Transcripts For CSPAN2 CDC Director Redfield Testifies On Coronavirus 20240713

It has been several year, march of 2016, since our last hearing on the budget of the nations leading Public Health agency. Before i do a formal welcome and so forth, i want to i was made aware of this issue which is really very, very troubling and that is that the administration has ordered the Immigration Court to immediately remove coronavirus posters and it just says that the Immigration Court staff nationwide have been ordered by the administration to take down coronavirus posters from courtrooms and waiting areas. The executive office for immigration review which falls under the department of justice told all judges and Staff Members in an email monday that all of the coronavirus posters which explain in english and spanish thousand prevent catching and spreading the virus had to be removed immediately. I just want to say that whatever ones view is on any issue that we face in this nation, whatever your personal views are, whatever your ideology is, that we cannot, we cannot in this Public Health crisis play fast and loose with peoples health. No matter what we believe, it is a moral responsibility for us to make sure that everyone is protected. Just came to my attention. Dr. Redfield, we welcome you, to to have you here and your colleagues that are with you, dr. Ileana arias, associate public director for science and horia, nce, dr. Debra dr. Chery berger. I might say, i also want to messienier who isnt here but she did help provide with us a bipartisan briefing we had for the subcommittee in february. Sorry not to see her here as well. In fact before we proceed to c. D. C. s f. Y. 2021 budget request let me start where where well all probably starting today, with covid19. I want to commend the thousands of Public Health experts on the state and federal level who are working so hard to keep us safe during this outbreak. That includes you, dr. Redfield, as well as all of the c. D. C. Staff. We are in a crisis and there are questions about our preparedness and ongoing response effort. 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 what level of investment do we need to train and higher the next generation of Public Health officials . That is one of the critical capabilities and i would like to give back to you more specifics, we were challenge to come up with specific budgetary requirements but it is critical. We have one program my predecessor started which is an important program, young people out of college gave them two years, Public Health Associates Program and put them in the Health Department all across the country that wanted them bend you get young energetic people at the beginning of their career not sure what they want to do and see the gift, what it is to do Public Health. It doesnt necessarily come out that way when you read a career magazine but they practice Public Health and a number of them want to go on to medical school or Public Health school and a number of them working in the cdc today. Expanding those programs to get young people to see the value of a career in Public Health is critically important and obviously to continue to retain the individuals we have. The Public Health associate program is important for the nation. Congressman harris . Thank you, madam chair and thanks for taking time to appear here, you are like a one armed paper hanger. Let me follow up on the Health Security network issue. We have all the Global Health security we want but when china denies the presence of the disease for a month, month and a half, what effect does that have . Bottom line, we know the fatality rate in china is higher than it will never be in the United States. What protections do we have against a bad actor like that . I just think if we have the regional presence of strong teams it will give us more eyes on the ground, nothing will be perfect. This particular outbreak started in a certain area of china. I had direct contact on new years eve or the day after with my counterpart at the chinese cdc. I dont think he was as in the light that he had a problem in early december. I cant really comment how the local Health Department in wuhan and how it was shared. As soon as he knew, i knew. They arrested the physicians, literally 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 we will get into that kind of closed system and somehow affect it, the communist chinese are going to continue that system and we have to live with it. What is interesting is one of the things i hope you do, advocates for the kind of innovation we are going to need on the vaccine front and antiviral friend, your background is biology. This idea that we produce mrn daybased vaccine is phenomenal but is an American Comedy that has not had a profit for ten years and this vaccine works we will owe it to american innovation. Bills like hr 3 will destroy american innovation. How important is the privatesector for this and antivirals and treatment when it comes to these Public Health threats . It is fundamental and critical and i will give you the biggest example, antibiotic resistance. We have a program that looks at surveillance and containment but we are never going to win that. It is a containment strategy. The only way to win it is new innovation. Innovation is fundamental to stay at of antimicrobial resistance, to rapidly respond with what tony faucis group is doing. Innovation has to drive and if we lose innovation we. Our ability to get the advances for antibiotic resistance, they will go aside. We made the point and the cbo agreed there were a dozen diseases we would not be able to develop treatments for if in fact that happened. Let me talk about bringing it back to the testing issue. Something you said that im curious about from a Public Health perspective, quest and lab core are paired up to do this. Could they have geared up sooner . You imply we have to have a parallel track system for Public Health bodies and this other system for private sector which sounds like it was ready to go because there is a profit motive, they are ready to go much quicker. Is that a model we should be looking at in the future . Do Public Private partnership with some of these companies that have the ability to rapidly gearing up to make this available to the Public Health sector . My point i wanted to make clear was cdcs responsibility on the Public Health side. The clinician like yourself, i anticipated the privatesector would have engaged, developing it for the clinical side. Cdc has tried to help because the tests we did develop, asked if they could commercialize it and we said fine by us but i think those decisions on the commercialized section. We have groups that can fill gaps, they promote that, but i can tell you having lived through the last eight weeks i would have loved the privatesector to be fully engaged. We have the wrong agency. Thank you, madam chair. Thank you, thank all of you for being here and thank you for being here and your tremendous leadership. These are challenging times but you have stepped up in so many ways. Let me ask with regard to Hand Sanitizer. I am not sure, i am trying to unpack how we are moving forward on this. One of the Prevention Strategies is to wash hands 20 seconds and if in fact we use Hand Sanitizers, that is part of the directive. Unfortunately you cant find Hand Sanitizer is. The small one i have. I have another one at home so i feel it every day. I have been in three cities in the last we 10 days. Know where can i find Hand Sanitizers. What is going on . How do we make sure hand sanitizes are available . There may or may not be water around. People who dont have a lot of money, vulnerable populations, if they were around they couldnt abide hand sanitizes and healthcare workers and medical professionals on the front lines, what is going on . How do we wrap our hands around it to make sure the directions we received from the federal government can be adhered to . Thank you. It is important we see the shelves. This is a scenario we drive. The Interagency Working Group is looking at a variety of things to figure out what can be done whether it is respiratory masks or medicine or Hand Sanitizer is but i do from the Public Health point of view remind people that 20 seconds of vigorous washing with warm water and soap is going to work. There are people looking to track the supply issue. A lot of people dont have access to warm water and soap and we need to know that. I will make sure it gets back to you. On the grand princess, thank you for your assistance on this Public Health emergency and operations taking place, i think hhs has been in the lead for the governors office. Can you clarify the role cdc has in this entire operation and what do you think in terms of timeframe how long it will last and what have you learned in the last 24 hours . The operational lead, the Mission Leader is the assistant secretary in charge of the response. We provide Technical Assistance and support under his direction to the response. We also are going to provide Technical Assistance and support as these individuals move to housing either travis or lackland or georgia but the operation is under control. Most importantly we make sure control issues are done right. We are the agency that gives the federal court in teen orders . You monitor the Public Health criteria and protocol as relates to the health and safety of the dockworkers and healthcare workers and the community . Where the ship is being docked is in an area where historically we deal with injustices so we want to make sure this is not another one of those instances that we unfortunately we provide Technical Assistance for response and preparedness. Our Technical Assistance is respected in the department but they are ultimately in charge. Who signs off on the health and safety, Public Health and safety . We go back to the assistant secretarys office. Okay. Thank you very much. Thank you for being here. I have a lot of questions. If you could be 6 think that would be great. We had several thousand views in the first hour. We are not cutting your budget. Thats why we brought you here. Are we passed containment . In different areas, we are in containment in certain areas. In general we are in a containment blended mitigation and in some areas in high mitigation. Does that include assistedliving and other Senior Living housing areas . A question people ask . That is a great answer. I want to ask for friday press conference, the president interrupted and said anyone who can get tested can get tested . Is that true . Anyone who needs to get tested . Got your Doctors Office. Can anyone get tested right now anywhere in the country . Through a physician. Is that yes through a physician . You through a physician. You quit keeping track of the cdc website. What you dont you dont know what you dont know, to keep track of those tests. Secretary azar doesnt know how many people were tested. Why are we not keeping track of that and only updating the cdc website three days a week . The World Health Organization does it daily and this is information people want to know. The reporting system includes Public Health labs. People will see all the tests done where they are done. We have a Surveillance System that does that. The answer from yesterday is already old news. Thank you for that. Others said we should be testing, doctor fauci agreed. Anyone with symptoms as well as healthcare personnel. Are we actively proactively testing folks like that and have a policy of proactive testing . We are recommending to physicians that anyone that has a variety of clinical scenarios be tested. How aggressively . We are aggressive. We are proactively, individuals with pneumonia or respiratory illness. It does vary by community where we have significant spread. The recommendations proactively testing. Not necessarily all Healthcare Professionals. If they have exposure in some cases, yes. What about Police Officers . We are seeing as we have seen in washington, that is one of the things about my trip that surprised me how many firefighters were no longer available because they were in 14 day quarantine. It goes with exposure. We have increased awareness how to approach a patient so you dont get exposed. How about a question of the tests going back. Other countries use the World Health Organization test, why did we not use that test if we made that decision . Our test was created as fast as anybodys test in the world. Who doesnt make a test. One of the german universities made a test. It went through regulatory review. Our test was quicker. I would defer that to the fda. I will ask them, thank you very much. Another question. There was an article over the weekend. I dont mean to be rude if im not looking at you. Cdc recommended seniors, not travel and it wasnt part of the White House Task force recommendation. Mike pence said was never a recommendation, the story was fiction. Did the cdc recommend Older Americans not travel . Cdc recommends do they recommend . Not at this point. At that point. Did you recommend to the task force dont know when that was. Over the weekend there was a report that did not say it and cdc recommended it. At what point did cdc recommend that . The last 72 hours we recommended that. I could get back to you with the exact date and time. Dont want to do a freedom of information request but i would love to know when it was recommended by cdc because there is distrust out there and they dont know who to distrust if we are not getting information in this is one where i am trying to convince my inlaws and they have Health Issues. These are the questions we are getting asked. When someone says you are recommending it i would like to know when it was requested. We will get the information for you. Thank you. Is that my time . It went quick. I apologize. I agree with my colleagues about the budget. You said the virus was expansive in italy. Is wrong and inappropriate to call the chinese coronavirus. I assume you would agree with that. Is. China was the first phase. As readily. And all of europe. If you look even just last night if you have a second, over the last 24 hours, 1500 new cases in italy, 1500 in germany. There has been other real misleading statements that are wrong. I read some. Tests have been perfect, this is like coronavirus like the regular flu. Is a hoax and anyone who wants to be tested can be tested, the number of cases will soon be down to 0, they will disappear, you can still go to work and it is okay to shake hands. This is misleading. If you want to correct that i assume you would agree those are misleading statements. Any that is not other than i do believe availability of testing to request and lab core is getting us where we need to be. Are you familiar with the public charge rule . Yes i am. I am concerned it might lead people to not get the care they need. I would concur with you. I have talked to some of your colleagues in the state of washington. We are looking at it to see its Public Health implications. Would you say we were at the beginning, the middle or the end of the Coronavirus Fight in the United States . I cant predict. What percentage of americans will get the coronavirus . It depends how effective our Public Health response is. I want to state we all have a role to play and it is serious when we set to practice washing their hands, coffins the other, try not to touch your face, wont count how many times i did during this but i will try not to and if youre sick, stay home. Did any Health Agency recommend to the white house that people over 60 should not fly on planes . Dont know the exact age but we have recommended the elderly and vulnerable including children with chemotherapy and others should reconsider travel. What is the age we leave the room. I didnt define it but i will tell you in the discussions we had the individual brought it up did say it was ayearold evan they were. What is that age . The data we have been looking at if you look at the data, the average age in italy is 82, 83, 84 years of age. The data ambassador burke has gone from china, italy and our own nation, 65 and above is where most people are at this time. One of the concerns we have in Nursing Homes, everybody is getting sick including the care providers. What is the level of concern about having enough care providers to take care of people as the disease spreads . This is the importance of being over prepared. If you are over prepared the body to protect Healthcare Professionals and not just Healthcare Professionals but the congresswoman knows that in washington they dont have firefighters. Firefighters are all quarantined. We have to be over prepared to respond to these outbreaks, not try to catch up. Time matters. We have more time in environmental disasters like hurricanes and flooding than we do when it comes to an Infectious Disease. Infectious disease if you are a week late, some of you criticize the testing or whatever it matters. Im running out of time. We have another round coming. One more question. I have some friends of people who are self quarantining themselves. You get exposed, you are quarantined for 14 days. Is that how long you have the disease . 14 days . The average incubation period from infection to systems is 5. 2 days. How long does the disease last when you get it . It varies if you do get it but if you get exposed you will develop symptoms in 14 days and be able to be diagnosed. If you stay asymptomatic we have no evidence you should virus longer than that. The florentine for 14 days, you come to work, then you meet somebody and get exposed again, you might have to sell 14 again which means we may all be in the process of self quarantining. You sound like what my wife said this morning. We fully intend, i do believe if we are all in this together from individual citizens all the way up we have a great Public Health department. We still want to stay with Public Health isolation and aggressive use of integration strategies. We are in a fight to contain, to stop this outbreak. Many of us are hoping, not knowing, hoping this will follow the pattern of flu and other respiratory viruses meaning transmissibility might change. It is interesting that when i look at the cases around the world and censor out all the cases, censor out all of the contacts of exports and you look in the Southern Hemisphere there are very few cases in the Southern Hemisphere right now. It is a great possibility that might change like the flu changes. We need to stay the course, be aggressive. This is why being over prepared is where the posture we want to be in, this is why the supplement you did in such a fast way is so important to us because it gave us resources to scale up. I think youre getting gavels there. Thank you for your willingness, the white house called you away but i appreciate your willingness to take a little time so i will start with the questions i was going to ask. The white house was calling. Is this a pandemic . I think the word is not important. Usually the who make that call. This is clearly a massive global outbreak. I know that chairwoman lowy started out talking about new york city. I am from a different part of the country, very rural district in the northwestern corner of illinois, 11 of the 14 counties in my district are entirely rural. As you can imagine my office has taken necessary steps to prepare for cases, doing what we can to make sure we are filling in people with what we know. We have been in communication with all our hospitals, Community Health centers, county Health Department 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 give you an example. One of the counties in my Congressional District is called henderson county. We have a patient physician ratio 70001. That is 12001. You can imagine a world octave isolate themselves due to coronavirus exposure, there are limited options for people. I am wondering if you offer, anybody at your table, other folks get an opportunity to answer this, what steps can Rural Communities take to continue treatment of providers get sick and cannot see patients. If you have any advice specific to moral parts of the country. I asked you to make a comment. This is an issue and this is why we have tightened the area of Infection Control. As we see in washington and california we had 600 Healthcare Providers and working in those environments. The source for most communities is a nursing home and they go into the hospital and the hospital, you dont have diagnosis because someone came in and visited who came back from italy and visited their sick mother in the nursing home and got sick in the hospital and has to be aggressive in Infection Control and work hard. This happened in wuhan. They had 130 infection beds, 20,000 and four weeks but they didnt have doctors and nurses and equipment, their Health System fell apart. Are they at more risk . They pray the virus doesnt get into the community in a nursing home. They had what doctor redfield just shared. Rural health has been an ongoing issue, the covid19 issue is shining light on the number of deficits in the healthcare system. We have been involved in resources, how it is Rural Communities generally have resources for what they normally wouldnt have. And talk about what is available in the kinds of things that may come to bear for covid19 as well. Anybody else have anything else to offer . Something else, and latex gloves, i shields, for a need for this equipment. The plan to make sure this protective year for Healthcare Providers. This is the important role. And manage stockpiles and interagency analysis, all the different things, masks, protective gear, and 9 Million Masks a day. And 31 million for industrial use. They will come up with a plan, they are over modulated. That is an issue they get in touch with you so they answer that question. Thank you for the information, we are never cutting your budget in any way, shape or form. Do you know how many people have been tested. What we mentioned can you tell me how many . From Public Health labs only. We are trying to get it together and a single point dealing do the individuals who get their test at private labs get the diagnosis from firms with the cdc. If there lab is not independently approved by the fda we do a confirmation of those state labs, those labs i have a question, the number today, resulted cases, the presumptive positive cases tested by the cdc. This is a rapidly evolving situation, a delay in conversation with these cases. The firm, there is not any further delay in the volume in previous media calls, it takes a day to ship tests to cdc and we have confirmation in 48 hours. The cdc has a test for Quality Control measures. Why do we have this delay. If they confirmed in new jersey, 11 confirmed cases, they are considered a case. Im under the impression they are waiting for confirmation, that they dont have about it. We will get back to you about what the reality is. I have a question about what happens if you are confirmed to have this virus and you are in a hospital or whatever. What is the treatment . The majority of people infected with this virus particularly those under the age of 60 are relatively healthy, to restrict their movements, stayathome for 14 days. They do not infect anybody else that lives around them. Nothing they can do . What they used to say, drink a lot of fluid, take some orange juice. And please please please honor the isolation. For people that are very sick and we have a number that is very sick, we have a an experimental drug that is available, this country has used it, a number of people have been treated with and theres clinical protocols going on by tony fauci overseas and in asia. We will now in april whether the drug works or not. The drug can save lives if it works. Should we expect the cdc to not confirm state lab results . We are moving in that direction. Why is that primarily what you all do in this situation . A number of these laboratories will come out with their Regulatory Approval to do the test. All states have the same standards, apples to apples, not apples to oranges . We put our standards in Public Health labs. Each state has their own but our standards working under our emergency operation, we are in the process of getting each lab with the fda and that is ongoing. From the clock. Thank you all for being here. We have been warned about moving from containment to mitigation and the lack of testing hastened our move out of containment phase in the mitigation. Was that true across the country . I would say one of the biggest drivers of what we are going through is the movement of the outbreak risk from travel from china to travel from europe. Seating communities. And and we will figure that answer, we are going back, blood samples a month ago, and my own personal opinion, the new cases we are seeing in the United States are disproportionately driven from people who return from europe and have gotten into community and we see secondary cases and tertiary cases. I will not die on my sword on it, theres more transmission that we missed. We want to make sure we remain datadriven. As we look at what is happening, we continue to see totals doubling and broadscale actions we need to take to mitigate this because our testing where the virus and infection rates really are. How are you working on the front lines on this, what is managed by the state and hopefully supported by the federal government. How are you working to give opinions on largescale gatherings . Is there a role for the cdc in this sort of work . We deployed teams on this issue, i will tell you, Vice President s office with the Mitigation Strategy in this country. Can you give me any preview . It is a framework for each of the states, and low risk, moderate risk and different examples for what they need to do. I will reach out to massachusetts in light of the recent cases they have had, they are one of the top five. Last night we had a long call to help leaders of the top four and we take this template and edit it carefully. We will incorporate their edits and go global and with the questions you asked, what are they going to do about the mariners game . What are they going to do about working from home . What are they going to do about schools . All of that is in play as an example so not only do we give them the framework but we have a couple of the groups that have been dealing with sustained Community Transmission for the last four weeks say how they are going to do this and we are here to give Technical Advice to all of the groups reaching out to massachusetts in light of the last couple days, if they want to engage directly with cdc. We sent people to new york and seattle and california and florida to help them and massachusetts is the next one of the Health Debarment wants are you making recommendations the people dont have gatherings over 100 people . Do you have that criteria . We are working in partnership with current state Health Department to come up with what we believe is an effective litigation strategy. Is that what the Vice President he will release the framework that will tell them how to do this and we will be following up with specific jurisdictions like i did last night and the last couple weeks to work in partnership to see how they operationalize that framework in their community . We are very involved. Rather than cdc giving blanket recommendations and this is community by community we are working with local Health Departments, expressing our technical systems and recommendations. I am almost out of time and i dont want you to interpret this is a flip question but is there anything those recommendations, structural barriers at our borders would be of any use in mitigating the outbreak of this virus . Not that i have seen. Thank you. Thank you. Ileana arias, i have a couple questions and the question to debra houry as well. This is about Public Health data. What we heard here is the coronavirus outbreaks confirmed a need for modernizing the Public Health data system. You work directly on the Public Health data initiative. If it had been implemented for the past five years and cdc had a modernized Public Health data system how with the current Public Health response be different . In the spirit of conjecture it would have been different in two ways, in two different ways possibly. One is we would have detected it much sooner and been able to contain it further and more effectively. The other is even before detecting, relying on different sources of data which we want to do more of and analyzing that information along with health data, could start seeing there might have been a problem even before getting scared about a number of cases being detected. It is a matter of detection and very quick prediction. Examples of things you cannot do right now, what cant you do right now . What we cant do right now is twofold and they are related. What is the delay in finding out what is happening and a lot of them have to do with unfortunate barriers from Healthcare Providers, states and to engage in that response earlier. What we did was provide a supplemental to improve surveillance and reporting. Cdc Public Health data up to the task of handling all the data from state and local jurisdictions in such an emergency. I refer to the 456 number that you gave us. Not 100 . The initiative, 75. The initiative would get us to 100, not only that but it would allow us to maintain it over time and keep up with the difficulty we are running into that you can appreciate, that methods are changing significantly faster, tools showing up faster than they ever have been and if we cant keep up with that we will do that even more. If we dont make those changes, 57 . Every state and local territory has that capacity too. We heard from them and talked about individual worksheets and data entry which holds up the process. Making your point we need to invest in this effort. Let me move to you for a second. First time into 2 years, firearm entry and mortality Prevention Research. Enthusiasm for researchers everywhere to move forward. What steps did cdc take . What areas are promising opportunity to address the Public Health emergency . Cdc a appropriates that and we move quickly on this funding. We issued our first Funding Grant and had informational call for potential applicants and a Record Number for interested applicants. The intent next week is to issue these grants, to look at areas like mass violence. How are some prevented and why are others not. Self defense firearms, when is it used against a person and when does it help for it a crime and School Programs which are they effective in preventing firearm violence and safe storage. What are the best circumstances . There is one is there any applicant looking at homicides versus suicide . We dont know yet. Our hope is to get a wide variety of applicants. We have greatly disseminated this to a Diverse Group of stakeholders. We appreciate the suicide funding as well. To look at primary prevention and Community Level prevention for that. Let me yield to my colleagues. You anticipated a question i had for ileana arias on the importance of Healthcare Information which we mentioned one way or the other. Could you work with our committee so we have a substantial what would be helpful in this area. What you had requested might get you to 100 . What we also need is a look forward as you mentioned your self. I know you cant estimate every piece of technology that will come along or what might be useful but we think through these things, you really have to have a multiyear plan even though we only budget when youre at a time. Really helps. If you can tell us on technology, we tend to invest once and the speed of change is faster than we anticipate so you have equipment that is out of date pretty quickly if we dont have at least some way of thinking proactively of what you might need Going Forward. We are working on a longterm plan building along the way. Part of that plan is doing what we have not done as much before, working in the private sector where those advances are showing up and introducing them into Public Health so that we dont fall behind the way we have traditionally done. I dont ask you to make a judgment. We have the system we have but i am struck, one of the things i learned when i was chairman about how states and localities are dependent on cdc. I want a Robust Partnership and i want that. I dont want people to think there is not a role for states to do a little bit more. My own state, the lack of investment, i will pick my own home. When youre providing 60 of the healthcare budget, the Public Health budget for state and local homes, that is something we are to be worried about is oklahomans as well and shouldnt be waiting for the best ideas, given template advice but we need to do a lot more in this area across the board, dont we . I agree with you and i want to add we are all impacted by the degree of preparedness of any state. If we have one state that is underprepared we are all underprepared. I would have loved new york is great, they had a they are doing their own thing, they got their lab test going up, it is state level, cdc, the state developed their own. I would like all the jurisdictions to bring up their own test, so we could have a race. This goes back to that core investment in Public Health. Let me ask you this. I want to ask two related questions. The first relates to china. I recognize the delicacy of your position. We want to work with china. This wasnt the best result but better than we have seen in the past but hopefully there is discussion going on with them. Not many are folks go as rapidly as they should have we could have been helpful to them, certainly would have been helpful to us and this kind of closed system does it puts one out of 5 people on the planet live there. They cant just i am glad it is coming down with their apps but is going every place else, the more Rapid Response would have made a difference to everyone else in the world and a special responsibility, they are a superpower. They have worldclass science and very capable people. What are you doing to invite them to integrate themselves more fully into the World Health Organization . We have had more than 30 Year Cooperative relationship. It was built by cdc america. I have a small group of individuals in cdc china you will 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 requested and wanted that. It had to go through higher channels and it was not done until the who did a report with one cdc individual and one nih individual but we do believe we would have been helpful early on and it would have helped in our policy decision. I will make this plea. I am out of time. Do you or your counterparts, i suspect they want to do it. This is a discussion that needs to happen between our political leaders and their political leaders. This is a matter of an area we should be what cooperate with each other on, help the overall relationship. I hope it is on the radar screen of our state department and our president as well to have this kind of conversation. We are not trying to embarrass our friends but they are a big part of the solution a big part of the problem. They can choose to be one or the other. All of you urged our counterparts to do that and i suspect they would want to do that because they are professionals who dedicate their lives to people like you do. This is where political leaders need to get involved for the good of all. That was my sermon. Taken to heart. Congresswoman loey. The vaporing epidemic needs to be left to every level of government, the cdc office of smoking and health is crucial and congress provided an increase of 20 million for all levels of government to have the resources to combat before we lose a generation of children to the harms of nicotine addiction. Last year vaping resulted in 64 deaths, 3000 hospitalizations and many but not all of the cases were attributed to vitamin e acetate. Why cant the cdc say with certainty what caused these illnesses . Do you consider vaping to be a risk to Public Health and my key question, are you concerned compromised lung health could exacerbate risks for those who contact contract coronavirus . The last question is yes. The first thing i like you learned about this from my grandson who told me i was cdc director needed to stop it because he has a brother with cystic fibrosis, i would like to have ileana arias tell you more and answer anything she didnt clarify. Thank you for the question. Anything that can go into somebodys lung is of concern to us with vitamin e acetate is part of that. We are concerned we shined a light on that and it could go away but other things taken place. One of the things that has become important for us is to make sure that although the response, the activation for the responses been ended the activities continue and especially surveillance activities looking at symptoms in Emergency Room Department and what is it they are using in those substances that might be related to fat to catch it before it gets to the point we are with vitamin e acetate. We are continuing to work on making sure we understand how adolescents are not adolescents anymore they are thinking of these substances, different from what adults think like and make sure we reach out and make them understand the choices they are making and try to redirect their choices to make more healthy choices so that not only continuing the progress we made on combustible tobacco but we are replicating that for vaping as well. But you know it is not working. I have been to college campuses, not only with my own grandkids, but met with the president on one of the men said what are you doing and as we discussed, i learned about it from a grandchild who told me before she was in college, she was upset, she was saying 65 of fifth and sixth graders, do you think now that we know it can be connected with coronavirus, maybe that will shake them up . This is a very important priority for us, ileana arias and the team, the Bigger Picture of adolescent nicotine addiction. When the decision was to take flavor products off and menthol was not taken off at that time, we are tracking carefully adolescents shifting to menthol. From the regulatory effect of the fda. Mine were in middle school. Using e cigarettes on a regular basis. You know, i know and our grandkids now and so tired they have been reporting rather than talk about the impact themselves, reporting what is happening to their friends. Are we making any progress . Is anything we are doing working . I hear the statistics are the same whether it is junior high or college, they are all vaping. What are we doing . Anything . It is increasing and when things increase it is hard to look around them. It will be a while before that happens. In order to understand that, understanding pretty colors, think about what is inside the package. It is a little easier, to control the environment so that they basically are protected from that side as well but it has to do with finding out why they are using it, how they are using it and how it is we can get them to stop. We showed progress but i would like to pursue this because we are talking everyones concern, but we failed, we havent done anything. We are trying to do something but we are not successful. Thank you. The fy 20 appropriation included 10 million for the first ever dedicated spending for Suicide Prevention at the cdc. There are unique populations that are at higher risk for suicide such as latina adolescents, veterans and nurses. I am cochair of the caucus along with my colleague jamie butler. I am particularly interested in a recent statistic that indicates suicide is a significant contributor to the unacceptably high and tenants of Maternal Mortality in this country. Speak to the connection between postpartum depression and suicide and tell us what efforts your center is leading to track and address this. I can start and turn it over to my panel. If anybody wants to add to it with regards to suicide, the 10 million appropriation going to Fund Applicants to look at data within their communities, identify who are the most vulnerable and the highest risks really rate and work with them to focus the effect on those areas and the trends might be Young Mothers and looking at the evidencebased Community Levels. And 6 , we know the age of 1044, the fifth leading cause of death is due to suicide in that group. That is increased age for suicide deaths but we are focused on primary prevention of suicide death, things like making sure they are good programs on social and emotional learning. 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 to look at things like why are some veterans not accessing va when theyre having suicidal ideations and look at what we can do more in the community. We work closely with samhsas for there is mayors chums. We talked about our technical package to help cities implement their strategy. Over the last two decades we can significant gains in the Life Expectancy for People Living with spina bifida. With adults living into their 60s and 70s. This creates new challenges because when young Adult Patients aged at out of pediatc care and the National Spina Bifida registry there is no system in place to follow and care for them. Cdc Spina Bifida Program has been flat funded at 6 million for the last six years and is currently down two Staff Members. Do you have concerns 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 . We are working withinn the confines of the resources 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. Its not just true of spina bifida, its true such as alzheimers and multiple sclerosis and other things that have been difficult for us to make much of an effect as we think we can with the resourcing we has a been there and we had to work with what it is we have. A lot m of that means measuringt and getting information to the extent we cant about either prevention but in most cases sort of managing. And then aat lot of information which is we were getting more requests now for data with the Caregiving Community in each of thee situations. Well then what funding level what which you need to ensure that the National Spina Bifida Program Covers the lifespan of individuals living with a disability and what are your plans to track people as they age out of the pediatric system . We have been working on a plan looking for areas that we need to go and get information to public that plane would look like and then what would be necessary in order to support the implementation. Thank you. Congresswoman frenkel. Thank you again for being here. Ongresswoman 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