Transcripts For CSPAN2 House Subcommittee Hearing On Coronavirus Response 20240713

Coronavirus. Like all other efforts on the supplemental package, it has been bipartisan. Let me commend my colleagues on both sides of the aisle, including my friend and Ranking Member, congressman tom cole. Before you begin of what to extend a very warm welcome to our witnesses, dr. Tom frieden, president and ceo of resolve to save lives, and former director of the centers for Disease Control and prevention. The cdc, from 20092016. And dr. Caitlin rivers, senior scholar at the Johns Hopkins center for Health Security, and assistant professor in the department of Environmental Health and engineering at the Johns Hopkins Bloomberg School of Public Health. Dr. Frieden in his testimony will provide a perspective based on 30 years of fighting epidemics including leaving the cdcs response to ebola, where we are and what we need to do to protect americans. Dr. Rivers makes a case why in the months and years to come will we need additional capacities and diagnostic testing, Contact Tracing and Health Systems to combat the virus. Im also so glad to have my colleagues here. I want to thank them for being here this morning, of the democratic side congresswoman katherine clark, Bonnie Watson coleman and on the republican side congressman tom cole, congressman andy harris and hope we will have congresswoman Jaime Herrera butler. Were all disappointed others could not be here because of distance, reduce flights and Health Issues raised by the position. Chairwoman lodi, kay granger, congresswoman lucille roy blunt outcome barbara lee, lois frankel and congressman mark felt can, john bolin are and tom grace. They could not attend but they did send questions which we will ask on their behalf. But i want to underscore that members should not be blocked from participating in the committees hearing. All Committee Members should be heard, that requires moving as quickly as possible into the 21st century and conduct virtual hearing. Every member should be able to participate. I am angry that the white house has just managed americas reaction to the defendant and e president has that everything he could to avoid accountability. Im particularly upset about the lack of the necessary testing and the personal protective equipment capacity, both of which could help us gain control. And then yesterday President Donald Trump told reporters that he would not permit dr. Anthony fauci to testify before the Democratic House committee because, and i quote, the house is a bunch of trump haters. Quote, they frankly want our situation to be unsuccessful. But they are allowing dr. Fauci to testify for the u. S. Senate next week. This is a bipartisan panel. Dr. Fauci has appeared before our subcommittee dozens of times. He has testified whether it was a democratic or republican chair. Chair. He has testified hundreds of times on capitol hill, working with democratic and republican president s yet, now the white house said no. Leaving no doubt that they are just frightened oversight. The labour hhs subcommittee provided billions of dollars of funding for the cdc, the nh, the National Strategic stockpile, hospitals and barter. With appropriate 175 billion for hospitals and other healthcare providers. Most recently 25 billion to expand testing and improved diagnostics including 11 billion in state and locality Testing Capacity. The purpose of todays hearing is to get a clear eyed view of the path forward for response to covid19. In the near term, as we work to mitigate the spread of the coronavirus, in the medium term as we develop therapeutics to inoculate millions of americans against the coronavirus. And in the long term, as we make investments to enhance our nations Public Health and global Health Systems to better prepare for the next pandemic over the horizon. These are the three pillars we will look to build. Todays hearing i would like to explore the recommendations of our two Public Health experts on the necessary measures that must be put in place, and the benchmarks that must be met to move forward while keeping americans safe. Science and facts must drive our policy, and that dimension from doctors, scientists, researchers and experts who command those facts and drive science to public policy. It is urgent that we do so, that these model or predictors according to the dark times and the washington post, that in the coming months 3000 americans could die every day. There is no time to delay. I Witnesses Today will give us the analysis, the facts, the science and the strategy that will help us to make the right decision. With that i would like to recognize my good friend, the Ranking Member of the committee or any opening remarks that he would like to the. Thank you, madam chair. Let me make a few extemporaneous remarks before get to my prepared remarks. First on what he thank you for holding this hearing. I think its a very important hearing to have and what you think all my colleagues that were able to make the trip here. We all understand why others couldnt, but it really appreciate each of your both sides of the aisle for coming. And i and i want to record to si joined the chairman in urging dr. Fauci be allowed to testify here. I think it wouldve been good testimony, useful to this committee. I think you so to this country. Frankly i think Going Forward this up could probably more than any other is going to need administration input, expert input as we make the important decision in front of us. And while im not naive enough to believe that theres not certain about the partisanship on capitol hill, some committees are more partisan than others, frank of the Appropriations Committee and particularly this subcommittee are not hyper partisan committees in my view. The record shows it. In the last five years working together on this subcommittee and with our friends in the United States senate, particularly senator blunt and senator murray, we have increased nih funding i 39 . We have weve increased cdc funding by 24 . Weve increased the strategic stockpile funding by 34 pacific we have have established Infectious Disease Rapid Response fund. I think thats a bipartisan record of accomplishment to be proud of and i think addresses back we all wish we had done more. The rally is where so much better off where were at because of the actions and i partisan sense by this committee. So its record shows it knows how to Work Together i just know it the record my friend the chairman, when i was chairman voted for final passage of the bill every single time. We negotiated, got to place we could agree and shalt beget it across. I was able to do same thing with her when she was last year assumed the chairmanship and help thats the way we can continue to work Going Forward. So again, i think were going to be called upon to make some really important decisions, and having read the testimony both dr. Rivers and dr. Frieden, a lot of that is going to call for sustained investment in the Public Health sector. Frankly, i think its going to call for us looking at the caps agreement on some of these accounts as well. I dont think you can probably get to where we need to go within the caps. So we need input what you know to witnesses here today will give us, and again i look for to working with every member of this committee and particularly with you, madam chair, to arrive at the right decision for all our country Going Forward. So with that again i want to thank you for the many calls in briefings that you held over the past few weeks to keep all of us updated on efforts to overcome this pandemic. Over the last several weeks the spread of covid19 is caused unthinkable disruptions to life as usual, and to continue to do so for some time, even as we flattened the curve. Following the unprecedented strain on our Healthcare Systems and the devastating economic kits to hardworking americans as a direct result of this coronavirus, desire for normalcy to return is certainly the sentiment shared by us all, but as state and local economies begin to reopen its import remember that getting back to business does not yet mean hitting back to normal. Even though the fight against covid19 is far from over, keeping businesses closed and workers at home is not a sustainable option for the longterm. While the federal government is provided some shortterm relief to help individuals, households, businesses and communities stay afloat during this period of extreme social distancing, our economies need to get moving again and americans need to get back to work. However, any such efforts to reopen must continue to keep the health and safety of americans at the top of mine and not undo previous progress in slowing the spread of coronavirus. This will be a balancing act. Until networking treatments, treatments, Effective Therapeutics and ultimately a vaccine to control covid19, the risk and the danger for disease remains. Returning to more regular functions and operations require gradual action, completed in phases and based on data. President trump and the Coronavirus Task force recently recommended criteria for states and communities to achieve before moving into phases of reopening. This includes a consistent downward trends in reporting symptoms, consistent downward trend in document cases, where positive test result hospitals been able to treat all patients without crisis care and robust testing in place for all at risk healthcare workers. While this is a helpful reopening blueprint, states are not strictly bound to it. Indeed, just as there are 57 unique states, there may be well 50 different approaches to reopening that carry the same spirit of caution in decisionmaking based on sound data. The idea behind these three phases is to gradually allow businesses and workplaces to open back up but not immediately a full speed ahead or without adaptations to prevent crowded environments. In the earliest phases this may include limiting the number of employees inside of workplaces, continuing telework practices, vulnerable and other Older Americans remain at home or limiting the number of customers inside Retail Stores and restaurants. Clearly, life is going to be different Going Forward for a while that it was in our immediate past. Regardless of the phase of reopening in our communities we must remember not to abandon practical and hygienic precautions like thoroughly infrequent washing hands, not touching our faces, daily disinfecting of services, keeping a safe distance from others and stay at home when youre sick. Finally, its critically important the federal government learns from this crisis and actively prepares to face down another pandemic in the future. While im proud that congress has generously invested in were the tools and response resources strengthen our readiness in recent years, it must be an even higher priority in the days to come. For the United States was as prepared as any country to face the emergency, you can never be fully prepared for what you dont know is coming. In this case, a mysterious and deadly virus originating in china only identified early this year and for which a vaccine does not yet exist. I look forward to hearing more recommendations from our witness, madam chair, this month and i get back of house of my time. Let me say thank you to the Ranking Member and assure you that we will continue as the subcommittee to Work Together in a collaborative spirit to do what is right in this area, and other areas that we have jurisdiction over on behalf of the American People. And levy also welcome our collie, congresswoman jane herrera butler. Youve come a long way, a a ste that is really been hard hit by the coronavirus. So thank you so much for being here really appreciate that. And now i would like to introduce our witnesses. Our first witness is dr. Tom frieden. Dr. Frieden is president presio of resolve to save lives, a Global Initiative and part of the global Public Health organization of vital strategies. Dr. Frieden was director of the centers for Disease Control and prevention, the cdc, from 2009 20092016. Dr. Frieden is recognized as one of the worlds leading experts come his Current Organization is assisting more than 60 countries during this covid19 epidemic as well as providing Technical Assistance to new york state and other jurisdictions here at home. During his time at cbc many will recall that he led the response to the ebola outbreak, along with his colleagues at the state department. He also spearheaded many new Health Initiatives in the u. S. Including initiatives to address the Opioid Epidemic and to reduce chronic disease. Dr. Frieden, were so pleased to have you here today. Your full written statement will be entered into the record, and you are now recognized for your opening remarks. [inaudible] microphone. Thank you very much, and good morning, chairwoman delauro, Ranking Member cole, the thing which maps of the subcommittee. I appreciate the opportunity to testify. In the next two minutes as you say i will provide a perspective based on three decades of fighting Infectious Diseases in the u. S. And globally. The bottom line is that covid is a terrible tragedy. Families have experienced devastating loss. Parents have lost their jobs, and all of our lives have been disrupted. Our war against covid will be long and difficult, and we must act strategically now to establish a new way of preventing future health disasters. At an appropriate time we can assess what went well and what didnt. Im acutely aware that hindsight is 2020. Its far too easy to secondguess decisions that others have made. We are just at the beginning of this pandemic, and must focus on the future. There is only one enemy here, a dangerous microbe. Its us against them, humans against the virus. We will get through this best if we Work Together, learn from each other, and support each other. Here are ten plain truth about covid19. First, its really bad. In new york city where i live ive heard for the past two months the sounds of ambulances day and night. In new york city its on the order of the 19181919 pandemic. More than 20,000 people when you look at all of the excess deaths in the last two months killed in less than two months. That is as bad as the worst face of the pandemic 100 years ago. Even now with deaths decreasing substantially, there are twice as many deaths from covid in new york city as theyre all on a usual day other causes combined. And sadly, looking at the u. S. As a whole, just calculating forward from the number of people whose infections have already been documented, there will be tragically at least 100,000 deaths from covid by the end of this month. Second, as bad as this has been, its just the beginning. Until we have an effective vaccine and unless something very unexpected happens, our viral enemy will be with us for many months and possibly many years. Third, dated is a very powerful weapon against this virus data realtime monitoring of trends, finding cases before the income clusters before they become outbreaks, outbreaks before they become explosive epidemics that risk the lives of healthcare workers and others. Fourth, we will be able to reopen as soon as safely as possible by basing decisions on data and creating together a new normal. We are all so impatient to restart our activities. Sheltered in place is a blunt but effective weapon. It suppresses the spread of the virus but inflicts severe Economic Hardship on individuals in the economy. We need to deploy all of the effective weapons in our arsenal. After flattening the curve, the next step is what we call the box it in strategy. There are four corners to each of the box in aspects. Testing widely and strategically, isolating people who test positive, using Contact Tracing to confidentially warn people who were exposed to the virus and quarantine in contact providing essential services so that they can be sure that infection stops with them. If any corner of that box is weak, the virus can escape and spread explosively again. Each of the four is important. Fifth, find the balance between restarting our economy and letting the virus run rampant. We are conditioned to think in terms of dichotomies, a versus bp right but in this case open versus closed is not a dichotomy. Its more accurate to think of a dimmer switch or a a dimmer dil than an onoff switch with gradations to avoid undue risk. Even when we are close, many essential activities continue. And when we reopen our new normal will be different. With care and creativity we can open sooner and safer. Our new normal change the way we travel, work, learn and go about our lives. The virus can create a new generation in minutes, but in human populations it takes weeks to see the result of repeated spread. So its as if we reopen theres a lot of spread, it will take weeks before we actually see it. Another false dichotomy is between Public Health and economic security. In fact, the very best way to get our economy back is to control the virus. And economic stability is critically important to the publics health. Sixth, we must protect the healthcare workers and other essential staff who are the frontline heroes of this work. They should never have to put their lives at risk to care for us. Having safer Healthcare Facilities is essential to enabling more societal activity to resume. Its one thing to take risks for yourself, but if the risks that you take for yourself into infecting a nurse or doctor and then their mother or father or child, thats something quite different. Seventh, we have to protect our most vulnerable people. Unless we take urgent action, the would be a lease 100,000 deaths in Nursing Homes throughout this country. All congregant facilities and highrisk settings require intensive protection. We must also act now to reduce the high rates of both infection and death among african american, native american and hispanic people. Eighth, government and private Companies Must join forces to make massive continued investment in testing and distributing of vaccine as soon as possible, ensuring rapid and equitable access in this country and around the world. Nothing else will enable like to get back to a precovid normalcy. Treatment can help and should be available sooner but are unlikely to be the kind of game changer at a safe and effective vaccine would be. Knights, we must heighten, not neglect, our focus on noncovid Health Issues. This is a very important lesson from around the world. Not only do underlying conditions increase the risk of severe illness from covid, but if we dont continue noncovid conditions that would be many deaths that couldve been avoided not for people infected with covid but for people affected by the disruption in services that covid causes. And when fall come through a we will need to do the best weve ever done a getting people vaccinated against influenza because that will make our job easier in the next phase. Tenth, never again. It is inevitable that the wouldbe future outbreaks. Its not inevitable that we will continue to be so underprepared. This is an interconnected world, a disease risk anywhere is a disease risk everywhere. And when the world is safer, we will be safer. It was very difficult as you all now know to secure funding for Global Health security, took years of effort and funding was only allocated after the ebola epidemic yet, at that only onetime funding. Therefore, congress and the administration deserve congratulations for quickly passing comprehensive, Bipartisan Legislation for supplemental funding for the covid response, by supplemental funding is a temporary fix. Its a bandaid. Without sustained support, our health will be unavoidably at risk onetime funds are very problematic come from the point of view of someone running an agency, you cant hire the best step, you cant enter into partnerships with countries and organizations where you can keep up your end of the bargain. And you cant hold contractors accountable for ongoing contracts. You in congress have a unique opportunity to take strategic action and protect americans from another microbial sneak attack. To protect us from Health Threats with to change the way we allocate funds. Weve all been through this. Discretion of funding the subject to cats and sequestration, even mandatory funding doesnt ensure stable support as we have seen. We propose a new approach for specific Public Health programs. These are programs particularly to prevent detect and respond how threats, and we suggest calling this the Health Defense operations or hbo budget designation. It would exempt only these Critical Health protection funds from budget control act caps. Its our Public Health can protect us. Hdl program should be required to have professional judgment record to Congress Annual just as in nh does for hiv, also i s in cancer. That way congress and the American People can understand whats really needed for a Public Health defense, congress can appropriate the resources required to sustain the Public Health system we need to keep us safe. This investment can save millions of lives and potentially as weve seen trillions of dollars. Good Public Health is good business. In my 30 years in global Public Health i never seen anything like this. Scary. Its unprecedented. We are learning more each day. I have outlined some of the things that we can do at home, in business, government right now to slow the spread of covid and rebuild our economy. We must make sure this never happens again by investing in systems, find and stop the emerging Health Threats before the spread, whenever and wherever thats possible. Thank you, and i look for to answering your questions. Forward. Thank you very much, dr. Frieden, and appreciative. I think so personally about this issue. I never knew him but my grandfather died in the spanish influenza, 1918 at age 36, leaving a widow and five children and one on the way. So it is really brings it all home that we could now experience this and our families could be experiencing all of this. Now i would like to introduce our second witness, dr. Caitlin rivers. Dr. Rivers is a senior scholar at the Johns Hopkins center for Health Security, as well as assistant professor in the department of Environmental Health and engineering at the Johns Hopkins Bloomberg School of Public Health. Dr. Rivers has been a leading Public Health voice during the response to covid19. She coauthored a report along with dr. Scott gottlieb and their colleagues at the American Enterprise institute, aei, a roadmap to reopening, which outlined a series of milestones and capabilities that states should meet as they consider easing restrictions on businesses and social life. Dr. Rivers is also the lead author of a report, Public Health principles for a safe reopening during covid19, guidance for governors, which is being used by the National Governors association as well as maryland and washington, d. C. To guide their reopening plans. I would also note that dr. Rivers worked as an epidemiologist for the United States army Public Health center as a department of defense smart scholar. Dr. Rivers, were so pleased to have you with us here today. Again, your full written statement will be entered into the record. You now are recognized for opening remarks. Thank you. Chairwoman delauro, Ranking Member cole and distinguished members of the committee, thank you for the chance to speak with you today about the covid19 response. As chairwoman delauro described im an epidemiologist at the Johns Hopkins center for Health Security at the bloomberg Johns Hopkins Bloomberg School of Public Health. I have coauthored a number of reports and guidance document on reopening safely and its license from the work of what want to e with you today. But first a little bit about the current situation. The United States still faces 2530,000 new cases every day and approximately 2000 deaths. Arrange that held steady for the entire month of people. Many states are either moving towards reopening or looking ahead to those decisions and wondering as we all are how to do that safely. Its clear to me where in a critical moment of this fight that we risk complacency and excepting accepting the preventable deaths of 2000 americans each day. We risk complacency and accepting our healthcare workers do not have what you need to do their jobs safely. And we risk complacency in recognizing that was not continued vigilance we will begin create the conditions that led to us being the worst affected country in the world. And so with that in my i want to highlight a few critical capacities that i think we should be prioritizing. The first critical capacity is diagnostic testing. Last week we performed about 1. 6 million tests which is a big improvement over march and even over early april when we performed about 1 million tests per week. These games are a testament to the impressive biomedical enterprise that weve built through sustained investment in science and medicine. But estimates of the number of tests that we will need to gain control of this outbreak start at 3. 5 3. 5 million per week ano up from there. We urgently need a National Plan or how we will close that gap. We need to understand what National Capacity we can expect at the end of may, at the end of june, at the end of august. Where are the bottlenecks, the untapped resources . Is not just for the test gets. Its also for all consumable supplies that are required for testing. The swabs, the ppe for the care providers, the bible transport media. A lot of components involve the diagnostic testing and at various points all of those have been implicated and intermittent shortages and we urgently need to understand where we are going with diagnostic testing at how were going to get there. If this work has been done i have never seen it and i fear that night has the governors and the mayors and the Business Leaders and the University President s and the school principals. All of whom are having to make decisions about how and when to reopen. So its not just the federal government that needs this information to each of all of us who try to navigate how will get from where we are to where we want to be. The second capacity is Contact Tracing. You heard from dr. Frieden Contact Tracing is really a key component, a key approach that will allow us to reopening safely. One thing that it dont a lot about about Contact Tracy i want to bring to attention is its also a key source of data that we badly need. We currently have very little understanding about where people are getting infected. I most new cases in longterm care facilities correctional facility which we know are high risk settings but dont have a good sense of whether 99 of our cases originate in those special study of whether its a small fraction. We dont we dont know when the people who are essential workers still performing duties in the community are getting affected or we dont know whether most infections are happening at home. Dating a better understanding of what that looks like will help us to guide better interventions. Interventions. If it is special settings, we know we need to be doing more to protect people there but we might also assess the risk to the General Community to be lower. On the other hand, if most of the getting at home that points for a need for some sort of central isolation capacity by which i mean if people feel that would be safer recovery in a hotel away from their families, for example, that should be an option that should be made available to them that we would want to know what fraction of cases originate in a household to understand that is an important investment. This information where transmission is occurring is of critical importance but is not currently being prioritized and it is Contact Tracing that allows us to collect this data. In addition to being a key tool for containment, its also teh will probably as to guide our response and the decisions we need for that. The third panel of healthcare capacity, were able to secure enough healthcare capacity to treat everyone with covid only through extraordinary measures i canceling elective procedure entry into the operating rooms into icus. Right as a start to think about unwinding some of those decisions is when states are moving to reopen. So we need to be exquisitely careful that we do not allow her Healthcare Systems to become overwhelmed by drawing down our Surge Capacity as we increased time spent in the community. We need to be careful that we do not again create the conditions of new york on wuhan. We should plan now for how we will staff and fund the. Oh medical teams to move from hotspot to hotspot. Ill point out that we making these decisions as we face Hurricane Season which will draw on many of the same resources. I think we need to be, plan for the worst Case Scenario and understand that we may be needing the search capacities, resources in the coming months. And we should also continue to fight for sufficient supplies or personal protective equipment to keep her healthcare workers say. This is been a continuous problem and its one we need to solve permanently. Its not acceptable healthcare workers dont have what they need to do the job safely. So these three capacities, testing, Contact Tracing a delta will enable us to transition safely from staying at home to slow the spread and to a gradual reopening. We should be working up to ensure that we have the tools to do that successfully. I now will detect breeze on a longerterm priority that he think we should keep in our sites. We see in the White House Task force briefing and on the bystanders Infectious Disease modeling or outbreak is playing an Important Role in guiding the company to respond and is not just covid. This is also an important capacity during 2014 ebola come during h1n1 and it will be an important resource in the future pandemics that we can be confident we will face. What many people realize is the expertise to produce most models is not standing National Capacity. Its mostly a volunteer force of academics who produce those models. This approach stands in stark contrast to the Weather Forecast in which the nation has invested in for decades to the National Weather service. We dont have anything like that for outbreaks but this pandemic underscores why that must change. We should consider establishing a National Soon the would perform epidemic forecasting and analytics. Just briefly one of the longerterm priority that a think we should be considering or opportunity rather. Is that we put in all its resources metal countermeasures for threats that we previously identified but we dont have dedicated programs what we call disease x or new pathogens that we didnt know existed until suddenly they are an enormous threat. I think we should be thinking about how we could stand up programs and find resources to help the tools we need to expand our capacities and raise the bar bridges for those pathogens that we dont know anything about but that we could be facing at any point. So in conclusion, thanks to the leadership of the house Appropriations Committee, the couches made important progress towards combating this pandemic. We must prioritize the strengthening of capacity and diagnostic testing, Contact Tracing and Health System so we can discuss only combat the virus in the weeks and months d years to come. Thank you. Thank you so much, dr. Rivers here at some point i would love to talk to you about your idea on a center akin to the National Weather service. As in the past we will proceed to fiveminute rounds, alternating back and forth by seniority as members were seated at the beginning of todays hearing. We are going to be respectful of her witnesses and try to give them enough time to respond to questions. I will move forward. Dr. Frieden and dr. Rivers, both of you have provided recommendations about the type of state and local capacity and needs to be in place before scaling back limitations on economic or social activity. According to reports disease modelers are projecting the country moving in exactly the opposite direction. According to a range of projections of new daily cases covid19 could surge this month and some are projecting that deaths could rise to 3000 each day. I would just like to ask a series of questions of each of you. To the best of your knowledge, is there a single state that is not the necessary parameters to ease restrictions . That has taken. We suggest in our report that you mention at the beginning of the session that there are four criteria that states should meet in order to save the reopen. And not all states have adopted these criteria but ill review them just as a starting point. The first is to see the number of new cases declined for at least two weeks. Some states have met the criteria. But there are three other criteria that we suggest they all be met. The other is in the Public Health capacity to conduct Contact Tracy on all the cases, enough diagnostic testing to test everybody with covid like symptoms not just those people with severe illness at enough Healthcare System capacity to treat everyone safely. To my knowledge there are no states that meet all four of those criteria. Dr. Frieden, is it any single state that meets the criteria laid out . I have not looked at all of the data from all states but i would make to the comic spirit one, there may be areas within states that are closer than others to meeting that and second, as a sit in my opening testimony, open versus closed is not a straight on off switch. There are things that are always open, essential service, a Center Retail hospitals, emergency facilities and are things that might be first to open. Outofdoors is way less risky than inside. Lower risk businesses, takeout from restaurants, outdoor recreation, even day care if done very carefully and safely may be lower risk. I think we did think of this as a dimmer rather than an on off switch. Just a quick follow up here and then i want to get to a couple other items. Any state testing 1 of its population every week . No . No . Okay, thank you. Any state or region been able to reduce the basic reproductive number below one come beneath the epidemic is to longer growing . There is some evidence some states have. Okay. Dr. Rivers, you are the lead author of the report where youre making recommendations to the governors. To be clear, its important for leaders to know that getting things open again will increase the risk of individuals, contracting covid19 and there is no way to completely guard against that. Let me ask this of both of you. Should the country be reopening now . Are we ready . Is it irresponsible to open the economy without adequate testing . I think theres an enormous need to balance Public Health with the economic pressures comments i think thats always a factor into decisions. I think even as we move towards reopening and the some states make a decision we still need to be focusing on increasing our capacities to do diagnostic testing and to Contact Tracing. The window we have to implement those invention is to open and so i dont think its either or. I would say that we need to continue to rapidly ramp up our ability to do all of the four things invention, not just test it also isolate people who are infected, contact race, and quarantine. By having all those things in place we can come up safer and souter, and restore our economy without a risk of explosive spread. I believe it was, i know it was, it was dr. Fauci who the last several days is and how many deaths and how much suffering i would willing to accept if you want to get back to some sense of normalcy. What is your sense of what is acceptable in terms of deaths or suffering to be able to get back to normalcy . If we dont have the Public Health, Public Health professionals advising us. I think when you to continue to prioritize Public Health. We have seen that several of the countries have regained control of the outbreak. South korea, singapore, australia. We can do that. Its going to be difficult and is going to take a lot of investment in our communities but that option remained open to us. We have to ensure that we protect our Health Care Workers and other essential workers. They are not making a choice. Their doing their duty of protecting and providing essential service and which do Everything Possible to keep them safe and we have to pay particular attention to the most vulnerable such as Nursing Homes, large congregate facilities, homeless shelters, correctional facilities, large factories were many people working together we can sit explosive spread that cannot only cause a lot of suffering death but also seed infections elsewhere in the community. Just quickly. The issue is, is that what the criteria is how many deaths and suffering i would willing to accept, in your view . I think this is a balance. We need to reopen so we can restart important medical care. We need to reopen for our economy but we need to do that in a way that is careful and doesnt risk an explosion of cases that sends us back into our homes. Thank you. I yield now to my colleague, congressman called. Thank you, madam chair, and i want to thank both of you for your excellent testament and again for the papers you submit. Dr. Frieden, let me start with you. Im very intrigued by the idea you presented about a special Health Defense budget come sort of equivalent of what the defense we call a local spin the come something outside the caps fit we just recognize we are at war, we spend what it takes to win the war regardless of whatever budget mechanism. I think this is come you and i have had discussion, the chairman and i have had this discussion about particular accounts that need perhaps to be exempted. Could you go through a little bit more detail and talk to us about specific account in your view we would need to sort and set outside the normal budget process and say when it comes to Public Health and threats that emerge, were going to have to be free to spend what we need in these areas . Thank you very much, and i appreciate all of your commitment to the station over the years. We discussed it for many years, and what weve seen as if its in discretionary, the matter how wellintentioned of and what is there going to be problems. If its magical, you might have fixed we think it is, it isnt. What weve suggested something similar to the overseas contingency account that allows for professional judgment of whats needed, and if we get it into the record a letter sent to both senate and house leaders yesterday and signed by a former Senate Majority leaders frist and daschle as well as myself, and multiple other former cdc directors madam chair, i would ask we could into that later if we make to the record. Without objection. That also includes a budget line examples of which would be included. They are squarely in the area of protecting americans. We wouldnt want to choose between our military raider defense and another part of the budget come in the same way we shouldnt have to choose between this kind of defense radar at another part of our budget. Mr. Cole, use it over the years americans are far more likely to be killed by a pandemic that by a terrorist attack im afraid the past month has shown that to be quite prescient. In the same way i think where to recognize that other than nuclear war theres nothing else that can kill 10 Million People around the world except a biological event. And we have to do everything in our power to prevent that from happening so that approach is essential to falter one, you identify the budget lines, make them off budget to this hdo or some other mechanism similar to the ocio account. Second, tightly related to that you require a bypass professional judgment, do not stop echo, do not get cut to a nearby omb. Give the actual professional judgment from whats needed so that in congress and in public you can assess that and that put it all of the accountability metrics for what we expect to see for the monies that are being spent. This is not a piggy bank. This is a specific investment in building up our national defense. Madam chair, i would suggest that something we need to work on together, maybe submit together for the consideration of our colleagues. Because it will take obviously agreement between the house and senate and executive branch but i think its a very good idea. Dr. Rivers, let me turn to you if i may and again i very much enjoyed reading your paper and your testimony. He made two points that were particularly strictly, probably because i agreed with them, one, your concern about we just appropriate 25 elegant daughters for additional testing. Im not sure exactly what we are doing with it. Whether we really have the program set up and running for it here same thing about your point on Contact Tracy. This is an enormously, you know, intensive manpower type operation, particularly something of this size. What are the sorts of things you would recommend that we do that you did okay, this would be inadequate testing program, this would be an adequate tracing program. We heard from experts over the last few weeks, different plans for Testing Capacity we should have and what we would do with that capacity. Im suggesting we start at the other side and figure out what are the components and where is the room to go up on all of those components . Thats the part thats not later i could say sure if we could test everybody once a week, that would get as this. Before every two weeks we would have these options, but is not clear which of those plans is feasible its i think its important we go stepbystep and figure that out here i think we need a National Plan in order to do that effectively. I dont think states should be left to do it independently. In terms of Contact Tracy, in addition to using that as an approach for containment, i think we should be prioritizing Data Collection, cdc recently put out new guidance for how Data Collection during Contact Tracing come rather how data can be collected during Contact Tracing does incorporate many of the Data Elements that a think would be really useful. So progress have been made just in the past week on that. Next we should be sure that data gets reported and analyzed. I think all of the state Health Department should reporting in and and i think the cdc should israel. Thank you very much. Thank you, madam chair. Thank you, and now i would like directors congresswoman katherine clark. Thank you for being here. Thank you very much, madam chairwoman. Its good to see everyone here, and thank you so much for being with us. We understand that testing is part of what we need to collect, the data that you so aptly described as the weapon that is going to help us defeat this virus and get our economy working out and i very much like your image of a dimmer switch when we condyle things up and down because we want parts of our economy or places it are different states to be able to open if they can safely do it. But i think it comes back to your box diagram, and it starts with testing. And as you described, dr. Rivers, we are under testing right now. Id be interested if you both agree the goal is 1 of the United States population, once a week here so that would be roughly 3. 8 million tests, and we are now at 1. 6. So do you agree that 1 is the right benchmark we should be aiming for . I think that is in the right ballpark that i would make the point that we dont want to test 1 of american evenly distributed. We wanted to be focus of people are symptomatic, healthcare workers, essential workers. And i would just add to that, we issued an outline, a briefing note of who we think needs to be tested by priority level because if you test 1 but exactly as dr. Roper said, if you test the wrong point process you will not be optimally controlling project a look at those symptoms come both likely to spread, most likely to die, healthcare workers with symptoms, contacts were symptomatic, hospitalist patients even without symptoms because they can spread it widely, all people in nursing home come if theres a case there because there can be explosive spread come essential workers for symptomatic. I think its key to look at the numbers but our estimate is that you would need at least two or three times current volume even if you only tested the highest priority people to do it but that doesnt mean there isnt a lot we cant do at the same time to ramp up our other things. Its not going to be one thing that gets us out of this except a vexing. Thats right. And so we have to do all these things. But with a test to get to where we need to be, to be testing those essential workers comp part of my understanding is that test that were using now is inefficient and expensive and requires a lot more of the swabs and other equipment that we frankly just having shortages of. So where are we with. Of contact testing . More instant testing. And even if their accuracy is not as good as the contests we are using, is it worth it if it is more widely distributed and let us test more of these essential workers and people at the greatest risk . There that are two broad wayf testing, with a virus itself, you are looking for the genetic particles like the pcr that is being done and looking for antibodies. Ill leave Antibody Testing said because there are many unknowns about it. With the point of care testing for the virus, there are some systems that are relatively rapid now but they are low throughput. Youre only going to be testing a few people each hour here or people over a four hour to trae back. So that rapid point of care needs to be looked at. There are new technologies and older technologies that may be helpful but you always thats always good to take a good example of notes had to be looking for a tiny amount of genetic material. So your idea of a test that would have what we believe this house hearing here to keep our longterm commitment to bringing you live gavel to gavel coverage of the u. S. Senate. You can continue watching this hearing online at cspan. Org. And now live to the floor of the u. S. Senate here on cspan2. The president pro tempore the senate will come to order. The chaplain, dr. Black, will lead the senate in prayer. The chaplain let us pray. Eternal god, we continue to depend on you to fulfill your purposes for our lives. You have told us