff had checked and c. D. C. Staff confirmed that theres not currently any delay due to volume on previous media calls. , it takes about a day to ship tests to c. D. C. And then we have confirmation within 48 hours. She also said the c. D. C. Does have a secondary test for Quality Control measures. Why is it now taking more than one week for verification . Why is it why do we have this delay as it relates to the six presumptive cases in new jersey . Dr. Redfield ill have to look into that. If theyve confirmed in new jersey, and i have that theres 11 confirmed cases in new jersey, as of now, theyre considered a case. Then we follow up and confirm it. Mrs. Watson coleman do they know what . Dr. Redfield yes. Mrs. Watson coleman ok. Because i got the impression that theyre still waiting for confirmation. Which suggests to me that they dont necessarily know that. Dr. Redfield well clarify it for sure and well get back to you so you know exactly what the reality is. Mrs. Watson coleman ok. Dr. Redfield thank you. Mrs. Watson coleman i have a question about what happens if you are confirmed to have this virus and youre in a hospital, youre whatever. Right . Youre in the hospital. What is the treatment . Dr. Redfield thats very important for everyone to hear this. Very clearly. A majority of people who get infected with this virus, particularly those that round the age of 60, age of 60, are quite relatively healthy, and they would go to home isolation. Wed ask them to restrict their movements, stay at home for 14 days. Mrs. Watson coleman and do what . Dr. Redfield do everything they can to not infect anybody else that lives around them. Mrs. Watson coleman theres nothing they can do . Dr. Redfield theres nothing they need to do other than what we used to say when i was a doctor, you know, rest, drink a lot of fluids, take orange juice. Please, please, please honor the home isolation. But i will tell you, for people that are very sick, and we have a number that are very sick, there is an experimental drug thats available right now in compassionate use. This countrys used it, a number of people in the state of washington have been treated with it. And there is clinical protocols going on by tony fauci and n. I. H. Comparing that to placebo both here and overseas in asia. Were going to know probably by april whether that drug works or not. And thats important because thats a drug that can save lives. Works. Orks. Mrs. Watson coleman should we expect the c. D. C. To not confirm state health lab results . Dr. Redfield i think were oving in that direction. Mrs. Watson coleman why is that . Isnt that primarily you what all do in this situation . Dr. Redfield whats going to happen is a number of these laboratories are going to come out with their own Regulatory Approval to do the test. Right now mrs. Watson coleman are we going to ensure all states have the same sort of standards . Were apples to apple across this country, not apples to oranges and peaches and pears. Dr. Redfield we put out our standards for the Public Health labs. Each state has their own. But we do put out our standards. Right now all the state labs are working under our emergency use ion or our emergency authority. We are in the process of getting each state, each lab to get their own with the f. D. A. And thats ongoing. Mrs. Watson coleman thank you. I yield back. Thank you, madam chair. Ms. Delauro congresswoman clarke. Mr. Clarke thank you, madam chair, and thank you all for eing here today ms. Clark thank you, madam chair, and thank you all for being here. I think the lack of testing that was done has hastened our move out of containment phase, into mitigation. Would you say thats true across the country . Dr. Redfield i would say, congresswoman, that i think one of the biggest drivers of what were going through right now is the movement of this outbreak risk from travel from china to travel from europe. And individuals are coming back from europe and theyre seeding communities. Well have to determine and well know quickly is that driving it or how much was their Community Transmission before that wasnt recognized because of less testing . Well figure out that answer because were going back and looking at, lets say blood samples, we can go back a month ago and do surveillance and see what was there but ill say my own personal opinion right now, the new cases that were seeing in the United States are probably disproportionately driven from people that have returned from europe and then gotten into a community and then weve seen secondary cases. And tertiary cases. Thats my own personal opinion. I wont die on my sword on it. Im open to the data to show us that is not true, there is more transmission we missed. Ms. Clark we want to make sure we remain datadriven. I appreciate that. As we look at whats happening i think well continue to see totals doubling and more of a move to broad scale, you know, actions that we need to take to, to mitigate this because our testing is behind where the virus and infection rates really are. Are you how are you working with sort of the front lines on this, which is going to be our local Public Health officials, managed by the state and hopefully supported by the federal government . How are you working with them to, to give opinions on large scale gatherings . Should they be cancelled . Is there a role for the cdc in that sort of work . Dr. Redfield thank you very much for that. We initially deployed teams into california and to seattle to work in the last several weeks just on this issue. Ill tell you today, Vice President s office will be releasing a Mitigation Strategy for all states and territories in this country. Guidance that weve worked on for the last couple of weeks. Ms. Clark can you give me any preview . Dr. Redfield its a framework for each of the states to look at a number of different areas and we put into low risk, moderate risk and highrisk and different examples of what they need to do. Ill be reaching out directly to massachusetts in light of the recent cases that theyve had. They now basically are the top five. Last night we had a long call with the top leaders of the top four and we asked them to take this template and edit it carefully. Carefully. Theyre supposed to have it completed by 12 00. We want them to fill it out specifically with the questions you just asked. What will they do about the mariners game . What will they do about the schools . All of that is in play so we give them a framework and have a couple of groups that have been dealing with sustained Community Transmission in the last four weeks say how they will do this. Because i do think this is critical. We are 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 and see if they want to engage directly with cdc. We sent people to new york, to seattle and to california and florida to help them and i think massachusetts is the next one that the Health Department wants assistance. Ms. Clark are you making recommendations that people dont have gatherings over 100 people, have you set that sort of criteria . Dr. Redfield were currently working in partnership with the current state Health Departments to come up with what we believe is an effective Mitigation Strategy. Ms. Clark is that part of what the Vice President will be releasing . Dr. Redfield he will release the framework. Well tell them how to do this. Then well be follow up with the specific jurisdictions like i did last night and the day before, actually for the last couple of weeks to work in partnership to see how they operationalize that framework. They will all be different but were very involved. Rather than cdc give a blanket recommendation since this is community by community, were working with the local Health Departments head on to come up with an, obviously expressing our Technical Assistance and recommendation. Ms. Clark im almost out of time and i dont want you to interpret this as a flip but is there anything in those question but is there anything in those, recommendations that say sort of structural barriers at our borders would be of any use in mitigating the outbreak of this virus . Dr. Redfield not that ive seen. Ms. Clark thank you. Ms. Delauro thank you. Doctor, i have a couple of quick questions for you and i want to get a another question in. This is about Public Health data. And i think what we heard here this morning is that the coronavirus outbreak for it confirms the need for modernizing our Public Health system. I understand you worked directly on the Public Health Data Initiative. Let me ask you a couple of questions. If the Data Initiative had been implemented over the last five years and cdc had a modernized Public Health data system, how would the current Public Health response be different . Houry ms. Arias so in the spirit of conjecture, it would have been different in two ways. Possibly. One is that we would hatch detected it much, much sooner and been able to contain it further and more effectively. The other is even before detecting, depending on relying on different sours of data which we do not now and want to do more of and analyzing that information we could start , seeing there might have been a problem even before getting scared about the number of cases that were being detected. Its both detection and very quick prediction. Ms. Delauro are there examples of things you cant do right now but what cant you do right now . Ms. Arias what we cant do right now is twofold, and they are related. One is the delay in finding out what actually is happening. A lot of it has to do with unfortunate barriers that the current systems have with getting that information from Health Care Providers, getting it from states, that we can use then to engage in that response earlier. Ms. Delauro in that regard what we did was to provide in the supplemental to improve surveillance and reporting. Are cdcs Public Health systems up to the task of handling all the data coming from state and local jurisdictions in such an emergency . And i make the reference to the number that you gave us, dr. Redfield. Ms. Delauro not 100 . Not what we know is possible. 75. The initiative would get to us 100. Not only get to 100 but allow us to maintain that over time. The difficulty were running into is that methods are changing significantly faster than they ever have been. Tools are showing up faster than they ever have been. If we cant keep up with that then well fall back even more. If we talk five years from now and dont make those changes, it might be 50 instead of 75 . Dr. Redfield its fundamentally critical every state and territory has that capacity too. Ms. Delauro yes. We heard from the them and we talked about Electronic Medical records. They were talking about fax l worksheets exce data entry and et cetera which , holds up the process. Making your point, we need to invest in this effort. First time in 20 years, 2020 appropriation included funding for cdc firearm injury and mortality Prevention Research. Enthusiastic enthusiasm for this. Dr. Houry cdc really appreciates the appropriation and we have moved very quickly on this funding. February 21, we issued our first funding announcement for our ro 1 grants. We had an informational call for potential applicants yesterday. Record number for interested applicants. Letter of intent are due next week and we hope toish issue these grants by september to look at areas like mass violence. How are some prevented and why are others not . Selfdefense use of firearms. When is it used against a person or helps in a crime. School programs. Are they effective in preventing firearms violence. Safe storage. What are the best circumstances for it . Are there any applicants looking at homicides versus suicide . Dr. Houry so we dont know yet. Our hope is we get a wide variety of applicants. We have really decimated this information to a Diverse Group of stakeholders. Its important. We appreciate the suicide funding as well to look at primary prevention. And Community Interventions for that as well. Ms. Delauro let me yield my colleague. Mr. Cole madam chair, you anticipated one of my questions that i had for the doctor on the importance of Health Care Information which weve all mentioned one way or another. Could you work our committee we obviously have a very substantial supplemental that we hope will be helpful in this area. You mentioned that what you requested might get you to 100 of what you need. What we also need is a look forward, as you mentioned yourself. And i know you cant estimate every new piece of technology that will come along or what might be useful. When you think through these things you really have to have a multiyear plan even though we only budget one year at a time. It really helps if you can tell us particularly on technology because we tend to invest once , and the speed of change is much faster than we usually anticipate and so you end up , with equipment thats out of date pretty quickly if we dont have at least some way of thinking proactively about what you might need Going Forward. Dr. Houry thank you for that invitation. We are working on a longterm plan and were building as we go along the way. Part of that plan is doing what weve not done before and thats working with the private sector where those advances are showing , up and introducing them into Public Health before than what were doing now so we dont fall behind. I dont ask you to make a judgment here. We have the system we have. I am struck by how states and localities are dependent on cdc. Again i want a robust partnership. I dont want people to think that there is not a role here for states to actually step up and do a little bit more and the locale needs to do more. In my own state lack of investment is here so im not throwing stones at anybody else. When youre providing 60 of the Health Care Budget or Public Health budget for state and , state and local, thats something we ought to be worried about as oklahomans and not being waiting around for equipment and advice. We need to do more across the board, dont we . Dr. Redfield yes. I agree with you. I want to add because, you know, were all impacted by the degree of preparedness of any state. So if we have one state underprepared, were all underprepared. I would have loved and state of new york is great, they have a great lab. They stepped up. They got their lab tests going up. Not just cdc, its at the state level, cdc and state developed their own. I would like all the jurisdictions to be able to bring up their own tests. We could have a race who gets the test quick. It goes back to that core investment in Public Health. Mr. Cole a point well made. Let me ask you this and, again, i want to be careful for two reasons. Ask you two related questions. The first one does relate to china. I recognize the delicacy of your position. We have got work with china. This wasnt the best result but better than what weve seen in the past. But hopefully theres some candid discussion going on with them. Not letting our folks in as rapidly as they should have. I think we could have been helpful to them and certainly would have been helpful to us. And this kind of closed system does invite one in five people on the planet live there and they just cant im glad its coming down where they are at but going up every where else. More Rapid Response from them would have made a big difference to every other place in the world. They have a special responsibility. They are a superpower. They have world class science and they have, you know, very capable people. So i would just what are you doing to invite them to sort of integrate themselves more fully into the world Health Organization . Dr. Redfield you know, congressman, weve had more than 30 Year Cooperative relationship and the reason it is called cdc china, it was built by cdc america. I actually have a small group of individuals in cdc china and youll see in my Global Health footprint plan, expanding that is part of it at least in china. We did offer directly to provide amplified assistance to the outbreak in early january. Our cdc colleague, my counterpart, actually requested that. It had to go up through higher channels and that was not done until the who did the report where we did have one cdc individual and one nih individual from the United States on it. But we do believe we could have been helpful early on and helped us in our own policy decision. Mr. Cole exactly. And ill just make this plea and im out of time here, this isnt directed at you or your counterparts because i suspect they wanted to do it. This is a discussion that needs to happen between our political leaders and their political leaders. It is an area that with we should be able to cooperate with one another and help the overall relationship. So i just hope it is on the radar screen of our state department and our president as well, they need to have this kind of conversation privately. Were not trying to embarrass our friends or anything else, but they are a big part of the solution or the big part of the problems. They could choose to be one or the other. I know all of you have urged your counterparts to do that and i suspect they want to do that. Theyre professionals and dedicate their lives to defending people just like you do. This is one where the political leaders need to get involved for the good of all. That was my sermon. Ms. Delauro take it to heart. Congresswoman. Mr. Lowey thank you very much. The vaping epidemic as we know is a Public Health crisis that must be met with every level of government. Thats why the cdc office on smoking and health is so crucial and why congress provided an increase of 20 million in the fy20 bills so all levels of government could have the resources could combat vaping before we lose the generation of children to the harms of nicotine addition. Last years vapingrelated respiratory illness resulted in at least 64 deaths, nearly 3,000 hospitalizations. Notwe know that many, if all of the cases were attributed to vitamin e acetate. Why cant the cdc say with certainty what caused these illnesses, and do you consider vaping regardless of the existence of vitamin e as a risk to Public Health, and my key question, are you concerned athat compromised lung health could exacerbate risks for those who contact coronavirus . Dr. Redfield first, the last question is yes. The first thing i like you learned about this from my grandson who told me i was a cdc director and i needed to stop it because he has a brother with cystic fibrosis. I would like ileana tell you more and answer anything she doesnt clarify. Thank you for the question. Anything that could go into a lung through vaping or anything else is a concern. Vitamin e acetate is a concern and that may go away but other things are going to take its place. One thing that is very important is to make sure that although the response has been the activation for the response has ended, but the activities and the the surveillance activities looking at symptoms people are presenting in emergency room departments and what is it that they are using in the substances that may be related to that. For like we were talking about before, to catch it before it gets to point where we were with vitamin e acetate. So that is continuing. In addition to that, were continuing to work on making sure that we understand how it , how theyescents think about the substances which is different than what the sure thatnk and make we reach out to them and make them understand what the choices are that they are making and help them to make more healthy choices so that not only continuing the progress that we made with adolescents on combustible tobacco but replicate that with vaping as well. Mr. Lowey but you know it is not working. Campuses to college with my own grandkids, and i met with the president and said what are you doing . Said, ir. Redfield learned about it from a grandchild who told me before she was in college, must have been 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 we know it could be connected with coronavirus, maybe that will shake them up . Dr. Redfield this is a very important priority for us and dr. Arias and the team is a Bigger Picture of adolescent nicotine addiction. When the decision was to take flavored products off, menthol was not taken off at that point in time, and were tracking very carefully to see if now underage are shifting and were going to really be seeing the data. We have a commitment. If we have evidence that adolescents are shifting to mental, we will put that up for reaction from the fda. But my biggest concern was mine were in middle school and telling me 50 of the class was using ecigarettes on a regular basis. Well, let me, since i well, lei have 46 seconds left, you know it, i know it, our grand kid our grandkids know it, and so far theyve been reporting rather than talk about the impact themselves. Theyre reporting what is happening to their friends. Are we making any progress . Is anything were doing working . Theyre reporting what is i hear the statistics are the same whether it is in junior high or now in college. Theyre all vaping. Dr. Redfield everywhere in the country, man or women, it is all the same. Mr. Lowey so what are we doing . Anything . Dr. Arias so it is increasing. And as you know when things are increasing it is hard to start , turning them around an it is going to be a while before that starts to happen. However what we are doing is focusing on things that happen effective in terms of communicating and how adolescents understand the communications and in order to understand dont just look at the pretty colors on the package, which they respond to, think about what is in side of the package, even if the packaging doesnt change. And there is what other sister agencies are doing in terms of regulation that will make it a little bit easier to sort of control the environment so that they basically are protected from that side as well. But a lot has to do with finding out why theyre using it and how they are using it and how it is that we could get them to stop. We showed progress. I am sorry. Mr. Lowey i would like to pursue this madam chair, because , were talking about it, everyone is concerned, youre concerned and im concerned but we have failed and we havent done anything. Were trying to do something but were not successful. Ms. Delauro ban it. Congresswoman. Ms. Roybalallard the fy20 final appropriation included 10 million for the first ever dedicated funding for Suicide Prevention at the cdc. And as you know, there are unique populations that are at higher risk for suicide such as latino adolescents and veterans and nurses. Im cochair of the maternity caucus with long what my colleague Jaime Herrera butler and in recent statistics indicates suicide may be a contributor to the high incidents of Maternal Mortality in this country. Can you speak to the connection between postpartum depression and suicide ideology and tell us what efforts your agency to doing to track and address this problem. Dr. Arias certainly i can start and turn it over to my panel to add to it. Suicide, thato milliondollar appropriation, the to milliondollar appropriation, were going to Fund Applicants to look at data within their communities to identify who are the most vulnerable and what communications have the highest risk rates and then work with them to focus effective intervention on those areas. So it might be rural populations, it might be veterans, to your point it might be young mothers. And to then really look at the evidencebased Community Level strategies to drive that. With regards to Maternal Mortality in suicide, i believe it is about 6 of maternal deaths that are due to suicide. We do see the increased age of suicide death, but we are focused on primary Convention Primary prevention of suicide deaths, things like making sure that there is good programs in schools around social Emotional Learning and improving connectedness and if those are at risk for suicide, make sure they are linked to care. Our vital signs found that more than 50 of people who died by suicide did not have a Mental Health diagnosis. Ms. Roybalallard are you coordinating with other agencies on this problem such as sensa and of the Veterans Administration . Dr. Houry very much so. We have been working closely with the v. A. And veterans organizations to look at things why are some veterans not accessing v. A. Look at what they can do more in the community and work closely with sampsaw and talked about the medical packaging done at cdc to help cities implement those strategies. Dr. Arias,allard over the last two decades weve seen significant gains in the Life Expectancy for those living in spina bifida. This creates new challenges because when young adults age of pediatric care and the National Spina Bifida registry, there is no system in place to follow care for them. The cdc program has been flat funded at 6 million for the last six years and it currently down two staff members. Do you have concerns that progress and investigation into critical lifesaving issues such as the cause of sudden death in midlife and prevention of sepsis related morbidity are possible within the current staffing structure . Dr. Arias were 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. So right now it has been very limited in the kinds of things that can be done. It is not just true of spina bifida, it is true such as alzheimers and multiple sclerosis and other things that have been difficult for us to make as much of an impact as we think we can because the resourcing has not been there. We have had to work with what we have. A lot of that means measuring it and getting information to the extent that we can about prevention but in most cases sort of managing. And then a lot of information , which is were getting more requests now for dealing with the Caregiving Community in each of those situations. Ms. Roybalallard what funding level would you need to ensure that the National Spina Bifida Program Covers the life span of those living with a disability and what are your plans to track people as they age out of the pediatric system . Dr. Arias so we have been working on a plan sort of looking for areas that we need to go and we could get information to you about what that plan would look like and what would be necessary in order to support the implementation. Ms. Roybalallard thank you. Ms. Delauro congresswoman frankel. Ms. Frankel thank you again for being here. You would agree this is not a time to cut any of our Global Health budget . Dr. Redfield as i said, i think one of the most important things we need to do is build a robust longterm foundation of Global Health. I think cdc is the tip of spear and i think this is a time to get that foundation built. Ms. Frankel so the answer is yes. We should not cut or no we shouldnt cut or the answer is, yes, we shouldnt cut the Global Health budget. Are there enough i dont know if i could ask it this, but are there enough masks for First Responders and Health Care Workers and if not where do we get them . Dr. Redfield again, this is something that asper is in charge of looking through and in making those calculations. So we could get back to you but i refer to that asper. Ms. Frankel i have a couple of practical questions. My mom is older than me. Thats obvious, ok. [laughter] ms. Frankel shes healthy, knock on wood. She was supposed to go to the doctor for a checkup and shes afraid and said im not going to go for a checkup, there could be a room of sick people. Of course it is a room of sick people. What do you say to that . Dr. Redfield i think your mother has a lot of wisdom. [laughter] ms. Frankel ok. I always thought that. Dr. Redfield unless she has a requirement she has to get done right now, were trying to get the elderly and vulnerable to just step back and try to avoid being in crowded places, avoid travel. This is with where we are right now. Ms. Frankel got another practical question. So were told to wash our hands and all of that. Dont touch our face. People are coming in contact , even ourselves with our clothing, with our furniture, and all of that is is it spread that way . Dr. Redfield congresswoman, that is a very important question. This virus clearly can live in the Environmental Services for some period of time. With the ship in japan, very aggressive studies are being done to see how much virus they find on railings and different places. Finding the virus doesnt mean it is infectious, but we can detect this virus for a prolonged period of time in and the role we call fomite transmission and that is why it is important as you put your hand on the handrail as you walk down, you need to wash your hands after that. Ms. Frankel and you touch the handrail and then touch your clothing but you can wash your hands but you cant wash your clothing. Dr. Redfield it is probably more touching the rail and putting the hand to your face. Ms. Frankel ok. All right. So is the information coming from the world Health Organization reliable . Dr. Redfield i would continue to say the world Health Organization is a very wellrespected Public Health organization. Ms. Frankel so as of right now, can anyone go to the doctor and get tested for coronavirus or we still have a delay in having enough tests for that . Dr. Redfield as of yesterday well i dont remember what today is. Is today monday . Tuesday. Ok. As of monday, quest labs and lab corp labs have made this test available. They have in Doctors Office. When you go to the doctor and get your blood drawn, it is not done there it is done by lab , corp or quest and now that same thing could happen if your doctor wants to order a coronavirus test. Ms. Frankel and i want to just go back to this is another common sense question, though. It seems to me that some of the reasons i mean, not shaking hands, washing hands, selfquarantine is not just about not getting the coronavirus. Well it is about that, but the fact is we dont want everyone to get it at the same time because we cant take the stress on the Health Care System or the stress on the economy, is that right . Dr. Redfield yes. And we dont want them to get it at the the same time they are getting flu. Unfortunately this virus is very right . Similar in the sense that it is a respiratory virus. So if you look at Hospital Capacity right now much of it is full, up to 96 , 98 . We dont have a lot of resilience in the capacity of our Health Care System. In the capacity of our Health Care System. Ms. Frankel are there test shortages in any other part of the world . Dr. Redfield i dont know exactly. But i can tell you obviously in areas like subsaharan africa, they have been spared right now and the reason for that is unclear. If it is seasonal well have challenges. And you asked me medical interventions before. The one medical intervention you need if you go to the hospital is oxygen. There are many Health Systems that dont have the capacity to deliver Health Oxygen to their people. Is that in this country . Dr. Redfield in other countries. Ms. Frankel thank you. Yield back. Ms. Delauro congresswoman lee. Thank you very much. I apologize. I had to step out to another committee. So if this is redundant, ill ask what the answer was in terms of pandemic versus epidemic, has anyone asked that question and where are we in terms of describing this emergency. Dr. Redfield i said it is really the the word is not that important. This is a major global outbreak. But the who is usually the organization that formally declareses something a pandemic. But clearly this is a wide scale global outbreak. Ms. Lee let me ask you about sickle cell, the sickle cell trait. It is been estimated by cdc that over 4 million americans have the sickle cell trait and the incidents of sickle cell trait 7 . Creening was over ive been trying to get to the bottom of this for years, is there protocol for learning families or Health Care Providers to the presence of sickle cell trait and informing them about the potential outcomes that might be associated with with the trait or counseling about the impact that trait status might have on familys future reproductive decisionmaking . I ask this because once a child is tested at birth, by the time theyre 18 or 19, who knows if they know or not whether they have the trait. And i have personal examples of that with regard to the the a1con between test. If you dont know you have the trait, the doctors are not required to test if you are from the specific target population. So how in the world do we deal with this . Because it is really a problem. Dr. Arias we could send you information about the Sickle Cell Program at cdc. A lot of that work is done in conjunction with and in partnership with providers and with the Health Care Community to make sure that they get that information to families and point out resources that are available to them. Point out resources that are available to them. Dr. Redfield and you could see that as we operationalize this data modernization for the whole nation, we could have data that could be in the system that the Public Health system nation could have access to. Ms. Lee but why when an adult gets a blood test, if this adult is of a specific population, why isnt part of that panel a test for sickle cell trait . I mean, if i have the trait at birth, at 20 if im getting married, or at 25, there is an issue there. I dont even know i have it. Dr. Arias sure. I could get back to you and find the systemic things that stand out the systemic things that stand in the way of that happening. A lot of it i would imagine has to do with the fact that it is known at birth and at assumption and the assumption being that is known to the individual and there is no point, but youre right ms. Lee if it is known at birth how do i know at 18 or 20 or 30 that i have the sickle cell trait . Dr. Arias the assumption is that if it is part of the back the birth record that you , have it. Ms. Lee there is nobody in this country, i guarantee you, who is an africanamerican who knows that they have the sickle cell trait based on birth record. Dr. Redfield well definitely get back to you. It is something we need to address. Ms. Lee thank you very much. Now, going back to the Reach Program and the issue of Health Disparities which my friend the congressman raised in terms of the budget. The Reach Program is a Critical Program in eliminating racial and ethnic disparities and its been eliminated from the budget. I heard a response about how youre going to make some moves with the cdc. But with this budget eliminating it, being eliminated in the president s budget, i dont think you could compensate for addressing racial and Health Disparities. You indicated some kind of move into the aspects of the program around to address this in terms of not disease specific but community specific or whatever. But this is unacceptable. When you look at people of color, you look at the native American Community and every community in this country that exhibits Health Disparities based on race or ethnicity, the elevated g program being eliminated is to me unethical, in terms of health and medical standards, and its a shame. So are you all weighing in on this . Is cdc saying this is not a Good Health Care decision to make . Public policy decision . Dr. Redfield i think you all know that were constrained right now in this environment. That is why i put focus encore focus on core capability. It will help all programs. All programs including the Health Disparities program by building this Public Health capacity. I do believe that block grant flexibility will give local communities to be able to invest the money they want, but were not turning our eyes off to the Health Disparities of the nation , and well continue to try to navigate how we can continue to address those. Again, im going to come back , ive done it multiple times. I think the core capability beyond cdc and to all of the Public Health structures that we have at state and local, tribal and territorial that gives enormous ability to function on multiple areas including Health Disparities. Ms. Lee thank you for that response. Unless directed by the federal government with some major protocols in place, with some Major Research in place, with some Major Investments by our government in terms of the Reach Program, were going to be set back. Thank you, dr. Redfield. Dr. Redfield thanks. Ms. Delauro thank you. I have an additional question 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 with hiv and other Infectious Diseases . What resources are available to support diagnosis and clinical care, and can this be scaled up with other partners . Is cdc able to send Health Specialists to support the africa cdc and its Regional Collaborating Centers . We provided 600 million in the past in the supplemental, we included 300 million for Global Health. If you could just answer those three questions. Dr. Redfield thank you very much, chairwoman. You clearly hit on one of the real concerns in subsaharan africa. In general, how immune compromised will react to the virus. One would predict it would be more likely to cause more severe illness. And in africa that obviously causes the other problem because more severe illness needs greater likelihood of dependency on oxygen. And many of the nations dont have that capacity to the degree they may need it. We have from the beginning, as you know, because of the pep far program, cdc has Country Offices all through subsaharan africa. Providing Technical Assistance to counterpoints counterparts in the country spewed the director of cdc africa is a cdc colleague gone on loan to hes now hired by the African Union and one of the best. We have helped him building Testing Capacity and there is Testing Capacity in west africa and in the african cdc in south africa. But africa is a great vulnerability. It is one of my biggest concerns on a global scale because if this virus gets into africa like it is into italy, there is going to be a lot of casualties. Ms. Delauro let me yield to the Ranking Member. Mr. Cole thank you. Obviously weve talked a great deal about coronavirus and health care and security and ill get to that in my close and i want to shift to another area. When i am home, i hear more about Drug Overdose deaths, more families and more people affected. Obviously i suspect the death toll this year will be worse than anything we see in coronavirus. It is just year in and year out. Finally last year we saw it come down a little bit. First time in 28 years. Congratulations for some of the great work at cdc to help us in that area. So Going Forward, what can we do and where do you need additional help . Ive seen different it is not always opioids. There are different substances that seem to be more common, even so. Give us some idea of the continuing problem and what we ought to be doing as a congress to try and provide the resources to help our fellow americans in this area. Dr. Houry absolutely. And thank you for that question. What i would say is the resources that we have received from congress have really helped us build that infrastructure. We are now able to collect syndrome Surveillance Data and with our current grant we added in a category to look at meth and other psychostimulants. Because we didnt want to be three years later when our grant is over saying what is going on with the trends. So were able to really pick up that in more realtime. We also realize that linkage to care is important and weve built that into current programs as well. In addition to what we can do to help provide for Health Providers. In the last 15 years i worked in the county er and watched this of all. Thats one of the reasons i came to cdc because i knew it wasnt , about the individual patient but what we could do at the population level. I still work in a clinic once a month to see the integration cdc integration of cdc successes that were doing like with Electronic Health records. Were now seeing that surge of methamphetamine and other substances. What i think is important is not to lose sight of how we got here. We need to look at the whole range. We are starting to see a decrease in high risk prescribing, but still many people that go on to other drugs got started with prescription opioids. Many patients in clinic are wrestling with cocaine use and heroin, and we can treat that. So having that linkage is crucially important. And then looking at vulnerable populations like tribes spewed were working closer to give direct funding to tribes and groups at Cherokee Nation in utah have integrated problems to identify the highrisk patients and link them to care to prevent them from having overdoses. Dr. Redfield i want to add one point. I think it is important to aggressively engage in innovation here. This is a chronic recurrent medical disease. It should engender the same aggressive research that were getting to get new cures for cancer or heart disease. This is going to be a medical disorder that will have effective therapies. We have them now that are a little bit for opioids. But we really need to have effective therapies to recognize this is the disease that it is. This is not a behavioral choice. This is a medical condition that needs that innovation, that medical research. The private sector has to get engaged to develop the same passion for cancer cures that for addiction cures. Dr. Houry as we look at the misuse in the first place and primary prevention such as the funding for Adverse Childhood Experiences and childhood trauma , it could lead to suicide and overdose deaths. So looking at that linkage in the whole spectrum is key. Mr. Cole thank you very much. You want me to close . Ok. Well first of all, thank you. This exchange is a splendid example of why we admire you so much because of your commitment to our fellow americans and all of humanity in the search for cures and defending people and therapies. Noblean extraordinarily profession youre engaged in. We appreciate what you do. And i hope we made it clear, not to you, but to the powers that be that we intend to continue to make these investments on a bipartisan basis. And i will just say to my friends, and they are my friends at omb, and i mean this with no disrespect, when somebody in Congress Tells you on a bipartisan basis were going to spend money in these areas, you can either help us figure it out by letting your people to work with us to where does the money make the most difference or not. But we will do it anyway. So it is just much better. And again ive had that discussion when i was chairman. Im sure the chair has had that discussion as well. This is something that congress decided to do, and decided to do it in a substantial way over multiple agencies, nih, cdc, strategic stockpile, mechanisms to get into the fight as quickly as you possibly can for all of our benefit. We all agree, i agree very much with my chairman, this isnt a republican or democrat thing at all. And weve just made that collective decision. It is not triggered by this particular event. As a matter of fact this event is vindication of the bipartisan judgment over the last several years that this was an area with areas we needed to make investments and we want to work , with our best people that with we think are in these agencies in a very collaborate way. So that we dont make mistakes. So thats not your requirement is to do what you all do, and that is to defend the president ial budget but i would submit for the record that administrations would be a lot better off had they listened to up several years ago in this area and we would all collectively be better off and i hope we all learn a lesson from that. There are some things to have a sharp pencil about and a very kenai, and look, and a very keen eye, and look, im a conservative republican. There are other areas that with where you need a substantial Public Investment to protect the American People. I think this is this area probably more than any other single one, although there is certainly a range of activities that were involved in. But here youre literally talking about the health and well being of people in a very individual way. In a very immediate way. In a way that could come out of nowhere when you least expect it , as Something Like this has happened. So i think it is sort of the collective of wisdom of congress over many years again, congress has doubled this nih budget. In these meetings, you learn a lot. Ive had the opportunity to go down and visit cdc and i learned a lot. As a chairman i learned a lot just sitting down and talking to the people and getting an idea of the range of capabilities. And i think we all reflect that over time. So i want to thank the chairman for the hearing, first one shes had since 2016 and very timely, madam chair. But more importantly, i just want to thank my chair for the bipartisan commitment here. Because this is not something that is likely to go away. And i think that is something, again, i hope the executive branch realizes over time regardless of who is there. This is a kind of enduring commitment. And so there is no sense sending us a budget that cuts things that were not going to cut and doesnt work with us in areas where we want to make investments but recognize that you have enormous expertise at your institution that we ought to be listening to as we fashion what those investments are going to go be. So we look forward to working with you and continuing this. I wish you very good luck. All of us very good luck in dealing with with coronavirus. Right now i suspect things get worse before they get better in this area. But at some point they will get better, and at some point we will turn the corner but i hope , the Lessons Learned here are enduring. I have no doubt they will be for this subcommittee because they have been. But i hope they are for the American People as well. We take a lot of things for granted around here. These are investments that matter. These are investments that if not made for years ahead of time cant be parachuted in at last minute, and we cant make the difference without a sustained plan for investing in what each and everyone of you do. And madam chair youve had that , commitment for your entire career. I appreciate that. We are very fortunate to be led by you at this particular time. Yield back. Ms. Delauro i thank the unfortunate why we have been able to produce i think quite remarkable labor hhs bills over the last several years. There is a compatibility here that i think at the outset would say, it is not going to work. But because of the competence and professionalism and deep compassion and caring and the values of the Ranking Member and our ability to Work Together, yes, there are differences, but those differences dont cloud the goals and the challenges that we see. And you know, it has been in the past history of this country that members on both sides of the aisle that crafted the responses to the serious challenges that weve had, they were not naive, but they understood that the challenges were that great, that wherever you come from, that our obligation and our responsibility is to see that we address this issue. And that is the kind of cooperative relationship that i find on this committee with my Ranking Member, and i think it is true with the subcommittee as well. So i thank you for being here. Very much to all of you. There are a couple of things. I did look up pep far, which is critically important, and that is been cut by half. We will address that issue as well. On the vaping issue, dr. Arias, the fact of the matter is that ecigarettes never had an fda approval, which is why i made my comment on ban until we know. I want to go on science. Thats stop it until we figure out whether or not and who where we go forward. I would just ask you, dr. Redfield, because you talked about the masks and i say this to the Ranking Member, what i heard yesterday was that, yes, 3m, it is 35 million and it is 4 million in terms of the hospitals or Public Health workers. 31 million is for the commercial sector. But it is only 4 million because that is all the insurance that 3m has. And without some notion of indemnification, we need the strength of the administration to say get more insurance and lets move forward with what we need for the Public Health. And thats something that im asking to do. At 4 wrong to stop million, because we cant get there. And there is no answer to this. But i dont know for the life of me who was monitoring the self monitors, you know, what they are doing. That is a hard task to if you want to Say Something about that , go ahead and then ill wrap. ,dr. Redfield ill only say one word, because we did this with the Ebola Outbreak a number of years ago. It is just heartening to see the cooperation of the American Public when they understand what were asking them to do. I think about 97 of them did what they were asked to do. Not everybody. But it is heartening to know the American Public, when they understand, that they will, in fact, abide to these clear instructions. Ms. Delauro and, again, thank you very, very much. You heard the concerns of there are serious concerns, we keep asking the questions, we want to make sure that the statement is accurate, that anyone who needs a test gets that test immediately and we allay fears. The crisis is here. We know that. We are all dependent on the strength of our Public Health infrastructure. If we are not strong, you said it, if were not strong in all 50 states, we are not strong. Let us help you with the core capabilities. And i wrote those down. Rapid response, predictive analysis and data modernization, Global Health security, and say and a Public Health workforce that is second to none. We want to do that. And, please, let us know, because you know you have listening ears here, to what you need and we want to get you where this country needs to go during this crisis. Thank you all very much for being here this morning. We bring this hearing to a close. Dr. Redfield thank you very much, chairwoman. [captions Copyright National cable satellite corp. 2020] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] [indistinct conversations] [indistinct conversations] [indistinct conversations] [indistinct conversations] testimony from cfp direct her kathy kraninger. Including the rulemaking seemed supeor