Transcripts For CSPAN2 CDC Director Robert Redfield Testifies On Coronavirus Response 20240712

Order first welcoming our witnessdi director of the cdc we thank you for being here this morning to discuss the cdc and the ongoing response to cover 19. Also want to welcome the subcommittee members congressman thomas cole and the full Committee Chair. And the subcommittee members who are here in person as those who are participating by secure video teleconference. With my Opening Statement and this is the first labor hhs education appropriations subcommitteeapri hearing i would like to begin by offering a brief explanation of how that will work in order to benefit both members and the public. This hearing room has been configured to maintain the recommended sixfoot social between witnesses and members and other individuals in the room necessary to operate a hearing. Some have opted use video teleconferencing which allows them to participateat remotely. On those with videoconference once you start speaking there will be a slight delay before you are displayed on the main screen. Speaking intova the microphone activates the camera. Do not stop your remarks if you do not immediately see the screen switchover. But does not change over after several seconds please make sure youre not muted. To minimize background noise to ensure the correct speaker is displayed we asked those that remain on video remain on mute until it is your turn to ask questions. Please remember to mute yourself at the conclusion of your questions should you seek additional time please unmute yourself so i may recognize you. Want to ask all witnesses and members the fiveminute clock still applies we will move and tall the issue is resolved and you will retain the balance of your time. Rsing the menu option you will notice a clock on the bottom of your screen that will show how much time isth remaining at one minute remaining the clock will turn to yellow and that 30 seconds remaining i will tap the gavel to remind members the time is almost expired when it is expired your time will turn red and i will recognize the next member in terms of speaking order we will follow traditional order beginning with Opening Statements from the chair and Ranking Member and the full Committee Chair and Ranking Member. We will then hear from our witness doctor redfield and proceed to questions members present at the time of the hearing the hearing is called to order it will be recognized in order of seniority and those every time it is called to order. Now i would like to move to my Opening Statement. Before i make opening remarks i went to request this afternoon there is a Memorial Service for george floyd. For the last two months around this pandemic we have been talking about how to get back to normal. However, what we can hear in the chance fors justice and the cries for inequality that going back is not good enough this tectonic moment is deep inequality and racial wrong. And that as we fight the covid19 virus before us now we must also fight the virus of injustice. Welcome to the labor Health Appropriations subcommittee. This is our second hearing to oversee the federal response to the coronavirus and it is bipartisan let me command my colleagues on both sides including the Ranking Member congressman tom cole and with usth this morning doctor Robert Redfield director of the cdc and prevention thank you for joining us today. Our nation is in turmoil. The coronavirus is the biggest Public Health crisis we have experienced in at least a century. To be blunt, the federal response is inconsistent and incoherent. And to have a better understandings of what has gone right and what has gone wrong we need to learn from mistakes and not repeat them we cannot stop the risk from this virus overnight but in the months to come we can spare the American People from unnecessary misery illness and death. And a typical Public Health emergency and historically the response would be led by the cdc our nations foremost public, Health Agency based on science and Public Health expertise that this administration has sidelined the cdc in our response to the pandemic and has chosen political expediency over Public Health. And as a result the us has had the worst response to coronavirus of any country in the world and it is particularly egregious because the Public Health should have been better prepared than any other in the world. Over the last three years on a bipartisan basis it has increased annual funding for the cdc by approximately one one. 1 billion an increase of 17 percent in 2017. That included the first year of the Public Health Modernization Initiative that would transform how the cdc collects, uses and analyzes Public Health data. We also created an Infectious Disease Rapid Reserve fund to enable thee cdc to respond to outbreaks quickly and protect Public Health. Ranking member call and i have worked closely together understanding the challenges to create that reserve fund and its critical to funding early response activities at the outset of this pandemic. Since march congress has provided seven. 5 billion of emergency supplemental funding directly to the cdc and id might add in bipartisan fashion instead of expertise stising into be sidelined for political interest that projections are Going Forward that would die each month another 100,000 dead over the summer months yesterday the New York Times released powerful and well researchedd expose of the consequences the piece open with a quote long considered the premier Public Health agencies the cdc has fallen short in its response to the most urgent Public Health emergency in the 74 year history. From the moment it reach our shores the administrations response has been mostly inadequate there is never any coordinated plan to address the pandemic and under the dangerous lack of leadership with covid19 and the most of any country i the world when it comes to Crucial Detail to set goals for how much of the population should be tested and then facilitate contract Contact Tracing to ensure communities that has been hit the hardest with the support that theyat need there is no National Coordinating strategy. Our federal response cannot be defended from a Public Health perspective other nations around the world from germany to south korea have found ways to keep people in their countryop safe it appears as if the United States is just admitting defeat. Is that acceptable or simply accepting the preventablece death of hundreds of thousands of americans with covid19 if they are asking us to accept that then in my view the answer is a decisive no. For us to keep our people safe the response needs to be led by the Public Health experts at cdc based on reliable Public Health principles not political appointees in the white house is our expectation the Public Health expertise must be at the forefront of our national response. We need answers to questions why has administration accepted the worlds worst outcome and preventable deaths that would have been unconscionable a few months ago . How will the country reopen if not a coordinated nationwide effort for Contact Tracing and isolating cases and with the cdc guidelines for reopening business and a social activity why are the guidelines not at the forefront . Why the cdc guidelines on reopening come after state started to reopen or were already reopened products we are asking the cdc to be the way and uphold its mission and as a nation top Protection Agency it saves lives and protects people from Health Threats to accomplish the mission the cdc conducts critical signs of Health Information to protect our nation against Dangerous Health risks and responds when these arrive and it is the right to mission. So let me say affirmatively that this Committee Supports the scientist and the Public Health officials at the cdc like those who are trying to provide science based guidance to the country. What went wrong . Why has the cdc been left behind . With the early declaration of a Public Health emergency by hhs on january 31st to say its not a question of this will happen but when and further said disruption to everyday life might be severe but people might want to think about that s now cdc produced high quality indepth publication take note the morbidity and mortality weekly reports and the experts have published evidence of universal testing to interrupt transmission of covid19 as well as critically important19 a work of super spreading events which are responsible for transmitting the majority of cases of covid19 they identify the cause the exposure a choir practice for 61 people led to 32 confirmed and probable cases and attendees at a church in arkansas poultry and processing facilities we cannot have the cdc that has that technical guidance we cannot have a cdc that has edited not scientifically driven or redrafted to sue political purposes we cannot have the cdc with Data Collection and reporting we cannot have the cdc feeling that transparency we need federal laterad leadership guided with Public Health by the expertise realtime rigorous and transparent. We need cdc and scientist and Public Health experts leading the way for all and i am angry the experience and commitments can be pushed aside for a political agenda that much change and congress has to change it and we have to redirect the current course to set us on the path forward i look forward to this importantsa conversation and appreciate your being here and all of my colleagues and i like to recognize congressman tom call for any opening remarks he would like too make. Thank you for holding this hearing and you are to be commended for it i went to associate my remarks without the tragic death of mr. Floyd and the Health Care Disparities at this pandemic as shown in bright light on this committee has worked on for many years and concern for everybody here. That will be a major task Going Forward as it has been in the past with a higher sense of urgency. Good morning want to thank you again for testifying. First i would like to thank you for publicic service the director of the cdc is no easy job leading your agency through a once in a century evente poses a challenge you lead that with a steady hand and want to thank you personally for your leadership i will depart from my remarks because sometimes in the middle of something its hard to keep it in context but those that have not been the worst in the world measuring performance but quite frankly im looking literally at todays little one dash latest statistic with fatalities per million on the population in the performance of the United Kingdom the performance of italy and france and spain and belgium and never the unknown netherlands they are all advanced countries with sophisticated Healthcare Systems you cant take the chinese numbers at face value quite frankly and beyond thatwo and i say this is no criticism of the countries involved but i do worry about of india and pakistan in that part of the world and sub Sahara Africa when this is all done bring about the friends in latin america we will see the numbers probably be worse than they are in the United States because we have a more sophisticated Healthcare Systemph i have no problem being critical or putting a flashlight on anything but in america we always think we are the best or the worst at everything that is case we may not be the best but i think we are better than most the numbers dont bear that out i hope we can focus on future stepsst together after more than two months of staying inside the American People need the guidance of the cdc more than ever to help navigate the path momoahead to reignite the econoc engines should be approached with caution with the uniqueou circumstances that has caused unprecedented disruptions and it will continue to do so for some time and the devastating impact to hardworking americans create challenges that will take months and years toic address. However i am encouraged to see those economies cautiously beginning to reopen i also welcome the renewed focus for usbased capacity and resilient supply chain. Look forward to working with my colleagues across the aisle to address these challenges i also want to acknowledge the robust response in a deeply partisan plan of the City Congress and the Trump Administration Work Together across party lines to deliver Critical Resources like the highly successful Paycheck Protection Program to set aside our differences to quickly deliver legislative action to address the pandemic the consensus is clear that congress is capable as ever for Decisive Action covid19 is far from over i hope the spirited bipartisan cooperation canor continue as we assess our past efforts to determine what more may be made on needed while providing shortterm relief for individuals and householdssp and communities stay afloat during this period of extreme social distancing, our economy needs to get moving again and americans need to get back toso work if theres any such efforts to keep the health and safety americans at the top of mind this will be a delicate balancing act until there are treatments and Effective Therapeutics and vaccine to control covid19 the risk and the danger remains i see progress in any of those areas so turning to her regular functions and operations completed in phases with the task force established phasedin in database it for states on reopening efforts the administration recognized now is not the time for a onesizefitsall model for each date that each governor to make as appropriate for the circumstances of their communities based on the needs and supply and local capacity the administration is fortifying the supply chain for testing supplies to ensure each state has access for reopening often shipping to each date finally its critically important the federal government learns from thisne crisis and actively prepares to face down another pandemic in the future congress has generally invested in those resources to strengthen the readiness in recent years it must be an even higher priority in the days ahead the United States was prepared to face an emergency you can never be fully prepared for what you dont know isr y coming in the future we must not just prepare for the emergency at hand believe the nation better for the emergencies ahead sustained and protectable robust funding for usbased capacity are vital components to this approach and something in bipartisan fashion over several years i want to thank the chair for holding this important hearing and i yield back the balance of my time. I just want to take a moment for traveling the farthest once again is our congresswoman. Thank you so much i would like to recognize the Opening Statement the chair of the appropriation committee. Thank you i am assuming this is working you can all hear my voice. We can. Loud and clear. I do want to thank you with my friend and Ranking Member for bringing us together it is a pleasure to join you remotely and welcome back before the subcommittee and with the greatest Public Health crisis of the past Century America has never needed more than we do right now and thats why i am so troubled the president has pushed away the science when it did not suit him time and time again the president pushed aside medical experts including the cdc on respiratory diseases because of the legitimate warning on the president encourage the use ofoc hydroxychloroquine even though studies have shown that coronavirus patients were more likely to die he even suggested have disinfectants like lysol and clorox causing manufacturers to warn of the danger with Poison Control Centers throughout the country. This is not normal my friends. This is dangerous. We have lost more than 100,000 souls. Done more than in my home state of New York New York has been a leader in testing to contain covid19 those that do not recognize state boundaries to succeed against the coronavirus federal Public Health officials must take charge to combat this information to get this right with many states beginning to reopen the cdc must remain vigilant to combat be an continued increase of cases as well as the expected wave this fall the president s preference for 50 different states fighting covid19 on their own will not stop these levels of destruction and to lead to more sufferinger and death. We need a National Strategy on testing and tracing and we need it now we dont need a republican friends but a United States plan and we need it now and we stand ready to support the 50 states in recent months to provide seven. 5 billion in emergency supplemental funding to cdc to respond to this Public Health crisishe in the health past heroes act to provide an additional two. 1 billion and we will do everything we can working together, democrat and republican, we have the responsibility to protect the public i only wish the president would do the same. Thank you madam chair. I think the gentle lady thank you for being here and thank you again for your Public Service all over the globe as well you can understand your full testimony will be entered into they record and you are now recognized for five minutes. I thank you for the opportunity to testify before you and with a longterm support of cdc the pandemic is the most significant Public Health challenge and as we sit here today as it weaves its way to our social consciousness our outward expression and grief i am deeply saddened by those that have been lost to covid19 in the United States and around the world and i fully recognize the anguish that our nation is experiencing now and today i call on American People to remain vigilant to protect the vulnerable to protect their community here grandparents and loved once you are at risk for severe complications we must lessen the impact on africanamericans and hispanics and latinos and American Indian and alaska natives disproportionately affected by this disease we not only hear a wakeup call but a clamoring for equity and healing through change that exist in the nation as communities make plans to cautiously reopen we need to embrace in our social distancing Face Coverings this will allow us to move forward to contain the outbreak along with readily available comprehensive Contact Tracing and the isolation of known cases is of quarantine to break those chains of transmission cdc provides tools and information to confront the novel virus. Per se cannot tell you how proud i am of the men and women in the dedicated Public Health professionals at cdc and how grateful i am for theirth service and their sacrifice to deploy over 500 personnelrs for the covid19 response field teams are on the ground providing officials with expertise and epidemiology and surveillance perfection and lab silence and Community Mitigation publishing more than guidance souments more than 1500 far with more than one. 3 billion times the cdc has responded to more than one 20000 inquiries and have reached over half a million more with your support cdc can award 12 billion to tribes and localities these funds are used to enhance diagnostics and the other measures that i previously mentioned the our partnerships with cms and Indian Health service to deploy teams for the needs populations of the highest risk of those and Nursing Homes and correctional facilities the outbreak has shown a bright light the Public Health professionals the First Responders in the critical infrastructurehe unfortunately this pandemic has highlighted the shortcomings that has been under resource for decades never has it been more clear that are nation Public Health it infrastructure requires modernization to support and elect comprehensive data and when we confront any disease threats cdc and Public Health departments must make realtime decisions based on Realtime Data it informs the red roadmap and policy it is the backbone of any disease response as a virologist and physician i know the importance of strong Clinical Laboratories we must equip with advanced technology and theto ability with those platforms required in Emergency Response and exponentially grow the necessary workforce to address covid and Public Health threats and in this nation its an investment not only of health and prosperity for today but for future generationsfu tomorrow. That when influencing covid but Healthcare Providers this winter want to encourage all americans to be prepared into a bracelet vaccination with confidence this single act will save lives as a person of faith and in good conscience i ask all of you we must resolve, we can to help lessen disparities in this nation i leave you with a reminder from our mutual friend from the late congressman cummings who used to say the cost of doing nothing is not nothing as cdc director and grandfather ask you to continue to work with me to build the Public Health system we not only need that deserve now is the time that i want to thank you for this opportunityis and i look forward to your questions. Thank you doctor redfield Many Americans say not facts are driving the decision our nation has 556 new casesna and seven deaths four days later urging the American People to file a stay at home guidance and says were asking everybody to work at home to perform unnecessary travel limiting to no more than ten people as this chart shows there are over 20000 new cases with more than 1000 new deaths and President Trump is telling the americanat people that we are reopening the economy and that everything is okay our politics dont need to make sense we had fewer than 1000 new cases we went into a National Emergency now we have 20000 based on those inconsistent responses ive come to a conclusione in march based on Public Health expertise and making these decisions based on interest of politicians and white house there are several questions to move quickly to show it isnt of her that the white house is trying to convince americans to just accept more risk and death. How does this make sense from a Public Health perspective . Theres a whole lot of folks in on toou ask questions. We have experiences pandemic we are learning every day the most critical thing we have learned is to understand who was the mostcr vulnerable weve seen that with the Nursing Homes and the elderly and in africanamericans and hispanics and native alaskans. And design our policies to protect those vulnerable individuals thats one of the fundamental lessons we have learned in the last several months and that is essential to the policies we have Going Forward to protect the vulnerable. So does it make sense for us to be doing what we are doing looking at 20000 plus cases and over 1000 us . That leads me to believe its not based on Public Health expertise but making decisions based on our political interest do we have a vaccine yet . It is under development. We dont have one yet. Are we close to achieving herd immunity . Now. Is there any evidence the virus has become less contagious or is becoming tired of infecting us . Now. All the states meeting the basic tests the guidance has been laid out for reopening . With the trajectory documented cases within a 14 day. These were guidance that we put out and to answer your question not all the states have met that. My understanding its a number of states but let me ask you one concrete example of this photograph this is the lake of ozarks i had the same this role response look at this. Look at these folks it is unbelievable and this is happening in the state of missouri the white house says they need to have the ability to trace the contact of covid and the state of missouri does not have the capacity to do Contact Tracing was everyone traced . It would be the state and we would assist them but we have not been asked to assist them for that. So we are not Contact Tracing and we have identified the person quick. I cannot answer for the state that because of the support we are building enhance capacity to do Contact Tracing and to get that fully operational when we well needed to maintain containment into the fall and winter of 2020. We saw the ozark photo from last week at the space x launch people gathered on the bridge would you put yourself in these types of situations . Important thing of all of this as you have pointedmpor out not just the individuals but to the risk of the individuals. That is what is happening. Two and a half months ago starting the president is starting down the economy since then the administrations failure to respond confidently squandered the opportunity to bring the virus under control protect the health of the American Family they were told it safe to reopen over 20000 new cases we do not have testing and to prevent more deaths it is no wonder the leading medical journal thean lancet called the federal response inconsistent and incoherent the president wants to get used to this to pretend it is business as usual so let me justsi say this i have such admiration for the work that you and cdc do that youre driving the bus and taking up in a dangerous direction the cdc is at the role that you have in the y past not only driving the bus but the president has left you at the curb it is wrong for the cdc but deadly for our country. I recognize my colleague. Thank you very much a different question but let me start with this. Are other countries in the world based on locality rates doing less well than the united state states . There are countries as you pointed out that are not doing as well are they reopening for business . But at some point they put 40 million americans out of work literally in the last few weeks we have done what we can as a congress and a bipartisan basis and we think we are making progress with the therapeutics and vaccines but people do have to go to work you do have to have a functional economy. And we did the shut down a lot of this was not to overwhelm the own on her own health care system. Can you give us of you if we are close to that are how has that workedt out in retrospect . It was fundamental there was enormous concern that i and others hadce that this pandemic could have overwhelmed our Healthcare System with the major metropolitanta areas such as new york and the connecticut area and northern new jersey. And we saw that actually happenedaly. In italy and in cha overwhelming the health system. It did so mortality rate for covid was up but also being in the hospital in general and thats a result the attempt to expand healthcare capacity. We were able to get through that in the sense with some augmentation but in most jurisdictions we could get through that. Is not just his health versus the economy but health versus Health Dimension 85 percent of children have missed immunizations there will be more deaths of measles then there will be from theor flu. We are trying to find the balance as we come back to make sure that we can begin to operationalize not only employmentto so we do think it is important that only to get the economy back but prudently but we have learned a lot the key right now is to protect the vulnerable and focus attentions on that this doesnt cause a lot of disease in young individuals but those with chronic medical conditions. To go to a topic weve discussed many times before because of the last five years we have increased funding for nih by 35 percent cdc 24 percent strategic stockpile 34 percent to set up the Infectious Disease Rapid Response my good friend the chair noted. Weve done quite a bit but still we were overwhelmed by what happened. We are responding right now in crisis mode with supplementals. Im really concerned about what we do Going Forward. The administration original budget was put together with no idea this would occur so thats no longer applicable in my view. I want to ask you he reference this in your remarks what kind of budget do we need in terms of sustained commitment what areas do we need to focus on thats not the real answer we need to focus your predecessor came y here to talk about the equivalent of the off budget account for the military to allow them and then to be limited by the budget the friend the terror not on we have a budget agreement with the cdc nih, fda food inspection and strategic stockpile and to be outside of that agreement to do what we need to do. I welcome your thoughts to what kind of investments we need to make Going Forward and then ultimately to help us in a crisis that not where we need to go. And for the consistent enhancement of our capacity at the very beginning in the first month of the cdc director my assessment was the Public Health capabilities t of Public Health we need both the cdc throughout this country and states local tribal territory is an adequate and we really need to be over prepared and not underprepared so if you ask me what keeps me up at night a dont say pandemic flu because we are just not prepared this highlights even with all the improvements which i treasure the data modernization fundamental, the reason were having trouble with healthcare disparity in understanding how this virus affects africanamericans we dont have the data and the data modernization is fundamental i feel the same way about laboratory resilience and multiple platforms and before september the Rapid Response fund that we put into place is critical and the Global Health security is the big elephant in the room wait until we have a real global threat for the security and i echo your concern its a greater probability than a real defense threat we do have the longterm base budget to how to get that done the Public Health infrastructure which you all know significant portion goes to state local tribal territory of your own state and communities that needs to be augmented and truthfully i meant what i said at theds end with my friend congressman cummings the time is to do it. C. Thank you. Thank you very much madam chair doctor redfield it is good to hear from you today. And then testing has been extraordinary with 50000 residents each day and then to take the steps to have a true picture to mitigate the damage so can you tell me why hasnt the cdc established testing benchmarksh and then with all due respect the virus to recognize state lines cannot fully protect the population of one state by holding up their end of the bargain so to truly protect the public i dont understand why cdc is not taking a leadership role to establish testing benchmarks. Thank you chairwoman for your question and also for the recent resources that you provided to hhs which 10,250,000,000 come to cdc to do just that and work with each other states to develop the independent plan and benchmarks and those are now under review do the 31st of may through june and then through june 15 for the rest the year it will be important so with the best state lab in the nation as i talk about core capabilities number two was laboratory resilience i am personally saddened there is a handful of state lab set needs to be done part of this investment i went all state labs to docabi that as they stepped up to develop their own test and that platform for flu with a rapid platform to lead the way. I agree with you were in the process of doingse those plans but i would add it is critical time to invest heavily in state labs to have the resilience to do exactly what the colleagues in new york could do in each of the 50 states. And to have a little time left but this committee has the benefit that the director of the National Center for immunization cdc if every 26 she said ultimately we expect communities in this country is not so much a question of this will happen anymore but when this well happened was this explanation correct . Yes. And wine of the Outstanding Scientist of cdc and respiratory diseases and she was the first leader of vim response at this outbreak. In the limited time i have left and then when the present wanted to fire her after her comments because of the impact on the stock market and then from any other facing role what does thisub say to those professionals who may be fearful of rest on retributions. To remain one of our outstanding leaders and continues to run for respiratory disease a greates scientific ally of mine and other leaders and in addition she is our lead for cdc on the task force and has not been sidelined and continues to use the expertise one of the most important agencies that we have it cdc. We have known each other im glad that doctor msn a is a key part of this project thank you very much madam chair. Thank you very much and doctor redfield for being here. I want to draw that distinction between march andti june and in march the chairman brought up we have a lot of cases now that we had a lot of cases by then and we didnt know a lot about the disease by then we know much more now when i would suggest to be scientifically based actions we should probably use data so for instance i remember sitting at the hearing in this committee where the death rate was speculated tott beth between three and 4 percent and the best estimate is six. 2 percent. When they track that for 20 years there was an effect that lasted 20 years with an average loss of longevity, one to one and half years for underplayed people. That is Serious Health effects were in the midst of reopening the maryland and one of the things in my district is very important is the Tourism Industry and restaurant industry. Our governor hasovid decided in accordance with cdc guidelines, we have the phasing documents, our governor decided we are ready for phase two, i look at the documents that cdc has with scaling operations from then restaurants and bars, it is step two we havers Indoor Dining if u can do after, you cannot do indoor. I would ask us about question. , is there anything in cdc guidance that would say Indoor Seating is not appropriate maintaining social distancing. To the government say cdc guidance is holding you back. Once phase two has been exceeded . No, you would not find that in there, as you pointed out the critical thing is to have cdc, were not an opinion organization, has to be science based. In the principal to the science that we have right now in social distancing is the 6 feet to meter distancing and that is the key. Thank you very much, thats what i thought and again, you want to talk on politics, some of the delayed is based on politics because as you suggest is not a lot of Scientific Evidence that at this point would delay the reopening is distant with cdc guidelines and social distancing. I have a question about masks, there is now a colt of masks, thats what i will refer to it as. Because we get criticized, im afraid to get a picture taken without a mask somewhere because someone will say how could you not wear a mask. In fact we dont know a lot about whether a mask is better or worse than a cloth or a face shield but im going to ask you something very specific about restaurant opening guidance per the cdc said restaurant workers should wear cloth masks and not surgical masks, specifically said wear a cloth mask, not a a surgical mask but my understanding is surgical mask is probably a little bit more protective with the other person in the room then a cloth mask. Is there evidence behind that . Is it just where we want to reserve surgical masks for other situation, is there Science Behind that saying a cloth mask is better than a facemask and face shields are not mentioned in the guidance. Not in the terms of better. Clearly there is Science Behind the potential benefit that if i am infected of wearing a Face Covering and changing the amount of infectious wires that can go across the 6foot space or repose based prewe have good data to show that but i think you hit the answer yourself, the real issue that preserve the medical surgical mask for the medical surgical First Responder community. That is the intent, not that theres any evidence one better than the other. Thats what i imagine. Again getting back to science, theres a lot of critique, when first people were told dont wear a facemask then told aware of a facemask, surgical mass, facial, the bottom line, you should protect the other person that you are coming near in case youre in asymptomatic. That is the purpose. Much i yieldvery back. Thank you, madam chair, doctor redfield thank you for being with us today, i would like to follow up on the issue of m masks, in early april the c reversed the initial guidance for masks being optional to advising the public to work cloth masks in Public Places at all times, in spite of this, the u. S. Culture has continued to be a barrier to universal acceptance of these recommendations. And they have become very politicized and those who oppose their use argue that mandating masks is interfering with individual freedom. A recent study by a group of Cornell University scientists showed that when quarantines is lifted, if 80 of the population wears masks with social distancing, the virus could be eliminated, unfortunately today only 15 states require the wearing of masks in communal places and the president continues to flow his opposition to the Public Healthnt recommendation, based on the science, why did you initially recommend the masks as optional and what fears do you now have regarding the spread of the virus, if states and individuals cant be incentivized to wear a mask in public including during these massive protest that we have recently witnessed through otherr countries. Thank you very much. I think fundamental to this was a recognition of the importance of a some dramatic infection or presymptomatic infection, when this outbreak happened the cdc had the original 12 cases in the first january, february, we did about a hundred context through contact followup, two were confirmed to be positive in both symptomatic of both spouses. So we had the view from my chinese colleagues in their experience and our experience that this was asymptomatic disease like most respiratory viruses are. But what we rapidly started to learn is there significant asymptomatic infection or what we would call presymptomatic infection and we learn the amount of viruses showed an individual letter asymptomatic as just as high as that is symptomatic. Mpd when the knowledgebase came, we realized we had an important Public Health tool that we needed to take advantage of and that is if people were asymptomatic or presymptomatic reinfected if they were wearing a Face Covering and they would have less ability to transmit it to others. Thats why we embrace this in Public Health tool. And we continue to seee this isa critical out tool as a sediment Opening Statement that we asked the American Public to be vigilant about utilizing particularly as a major mechanism that we have to protect. Can you also elaborate on what your concerns are when you see these masks protest and when you see as things are opening and you see people on the beaches and then Public Places who are not wearing masks, what is your concern of what the possible outcome of that will be in terms of the spread of the disease. Obviously we are very concerned that her Public Health message is not resonating, we continue to try to figure out how to penetrate the message with different groups, the pictures that the chairwoman showed me are great examples of Serious Problems and i say that we will continue to try to message while we can. We will encourage people that have the ability and request to require a mask when theyre in their environment to do that. We do think this is an important Public Health tool and we will continue to try to figure out how to get more and more people to embrace it. I was just remarking when i go home in the Baltimore Area i dont see anybody without a mask but a lot of times when i walked in washington, d. C. I will see a lot of people without a mask. Lose a different cultural approach but we think its a important Public Health message and i think it will be key, the social distancing strategy that we learned are something that we need to perfect, we will need them to be our majorur defense again in october, november and december. I hope that you can start with convincing our president to be a champion of advocating for masks to prevent the further spread of the virus. I yield back. Thank you. Congressman. Can you unmute and start from the outset. Thank you, madam chair, i appreciate the opportunity and doctor redfield we appreciate your presence with us today and i want to thank you, the 5000 members of your team that are helping during the Health Crisis and also just for the sacrifice that they and their families are making to help protect the vulnerable. I want to talk with you, one of the areas you brought up as a concern was the ip infrastructure, one of myy priorities on this committee has been to provide funding for the cdc Public Health data Modernization Initiative and i think the pandemic has really demonstrated the importance of that, some of the early reporting said that the cdc response was hampered by an antiquated data system that had fractured Public Health across United States, im wondering if you could speak to the early response as well as what youve done since that time and as we go forward, what do we need to do to invest in the data modernization. Thank you, again i want to think the chair in this committee, you heard those discussions that, i had i think in the first weeks of my directorship and we talk about the core capabilities. The one that i said that was the most important wast data. We need data. We needed it realtime and actionable. And i mentioned that i had everything the first month i was on with a opioid test and they finished this in april 2018 and when they finished i asked my cdc experts what the data was through and they said march 2015. I said is that the most recent data and they said i yes. And i said i did not know i was becoming a medical historian. I sure that, with the chair and hathe culture and others, we wee appreciated. We have a long ways to go, not just the data system at cdc, its a data system throughout the nation. In some states they have decentralized Public Health Data Collection, if states that are collecting data on pin and pencil. So this data modernization that you all started, i do believe to get us over the goal line it will acquire a substantial enhancement of the investment, were talking about building a comprehensive data system for the public of this nation. When that is accomplished, it will be a gold mine. We are able to do surveillance now in the twoyear lag and three year lag for the opioid test, we now consult in 48 hours. Hwe saw it with the molly syndrome with a ecigarettes, how rapidly we were able to detect that because we could use surveillance. I want to encourage you to continue to accelerate the ability to modernize thisin natn system and get it done once and for all. Its going to have Enormous Health Benefits for us across the nation to respond to that which we dont know when we will need to respond to, even myne short time we have a volley, deaths from marijuana, dust from this obviously, all these things, we have the acute paralysis in children. All of these things would be enhanced so much if we had a realtime actionable data system across the nation. Thank you i want to follow up with you along the lines of the Data Collection and talk with you about the Skilled Nursing facility, its no secret that nursing home and longterm care facilities have been among the hardest hit during this pandemic and data from cms suggests that 26000 nursing home residents have died from covid19 and more than 60000 have fallen ill however, only 80 of Nursing Homes that recorded data to the cdc, these numbers are only going to increase, two questions, how has the cdc worked with cms to ensure greater compliance of infections and deaths and Nursing Homes and weo when do you expect that can get this data reporting as close as possible to 100 . This is a major priority. Our group are working very closely together, this is really one of the key priorities to successfully combat the impact of his impact on Nursing Homes. We have the ability now to have these Nursing Homes required to report all of their infections to us and deaths and for us to get those into cms and for cms to face c them forward so the American Public knows what Nursing Homes are doing well and what Nursing Homes are not doing well. And we know which ones we need to go in and help them even more with infection control. I am hopeful that willio have ts completed over the weeks ahead, this is a priority, its a requirement by cms that these Nursing Homes do report, it was just a couple weeks ago we were under 20 we recently 60 and now 80 and i heard numbers it might be 90. I think we will get this done hopefully before the beginning of july, its ani priority, gett done this month. Thank you, i yield back. Congresswoman lee. It is very timely, let me just say you know and i think everyone recognizes, we have a pandemic upon a pandemic in the Africanamerican Community. So today i want to take a moment to offer my condolences to the family as we mourn and grieve his loss and hope that justice is served in his memory. That goes right into the disproportionate rate of African Americans and people of color who are dying from covid19. Doctor redfield the ppp that help the care enhancement acts which became law april 25 and mandated that they provide us with a report on covid19 data based on race, ethnicity and social Economic Data within 15 days. Now within 21 days excuse me. We received a report on may 15 and of course you signed this report, it was two and a half pages long, no new insight and what it did was link the website of data that was outdated and it was very limited on testing and demographics. In the cdc and the Trump Administration did not complete the assignment athe all. Doctor freedman, what is your plan for how you will target resources and federal response to black and brown communities which are disproportionately being hit and as you said the impact is greater, is disproportionately with people of color, how will you target everest federal response if you dont have the data and you said you wouldou provide this, i actually called on may 18 to your deputies and asked for this data as it relates to where africanamericans are being disproportionatelyly hit and i t told the cdc did not have the data to illustrate these disparities. I want to know, how are we going to get the actual data in the report quickly so we can target the federal response and secondly i cochaired the Asian Pacific american caucus of health force. Im concerned about the fact that the data as it relates to the aap i community is not disaggregated which makes the challenges to properly allocate resources into ensure positive outcomes and one of your reports you had the aap community designated, what are you going to do in terms of collecting data as it relates to the 885 pd how will we get your next report due on june 14 that tells us where we need to target these resources based on race, ethnicity and social economic status. Congress only i want to thank you for your question and first a personally want to apologize for the inadequacy of our response, it was not intentional, unfortunately its reflective of what i tried to say and we do not have the data that we needed to be able to answer not in a responsive way. And that data comes into us obviously from the state and local Health Departments but that response was not adequate ands. I apologize and unfortunately it was under my signature. I take responsibility but we are correcting it. I think there will be an announcement today because of what you all have done with the cares act, its not going to be a requirement for all Laboratory Tests to be reported to cdc to include the test, the zip code of the test, the ethnic and racial demographics, the age and the and as i said before, data is the roadmap, is fundamentally the key first step that we need to do to address thed Health Disparities that used to correctly haveo highlighted. I think many of you know i spent 22 years practicing medicine in urban baltimore and they understand the healthcare in this nation and i have every intent to get that data so we can begin to understand, clearly increasing access to knowledge of infection in vulnerable communities is critical getting testing were available so what report are you going to release today so we know in advance what we can expect. Is not a report, it is requirement that the report that the cdc will include ethnic, race, age and demographics and zip codes. We will be able to generate exactly what you have been requesting, very specifically so we willwe know exactly where ths virus is occurring. The next report to congress is june 15, will we have r that data based on the cares act. All i know whatever data i have in pushing years and my goal im not going to promise it will be perfect on the 14th but it will be a lot further along than the last one and we will get this solved, if not by the 14th, then by the next one. I know my time is up but let me ask you will the aap i data be disaggregated, we need that because otherwise we will have l true picture of where to target resources. We will try to make sure this data is forward facing down to the zip code level. Im asking does aggregation based on the aap the Asian American Pacific Islander community, will you saying the chineseAmerican Community, this is the data and the filipino community,memm the japanese amen community this is the data. This is aggregating. That ill have to look into but ill take your concern and recommendation that we work to see how to accomplish that. Thank you very much. Pgh thank you, madam chair and thank you, doctor redfield for beingan here. I have a difficult question for you, i think its really important to understand what we can do to not be in this place again. I value so mature work in your many sleepless nights in the work ofyo your agency, i know ty have been on the front lines, i was reading an article, i saw an article from the wall street journal and i saw one from the times today of cdc and testing. One of the things that was quoted former officials and the cdc said the cdc culture locked agencies in a place to of consequential failure and the inability early on to provide state laboratory around the countries affected diagnostic test. And then if i fastforward im not trying to say im not trained to take a figure down despite what everybody is probably thinking, i want to understandne this. I understand that the Public Health emergency was on january 31 event that any lab had to get permission then to get approval to do her own testing. Basically it was about a month later before test started really slowing, early on the control situation was aggregated, whoever made the decision that it was aggregated in cdc was going to produce the first test and send them out to the states. What we now know, those tested not work. They were sent to Washington State and they had to send them back. Ultimately what i feel like happened was, we have to have diagnostic testing ability and we had to ramp that up quickly in order to stop infection. Now were out of place of new infections for reopening and thank goodness the private companies were able to step up, we broke down the bureaucracy and they were able to step in and fill in homes. I know my community, my local health, i spent months trying to get testingin capability or private labs, i know because of relationships within the vancouver clinic in southwest washington they could use theirl relationships to kit that going. It was like everybody was doing their own thing to d make it moe forward and we are trying to break down the bureaucracy. The wall street journal says back in april that an fda official in the cdc headquarters visited the law and prepared the test in the lab was a mess and it became clear thates the test had likely been contaminated said one person familiar with matter and then they distributed pulled back the test and theres been an investigation and i am not seeing the results are. I know that your heart and soul is toou protect and to promote e Public Health of the people in this country. Theres no question about it, your long career which we are praying for. In recognizing these problems, my question is and i keep hearing we just need to put more money into Public Health. I agree and i want a realtime active data system, but this committee in a bipartisan fashion had increased funding dcfor cdc, we instituted a Rapid Response team, we say yes to Public Health request, we really have and yet here when it all counted some people in some places made decisions that this was going to be constricted by the federal government, the federal government was good to be when the innovated and distributed, i dont know if all the money in the world can fix what some have called a cultur culture this is the New York Times, the culture ofim the cdcs to improvise in a quickly evolving crisis. , when i read that, i dont think the cdc, i think you guys are doing what youre doing in your lane. But when it when we all be better served if the doors of collaboration open at the very beginning, and it was not public llalth or private and i we got our challenges with regard to qwest and labcorp. If we wouldve thrown open the doors and said together we willd move forward and i would ask you, do you want your legacy to be building a robust Public Health system, could you legacy include fixing something that is a silent approach within the cdc and that will require you to fight upwards, not just downwa downward, is that something youd be opening to consider in terms of writingyo the shift ina pretty god is on the fall but it could be, is that something you would consider . I appreciate your comments, a couple quick things, i do believe to level the field is at the cdc developed within ten days that it was published. That is not a flawed test, works perfectly in admin january the diagnosed of the original cases and in order to get the test you had to send the blood to the cdc. There was number moment in this nation when any Health Department could not get the test, they just had limitation. There is no question their shortcoming of cdc. I have to push back on that, my Public Health department could not get that test. Im saying if they chose to send it to cdc they could get the test. Thats what i was sayingt. Congresswoman. We always have that capacity, the shortcoming is we tried the manufacturing the test so each health apartment without their own. I dont think youll see cdc and the manufacturing position anymore. In that time there was a shortcoming in a contamination, there is an inquiry to figure out what was there and why happen but i will say within five weeks it was corrected in for me within five weeks of the sequence we had the testing now available in the public which some people may think is delay and is a time of a new pathogen to have a test of n public healh around the country i think that is still an accomplishment. Let me added there, that six weeks, that six weeks was the six weeks that we had to get ahead of this virus. Et that six weeks you said five weeks, on generate 29th to february 29, thats when we shut down and weird digging our small business, were digging everybody out i know as a brawler just that is good, we have to change a culture of the organization and that was a five weeks that we had, that was our lead time. If i can make one last comment. Can i make one . I know time is up, i will go through the other comments because we can talk offline one that. But the issue that really has to happen in one thing we have to correct is a day cdc got in the lane to make a Public Health test, the private sector had to be in the lane to make a test for the rest of america, it was not cdc, they make the. Public health lane, and took unfortunately weeks and weeks for the private sector stepped up and develop what we have over 17 million test, the privatete sector is in the game, the Public Health is all small part but that has to change to. Thank you, madam chair. Congressman. Thank you very much madam chair thank you, doctor redfield for being with us, they have a lot of questions, if you can be as concise as possible i would certainly appreciatenc that. It was in third earlier by Ranking Members and i think you answer the question we dont have the worst amount of cases in the highest amount per capita on the planet is not correct. That is correct. However, according too your data we have had over 1. 8 million cases of coronavirus, that is nearly a third of all cases on the planet and by far the most of any country, is also correct . Of those that have been reported, yes. Also wee had 106,000 deaths and by far the most in the world, is not correct. Again those that have been reported yet. The debtor is 320 per 1 million which is six times the reported global average, is that correct. I would have to double check that, i dont have that figure in my head but i have confidence that you have data there and id be glad to check that. Thank you. Theres only eight countries out of 195 countries that exist on the planet that have the worst ratio per capita, qatar, san bernardino, beran, kuwait, luxembourg, singapore and chile. Altogether there population are 33 and ahe half million people, about a tenth of the United States. Its not exactly impressive to say we dont have the worst but for almost every country we have the worst amount of cases that are out there, do you have to agree that countries like germany with the rate of 220 out of 100,000, new zealand 31 out of 100,000 in 22 out of 100,000 have been more successful than the u. S. In controlling the spread of the coronavirus. Based on the reported cases that we have, that would be correct. One of the problems that we have in the United States fortunately is back in mid april, your agency was putting together detailed stepbystep recommendation for businesses, child care facilities and other restaurants to reopen and that got sidelined for a month in fact i think it finally was on may 20 you released those guidelines that on may 14 he put oa decision trees, who made the decision to delay they guidelines. All of these guidelines that we had developed. The question is who made the decision. I was just trying to answer, these guidelines, forming them was a reiterated process, is not a question of delaying, is a question of competing the process to make sure the guidelines had the input. Who made the decision specifically that they would be released on may 20 rather than anytime soon or. It wouldve been me. And were you at all and complication with anyone at the white house and if so who. We were working again to the innerr agency group, that has multiple agencies that have input when these guidelines crossover, as they mentioned its a collaborative i can tell you that release, and states like wisconsin or the state Supreme Court and other states were opening they came after all that happened and it created a lot of chaos, we had a spiking cases after that. The me ask you another question. We know that chemical agents that are similar to teargas and teargas itself can cause people to cough which can spread covid19 is that correct . Definitely coughing can spread respiratory virus including covid19. And teargas and chemical agents like teargas can cause people to cough. That has been my experience. Have you made any advice to the president into any agencies in the military to not use teargas for chemical agents for the recent protesters of because obviously that could cause an increase in covid19 due to the coffee. I think you raise an important point, we have advocated strongly the ability to have Face Coverings and masks available to protesters so they can least have those coverings which raises an important question. Would you make that recommendation . I will pass on this, to the next task force meeting. I appreciate that. With six seconds left i will yield back. I think the gentleman. Congresswoman clark. Thank you, madam chair and thank you, doctor redfield. As you acknowledged in your opening comments, at a time of national anguish and turmoil, this pandemic did not create inequities disparities or racism but has magnified the lethal effects of all of e those. We will only emerge through this publicis Health Crisis, this economic crisis in this moral crisis, if we demand that our american ideal of equity truly applies to each and every one of us. Doctor redfield, the cdcf websie contains pages off information n the Health Outcomes for people of color, higher rates of asthma, heart disease, diabetes, to name a a few. I understand from your answers to congresswoman lees question that tomorrow you will have an announcement or two they about mandatory demographicry reporti. But was an eminently predictable that covid19 would disproportionately impact black, lot next in indigenous i communities . You know congresswoman, i dont know but its clear, once we understood that individuals with certain medical conditions right greater risk once we step back and understood certain social factors in Living Conditions would be critical and became radically selfevident. Is played out very quickly and evidently in my district and i think its true across this country. And we have to do better. This plan that youre putting forth, is it a written plan that you will be sharing with specific benchmarks on how you will collect this data . The announcement that is coming is coming from thes secretary of health, its not the cdc but it cdc that will get this, you highlighting is an important area and those of you who have been able to visit cdc, the whole area of Health Disparity in the whole area of social deterrence of health and the whole area of making purposeful meaningful progress in this, not just for coping but for all the Health Outcomes that we have. I did mean when i said the time is now to get a purposeful program to address these inequities. I have visited the cdc and i appreciate your commitment to that but in this particular case with this pandemic reaction, there was public outcry and outcry for members of congress and pressure to have this information. I am interested in who wrote this plan that is going to be released today. Is that the cdc or someone with hhs. I understand the care act will be announced. Do you know who wrote it . Its onee the plan is a response. I requested that we get a plan so we can make sure that we collect this data, going back to the other point, we have seen native hawaiians and Pacific Islanders have the highest covid19 rate of any race group in california. And in many states Asian Americans have a case fidelity rate significantly higher than the overall population and i hope you will do more than look into the disaggregating of a api information and you will make it happen. I also hope you will of the lgbtq community, june is pride month, its a great time to add them to your forms, your surveillance forms in particular a person underur investigation r in your website also states that a lack of Health Insurance is one of thehe reasons that communities of colors faced systemic Health Disparities in a particular they have been hard hit by covid19. His innate your professional opinion that dismantling aca in the Administration Proposed budget cut of 1. 6 trillion to Medicare Medicaid could actually harm people in their particular people of color in this country . You know congresswoman, the way i can answer this is i share with you, the deep commitment ndat all americans get access to highquality healthcare and that we effectively address access issues. Do you think there is a way to address the disparity of healthcare in this country without expanding rather than reducing access to quality affordable Health Insurance. I think we clearly have to make sure the allamericans expand the ability to get access to highquality healthcare. The manner in which we do that, im not really here to comment on that. Im not asking you to comment on the manner im asking is there any way in your professional opinion to address these disparities if we do not expand rather than contract access to healthcare inon t this country. I am friendly with you that we need to continue to expand access to highquality healthcare in this countryry for everybody. Thank you, yieldnt f back. Congresswoman. Thank you, madam chair, i want to think your staff, i hope i said her name right, she set us up well for this and im finding this meeting very enjoyableve even though im sitting in a home that makes it even better. Thank you, doctor redfield for your service to ourur country. I have a few questions. First of all doctor redfield, do youag agree that the cdc mighte learned more about the virus in the domestic response had we had a greater Global Presence of the days and months leading up to to hire people to help augment the epidemiologists and then look at the resources we gave them and home americore win be another source but we have to get it built between now and september and get these Public Health work forces up and in some states it may be 500 other, states may by 5,000. Were in the process of doing that state by state by state to help them understand the work force they need. What exactly are you doing to build the Contact Tracing work force. Were really a couple. We have over 600 cdc people imbedded throughout the country, but we have through our foundation, our foundation the Cdc Foundation is there to hire for the states additional personnel, and we can augment that substantially. That process is ongoing. And in addition obviously we have disbursed the resources that you all have given us to the states to encourage them and some states have already, i know, hired on their own over a thousand individuals that are being trained as contact tracers to work under the supervision of the people they hired through our foundation, and well continue to do that, and lastly, im hopeful that americorp will also be having a Public Health work force that will provide more longterm augmentation of this Public Health work force, so, were working state by state by state to see them augment and as i mentioned some states hear already augmented over a thousand. Finding that magic number i dont i dont know. Too think in some states its going to be over 5,000 people, maybe 10,000, other states its going to be 300 to 500 people. But it is fundamental that we have a fully operational Contact Tracing work force that can every single case, every single cluster, can do comprehensive Contract Tracing with 24 to 36 hours, 48 hours at the latest, get it completed and get it isolated so we can stay in containment mode as get into the fall and winter of 2020. Thank you. Madam chair if i may follow up with one more thought on this Contact Tracing, is were watching all these Peaceful Demonstrations and i know a lot of people are very close together so i just would like your what too you advising the states if the number of cases overwhelm Contact Tracing ables . I think the first thing i would like to see is those individuals that have partaken in these peaceful protests or been out protesting, particularly in areas who have no minneapolis and d. C. , we want those individuals to highly consider being evaluated and getting tested and obviously good from there. Because i do think there is a potential unfortunate for this to be a seeding event and the way to minimize is each individual to protect their loved ones and i was out i need to go get tested, make sure youre not infected. I dope think you answered the question but the question was what are you advising the states if theyre overwhelmed and dont have the contract tracer. I want to work with the states. Agree with tom freedman we need to build the work force and need to work with us now to make sure they have the theyve overprepared. This i not an area you need to skimp and be underprepared. This is the time be overprepared and if you hire extra contract tracers you can wife with the hiv Elimination Program or vaccination or Maternal Child Health program but no at time be understaffed. Thank you, madam chair. Yield back. Congresswoman. Bustos. Hell, everybody. Thank you, dr. Redfield. Appreciate your time today and thank you, madam chair for putting this together. Back to congresswoman frankles point, my entire screen disappear right when i went to go and use. So this is were all learning i think we are allll learning ts together but doctor redfield, many of my colleagues congresswoman clark brought this up a little bit ago and congresswoman lee did, i am very concerned by how covid19 is impacting our communities of color. I would like toeh start their wh my final questioning with you. Im from the state of o illinoi. Africanamericans wer represent of the population but nearly 30 of the covid19 deaths. Hispanics represent about 70 of the population illinois and 31 of the people diagnosed with covid19. I will drill down to my own Congressional District i live in downstate illinois and i want to look to my district, Winnebago County which is the farthest northeast county in my Congressional District. Africanamericans make up 13 of the population at 25 of the covid19 cases. Emporia which is the southeast of my Congressional District, africanamericans make up 18 and 36 of the covid19 cases. Rock Island County is where i live in sitting in the Mississippi River is to my left and that makes up 13 of the population in 22 of the covid19 cases. Doctor redfield, given these facts, i want to ask you how social determinist can fuel such disk entrances to six in further, the southern part of the city of. Africanamericans states with serious food desert issue, i heard a story of a residence or who literally had to stop at 16 stops while gainin getting to ar productive only way they had access to fresh produce. My question is this, can limited access to healthy food increase poor Health Outcomes and lead to issues like diabetes and obesity . Do such conditions put people at higher risk if they contract covid19. Thank you very much congresswoman, you hit on a critical issue, something i would love to work with, the social determinants of health as a laboratory scientist, i kinda shrug my shoulders and i dont know if thats going to be relevant but obviously data is the key and i happen to be data driven and ive seen overwhelming compelling data that childhood does do that. I would like to work with congress to develop the mechanism for this nation to understand longterm which ones are the most important, i talked about trying to set up a study over the next 20 years that allows us to kneel down firmly, is at the grocery store, the first area, violence in the home, what other critical social determinants. But to answer your question directly, there is no question, there is no question that the social determinants of health has pertainedrt access to qualiy food and have enormous Health Outcomes. Lets drill down a little bit, part of this and my line of questioning, i want to make to the point, i think runag the sae page here and i hope my colleagues are as well. Further, there is a 2018 Health Council report that says two out of five black residents are below the 100 federal Poverty Level in the rockford region, that the farthest northeast region of my district. Doctor redfield can you talk about how poverty can lead to negative Health Outcome income Poverty Levels put a person atn, greater risk of contracting covid19 . I dont think theres anyue question. What i would like us not me but hopefully my grandchildren or maybe in the next five years, ten years, 15 i would like us to understand exactly which social determinants of health of the most influential and get these things corrected. We dont have to wait for an answer to startm correcting them because some are obviously intuitive, but i do think this is the critical Public Health issue over time, the social determinants of health. Thank you, doctor redfield, and my five remaining seconds what i would like to point out is a bill called the social determinants of health excelerator act, i want to draw that to the attention of my colleagues and doctor redfield, im hoping that this t is something that not only will have a debatear around it but ao pastor congressional session. Thank you very much i yield ba back. Congresswoman. Thank you, madam chair, thank you, doctor redfield for all your testimony this t far. I want to follow up on questions that have been posed to you. It is supposed to break down in the demographics and how its affected certain populations. Will the information was coming out on the 15th include the number of positive cases by race, ethnicity et cetera, the number and percentage of deaths under those categories, will they be broken down to the degree. Just to clarify again, this is the beginning of finally getting the data that we really need to do all that you i just ask. Is not a no. That is not a no, im saying its a beginning to have the data to get the report in the manner that you ask. The first step is to get the data, that is what the announcement is later today that the data is coming to us and that gives us enables us to give those reports and the granular detail. With the granular detail be in the report coming out on the 15th or are we waiting for a later report. I will give you all the data that i have at the time. You not answering the question. I will give you the data that i have and thats really all i can do. Reclaiming my time. When will testing be available to anybody who wants it and thinks that they need it. Do you have any idea. I think the key on this testing is to be a decision between the individual and their health provider. Im simply asking, is there anytt impediment to anybody and getting testing he wants to be tested if they have a a doctor and the doctor says yeah, is there any Testing Capacity that exist to meet that need. There should not be an impediment congresswoman. If they dont have a relationship with the doctor and youre just an uninsured individual, how do you get tested. Theres a variety of different testing sites have been set up and i think over two thirds, 70 have been set up in areas that are considered socially disadvantaged, those testing sites are there and available for the American Public. If are going to consider reopening our economy, is there any science that informs us what percentage of a population needs to be tested and their information before we know that were in a a healthy mode as opposed to a curve simply because of a few numbers wein ae testing, is there percentage of the population, i know each state would be different in terms of the number but is there a percentage of the population. Thats an excellent question. What we have is estimates from the w. H. O. And others that the threshold of being adequate inqu your testing is when one out of every ten tests that you do is positive. Thats how many based on how many are testing. Im asking you, what is the percentage of the population that should be tested. I dont know the answer to that question at this pointen in time. Other people in the Science Field who feel that they have a handle on that and if so would you find out ensure that information with a. Yes congresswoman. Thank you. Earlier on in response to representative, you made some comments if this were a global threat, is this not a Global Health threat, this pandemic . Yes it is a Global Health right you mustve misunderstood me. Then should we not be connected to the world health organization, have you have any position on that and have you given the president your wisdom and your advice on that . The w. H. O. Continues to be a close colleagues of ours humor currently working on outbreaks. We continue to have a closed operation with the w. H. O. Thank you, it does not seem to be a priority of the president. I will ask you a question abouto the ozarks and the wonderful time that they had a memorial day and the launching of the space shuttle. Even though those states may not have asked for your help, because there is a possibility of additional infection or higher rate of infection because those people were so densely integrated into whatever they were doing, is there a role for the cdc to be proactive in reaching out to them to see if we can get a handle on what possibly could be a problem before it becomes a big problem and if so what would that be. I agree with you, we do routinely reach out to the different state Health Officials and offer our assistance and in those circumstances i have 38 teams out assisting different states and territories with the different outbreaks particular in the area that you mention Contact Tracing. We will continue to emphasize that obviously there are colleagues in missouri and florida that we are prepared to provide assistance if they would request us to come in and help. Thank you chairman, one last thought, given your experience in your interest in this area, was it not obvious todc the cdc that the africanamerican communities would be bis proportionally negatively impacted by the covert from the very beginning . Again congresswoman, i think we have and will continue to work. For you. Impact of this in the Africanamerican Community and we have the challenge we have is we havent got the data we need so that we could give the American Public the analysis and again were going to continue to commit to get that data so we can do that. Thank you, doctor. I guess we have 0 go where the action is, thank you, i yield back. Thank you. Were going to begin a second round but it can. I yield back. We will begin a second round but only two minutes doctor redfield has a hard stop at 1 30 p. M. That we can only go to minutes. Tried to be as lenient as i can because it is a critical hearing and people have excellent questions they need to have answered. Andith that i will start a we will talk about vaccination and the influenza vaccine campaign. Doctor redfield, you said in april the need for enhanced Vaccination Efforts this fall for seasonal flu as you noted with the coronavirus epidemic would be at the same time to put a tremendous p strain on the hospital system. Yes or no do you still stand by your april 21st question or your answer . Yes. We will have a difficulten time. We have to be prepared to deal with that effort and we will also have companies around the world racing for the vaccine for infrastructure medical supplies workforce and a bunch of unknowns which have to do for supply et cetera so explain that aspect of a massiveam Vaccination Campaign what activity and what is the funding capability . If you can do with all the funding now i want tous budget and negotiations while we are dealing with the senate on the heroes bill. N is that in reference to influenza . The vaccine but also answer the question on influenza what we need to do with regard to that spectacle the one the coded vaccine effort is moving very rapidly. I will leave that there it is my expectation we will have one or more vaccine available. The infrastructure. For putting this together and a budget for putting this. Together we need it now. We can get back to you. I want to emphasize the importance of flu vaccine and we are leading that effort to etget the nation to accelerated only 47 percent of the American Public took advantage of the flu vaccine we are hoping the American Public will see the flu vaccine is one major way to help the nation get to theon fall. That will be a further strain on the system of this virus. The death rate in the United States 333. Nine per million the United Kingdom 556, france 433. Spain 5380. Belgian 539. Netherlands 347. Sweden for for sex. Ireland 341. Those are advanced countries with firstrate healthcareth and frankly likely to produce numbers that we can trust. Personally for the record i dont trust numbers coming out of russia or china or iraq and the rest of the world doesnt have the infrastructure to give us with the tasting capabilitie capabilities. Japan 7. 1. New zealand four. Five. Taiwan zero. Three. Hong kong zero. Five. I say that clearly there are places that have done this better if we have lessons to learn but i want toar be clear we are not the worst in the world and this data is interesting to compare because its not the same data from the same source so near and dear to my heart with a few seconds left recent data from university of california that tribal nations were states s the five with the highest infection rates in the country would all be tribal nations. On a per capita basis five tries have more coronavirus cases in the state of new york. And with the infection rate more than doubled given that challenge of that community can you tell us quickly what you are doing to help tribal nations deal with this . Its important clearly the native American Community has been disproportionately hit we havent been able to award for what you granted cdc almost 60 million with 200 million to help give them thepo Financial Support weve also provided a number of Rapid Response teams from indian countryy to basically provide Technical Assistance with more significant outbreaks as you know to help them with the Community Mitigation as well as some of the unique challenges they had to deal with the water security and we will continue to augment the ability of theal tribal nations in terms of both Technical Assistance and resources because they are disproportionately affected. You are on mute. We can hear you now. Doctor redford. First of all let me acknowledge under the leadership of both congresswoman as has been mentioned efforts have been made to address the serious short policy dc funding. With the local and Health Departments resources and still to have the antiquated infrastructure. There has been discussion during the subcommittee you have received billions of dollars to address covid19 and also it is anticipated you will be seeking more money under the heroes act. Can you explain to the committee the difference what this supplemental funding pays for and the base funding that you actually need to address the shortcomings of the cdc infrastructure and core capabilities . And quickly please give your opinion with regardspl to your predecessor tom friedman said to create a Health Defense operations but is it budget designation that would exempt them from the budget control act spending cap so we dont have the same situation where cdc gets money through a supplemental to Public Health crisis and then we go back to the erosion of funding cdc. The majority of the funds that we receive from the supplemental we have pushed out to those departments to give the Immediate Response capability and that cdc more than 5000 people that we have moved to help support this response was directed at the Immediate Response activities as well as building that capacity in the states that we mentioned with those rapid ready testing and isolation and the issue many states dont have the capability to isolate people that dont have adequate housing this all has to be built. The real challenge that has been alluded to by the chair and the congressman as well as yourself is how do we get thissn into longterm base funding to make sustainable progress in the core capabilities. I will just say i dont know the best way to accomplish that but it will be very very important. I think the comment you also work with the Emergency Response fund the ability to have emergency funding the way things happen around the world is important. If i am correct despite real being greatly increasing the test so you can confirm more cases, we are down 40 percent from our peak . 32000 down a 20000 . We average about 20000 per day. We are down 40 percent despite we opening and more testing. So that is evidence i guess that we really are on a decline in now is the time to think aboutut s reopening becaue we cannot stay shut down forever. You but up a point the cdc is expected to be the foremost Public Authority in the world that needs cooperation with other authorities explain the cooperation between chinese authorities in cdc in january when we really needed einformation about this epidemic that would become a pandemic . As you know we have an office in beijing. It is limited in its staffing although i have augmented by another technical expert. I have been in regular discussions with my counterpart the chinese cdc director over the newr, year and we did have discussions about an unidentified illness. We did request an invitation to assist directly and in particular after the coronavirus we reiterated that formal request at the levels above him to grant that unfortunately we have not been able to haveci that scientific interaction we requested. Is it also because they consider cdc the world leading expert in Public Health or was a political . It was a rhetorical question. I know you cant answer. I assume the release of the Genetic Information was held back until it was reported outside public channels. The bottom line is you cant do your job if you dont get cooperation and we didnt i yield back. Meeting next week with a black hispanic native american members of congress its a very important meeting and we thank you for that. Second let me say what it relates to what we talked about i am really surprised to hear your response doctor redfield because we have a roadmap the National American dental association and all the africanamerican doctors Asian Pacific americans the hispanic community, we have a roadmap on how to deal with the social determinants of health care. Even mr. Thatcher came back in the day and i was surprised and disappointed in your response it takes the political will of this administration to address that so we need to discuss that with you further. We cannot wait we know those social determinants we have a roadmap that has been completed for many years on exactly how to express that. Me ask about Contact Tracy because of the sensitive nature of this work we want to make sure ou Contact Tracing is from the community, trained and provides a sensitive type of work. Can you complement on the protocol not having people coming into the community but how they are trained to provide this type of work t wor. I am very familiar with the thatcher report and i have hardly one high regard for it it was a critical 29 turning point i was trying to raise the idea to get scientific proof but not waiting and i look forward to working with you on that. On Contact Tracing i cannot agree more its the same thing we discussed we need to have trusted members of the community to get the work done. We dont need outsiders coming into the communities to do this work we have a significant Training Program and we have to expand the Community Base of trusted individuals to do this work. I cannot agree with you more. Thank you madam chair. Let me ask you a question about supply we had a trouble getting supply from the federal government around april 8 that we would get them from cdc and in april we have less than 1 percent of those requestedat of all the information request i find it confusing that of all the ppe one out of every five items that we need and then the weekly get them from public labs from the state when there are 60 labs doing covid test we need more reagents in the state were not able to get them right now from fema or cdc. Longstanding to support the Public Health labs is the mechanism for the Public Health labs. I know we have been transitioning to the private sector providing for the enterprises to me look directly into your request to see if i can get better clarity and get back to you and your staffeset s on. They say cases are going down that this morning last hour tweeted we are slowly expanding the number of cases according to a Morgan Stanley reportrtbe that there is no consistent standards for people reopening what did we do wrong that we are the ninth first in the country only behind iran and qatar . I do believe and we have our response i dont want to get into the million the numbersit we had after the slow start we had about getting the private sector engage not to say at the end of the day its not where it needs to be that i will say that each day and week we continue to make progress and we will continue to do that i will look at the specifics of your question related to where they are coming from. Congressman graves did not get his five minutes and for the first round he is recognized for five minutes. I come to you from georgia thank you for your service we are grateful for your work. I want to go to Antibody Testing of how we get those fda approvals and just to get some feedback and what we can expect . There are a series of Antibody Test that they got out of the market that a number has been pulled back but there are a series of fdy i get you the names that are quality test so what does antibody mean cracks we dont really know exactly what that means. If you have a valid antibody it means you have been infected at one point we dont know how long that will last. But when does the Antibody Test mean you are immune . That is what we are still trying to find. To understand the full extent during this initial experience they are still susceptible for us to understand what might be coming some cities is much different but that is the key with it has critical applications are not we dont know. Seems like theres a lot of potential for fraud. And you also share with us with the reliability of the testing as well . Your point is critical we can get you the actual list of testing that we know we do not recommend if the fda is asking to get off the market and then another group a that has performed well i can make sure you get that. Ortho was one of the main ones we have been using for Antibody Testing i can get you that make sure your office has that. Talk about testing with covid19 is there any value testing forr antibodies . I know many dont get tested because they are concerned they currently have the virus is there any value testing for both simultaneously . Do you believe Antibody Testing something previously from covid19 testing . The challenge there is just trying to understand the Clinical Utility of the Antibody Testing is cms and we will pay for the for specific clinical indication my understanding is they do currently pay for it with that the understanding you been previously infected by theha virus that is the one part. I was going to Say Something else but im having an adult moment in the first part of your question. Should the test be iconducted simultaneously . The one area that has major clinical relevance his children weve seen is hyper inflammatory syndrome we are seeing in children luckily it is very rare bad it occurs post a Covid Infection and it does help understand that is the causation so we do use Antibody Testing to try to find cases of children with this new rare inflammatory system. Ue may think the answer to your question to be honest and transparent is i know i dont know. So we really dont know what this Antibody Test means right now if they test positive it sounds like we dont know if thats a protectant or how might it last or for how long. That is correct it is one of the critical things he will learn between now and january. Thank you again and thank you madame chairwoman for letting me jump in a little late today. , talk about one minute about the disparities and outcomes if the cdc has made any e effort to ensure the public test sites are installed in communities of color . That was orchestrated by the assistant secretary of, health i dont have the exact number but i can tell you between 60 and 70 percent per put into areas basically in areas that had social disadvantage sites but i can get you the exact number because there was a direct intent to open the sites where the federal government open these testing sites that are being developed with cvs and i can get the exact information to you but it is substantial and the answer is yeses. There has been a recenthe investigation saying it showing up more and wealthier in wider communities and we want to make sure we are putting our scarce resources where they are mostls needed and not everybody has a car. I agree. Very important. Going back to what my colleague mentioned briefly which is the who. Back on april 15 you said we have a long history of working together in multiple outbreaks throughout the world that im ngrd to hear you say you are continuing that relationship. Do you stand by your comments in april and feel this is an important partner for us at this time with a Global Pandemic . Yes in the last couple days i was telling the chairwoman before thete started we have a new Ebola Outbreak in the western congo we jumped right in with who. Has this Committee Administration completely severed our ties are you worried about the impact to develop our access a vaccination . I dont want to get hypothetical. I feel confident the Public Health partnership that we have although modified in some way at a political level i dont think it will be modified with the Public Health efforts. Thank you. Thank you madame chair. I have a softball question. Older adults represent higher risk of covid19 with hospitalization and mortality rates and cdc correctly has told us to stay home but now we see that isolation is exacerbating loneliness making it more difficult to obtain food and to be physically active. So would cdc benefit with an increased collaboration during the pandemic to meet the Public Health needs of Older Americans t . You raise critical critical questions. As you said many Older Americans who have stayed at home have also had negative consequenceses of isolation and lack of human connectedness and other issues they are maintaining with critical activities that may be not necessarily have given medical care for those chronic illnesses that they need. We are committed to continue to work to figure out that maximize the health and wellbeing of these americans in any way we can assist. I know this is an important issue for you and we arend prepared to help improve that. This is a critical target groupro unfortunately for this virus. I am 68 and i am in that group of Older Americans. Just to remind you come i know we talked about this, but filing Bipartisan Legislation that we establish a Resource Center for Older Americans within hhs with the aging Grant Program at the cdc. I yield back. Thank you madame chair. We have seen large outbreaks of covid19 unfortunately communities and prison staff is put at risk because of your presence continues to transfer inmates without first testing withd covid19. This is in part because the cdc guideline do not recommend testing inmates before they are transferred even with those cases if the transfer is absolutely necessary to perform verbal screening and a Temperature Check so as a result a few weeks ago they transferred 19 inmates from the chicago prison where there are cases of covid19 to a prison in my Congressional District were there were zero cases and they did this without first testing all inmates sent out two of those have tested positive at our present which by the way there are no hospital tt lo where the hospital is located so those inmates testing positive with covid19 we have that but then for weeks because of all of this going around i was pushing the bureau of prisons they said they cannot test before transfers because they dont have adequate testing supplies what is the cdc doing to test capacity is should they be tested before they are transferred with cases of covid19 . I am hoping you will end this by saying he will update your guidance those are my two questions. You raise a critical issue we are learning as we go along one of the areas we prioritize y w when we talk about the 10 billion of the outreach with that testing strategy with their priorities we have given them is that comprehensive surveillance strategy to be tested and weekly testing for the workers in the nursing home to develop their prison guidelines that is debated back and forth but there is a strong sense of getting everybody tested in the present a new people coming in i cannot tell you where that will land but we are discussing that now and encouraging states to use the new testing resources to accomplish that the same goes with homeless shelters and studies they are critical areas light like meatpackingre plants that we need this expanded testing. We can talk more offline i m yield back. Doctor redfield i want to explain my concern about opening up various y states for those that need to be tested as part of the population son may be testing more than others some may have more relevant data because they are testing more for the state next to you is only a fraction is there not any kind of guidance and with that opportunity to open up . I know that threshold is at least 2 percent summer at 10 percent and you have raised this earlier and again and those to discuss because it is clear to benefit from this guidance. When the aca was passed ten years ago there was a section where the cdc had a responsibility to collect information and those data requirements with congresswoman lee and those and creating something brandnew and then dad operation. So that means your form is out of compliance with the aca and a law passed ten years ago . The form for case reporting has that information where the challenge has been with the actual Laboratory Test results and historically that is not something that was necessarily independently reported to cdc that data we do have good racial ethics and distribution and we know where its comingndd from. But also for the test results and they come in without that information now every test result every positive or negative will have those that we discussed. It will be very helpful for us to have an additional sense of information based on testing. I yield backoaoa. First thank you for holding this hearing it is very informative i want to thank all the members of bothde t sids with the participation the questions were good also i want to thank you for being here you have one of the most baportant jobs of the United States and probably one of the toughest i appreciate you publicly chief of staff to make that possible in the chair talks of him directly and cannot be more helpful to make it possible. We covered a lot of ground today and i think its very good a loty this is driven by coronavirus the massive supplementals that we have devoted much more money to this then your normal entire budget and have done a tremendous job to move this through the chain at cdc to the state and tribal partners to deploy these well. It acknowledge the hardworking staff i also want to close by saying i am confident that congress would continue on a supplementals with the longtermeedidi fundind to talk about that the opening remarks this committee and congress frankly are dealing with the budget it does not apply now. That the Defense Budget is one thing december 1st 1941 very different 1942 this is a biomedical pearl harbor we need to recognize that and not just deal with this but build the capacity but spend billions to save trillions we know the cost of this to our economy and country we need and the leadership with the bola the supplementals can be helpful and with the supplemental runs out. We need that longterm thinking because we know we will be dealing with this in the fall for the foreseeable future and also we just got one heck of a lesson from the biosphere and how even when we think we have done pretty well, it wasnt nearly good i enough. We will work with the chair to make sure you have the resources and that this committee has the resources to invest to give the American People the protection that they deserve and require to work with our friends aroundus the world. We do this for ourselves work with others appropriately so this is a Global Pandemic there are no isolated countries, we need to Work Together thank you for your leadership in that area you have been a visionary for this a long time talking about this before dealing with this crisisnk thank you madam chair for the hearing. I think the gentleman and my friend its good to partner with you on these efforts and thank you for being here today mr. Redfield. And a representative harris said we been successful to reduce the cases byhe 40 percent from the peak of 32000 a day down at 20000 per day so we are ready to reopen and i just reiterate what we talked about in march to declare a National Emergency with 556 cases all underdeveloped countries have cut cases by 90 percent or more before they reopened the federal position seems to be we cant do what other countries do so we just have to live with 20 new thousand cases per day that put us all in danger in my view. I agree with my colleague we need to have longterm funding with capacity but i would just say this to you doctor redfield because you made a comment that the doctor that had the lead role in the response to this was grounded at the cdc that is no longer the case. You are no longer at the center on this issue. It has gone to fema and to the white house. I will be very honest withld you i want to filter capacity and get you the data to be science driven but by god i do not want your science and your Health Experts challenged by people who do not know and understand either science or Public Health and i would like to add we have talked about this at this hearing, your guidance change and delay and the duplication the National Health and Safety Network hhs shows a message from this administration in my view that cdc is being undermined. It violates every rule in your 450 page manual all of the lme. Talk about lysol. We need credible messages, credible guidance, we need to hear more directly from cdc experts and the h media briefing. One more comment from you and one more thing to say your briefings stopped you had daily briefings and they stopped and they need to continue and i hop hope, we finish will you continue this daily briefings . That is a yes or no answer. We had a weekly. And we how those back from last friday. And then to meet every other week. And the publication in nature to analyze that Economic Impact in the conclusion we need to focus on Public Health and to reference these photographs i showed earlier. Reopening before the virus is under control to put economic recovery at risk. And until we get that loud and clear with the Public Health community, we are not going to succeed economically in my view. The number of tests every day and knowing that is important. We need to do is testing and where they are not. I am and i science of doctor redfield i dont have scientific knowledge that most of us do not what we do is provide the resources that allow you and your colleagues at the cdc to do what you do. So wee have reliance let me just say to you, dont be afraid. Stand up. Talk about what your scientists do and i will tell you that we will provide the resources that you need to do your job there will be a great reluctance speaking for myself, on my part to go further because theres not a partnership Going Forward. Thank you for your service thank you domestically and internationally. That is where your heart and soul lies in the science. Let us hear from all of you on that. Thank you we arere adjourned we are over or closed or whatever the proper word is. Adjourned. [laughter] it is adjourned. Thank you. [inaudible conversations] [inaudible conversations] [inaudible conversations] lives seeing a loss of confidence a wave of cynicism unable to trust we are told by anyone who calls themselves an expert it is difficult for us to rise to a challenge like this the first reaction is to say know they are lying to us in a lot of National Institutions will take on the challenge of persuading people again they exist and are here for the country. Dehumanizing people humanity is infinitely diverse the bonds of common humanity must overcome the divisiveness of our fears and prejudices. President clinton remarked 57 years ago doctor kean dreamed of a day when is for little children were judged not by the color of their skin but by the content of their character. Today that dream seems even more out of reach me will never reach if we keep treating people with color the unspoken assumption they are less human. President bush said this tragedy and other similar tragedies raises the longoverdue question how to and systemic racism in our society the only way to see yourselves in the true light is to listen to the voices of so many hurting and grieving those who set out to silence those voices do not understand the meaning of america or how it becomes a better place. President obama who delivered his message on social media said it falls on all of us regardless of race or station including the majority of men and women in Law Enforcement who take pride to do their tough job the right way every day to Work Together to create a new normal in which a legacy of bigotry and unequal treatment no longer infects or institutions or hearts. You can read the entire statements from former president s online at cspan. Org. I am truly delighted toe