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

Redfield, director of the center for Disease Control and prevention and we thank you for being here this morning. Doctor redfield, to discuss the cdc and ongoing response to covid19. I also want to welcome the subcommittee members, Ranking Member congressman thomas paul andour full Committee Chair. I want to thank you to subcommittee members who are here in person as well as subcommittee members who are participating by secure video teleconference. Before i moved to my Opening Statements and because this is our first labor hhs and Education Appropriations Committee hearing with some members participating remotely, i would like to begin by offering a brief explanation of how it will work and in order to benefit those members and the public. This hearing room has been configured to maintain the recommended sixfoot social distancing between members, witnesses and other individuals in the room necessary to operate the hearing. Which we have kept to a minimum. Some members have opted to use secure video teleconferencing which allows them to participate remotely. For those on videoconference, once you start speaking, there will be a slight delay before you are displayed on the main screen. Speaking into the microphone activates the camera. Displaying the speaker on the mainstream. Do not stop your remark if you do not immediately see the screen switch over. If the screen does not change after several seconds, please make sure you are not muted. To minimize background noise and ensure the correct speaker is being displayed, we ask that the members who are participating by video remain on mute until it is your turn to ask questions. Please remember to mute your self at the conclusion of your question. Should you seek additional time, please unmute yourself so that i may recognize you area i want to remind all members and witnesses that the five minutes clock still applies. If there is a quality issue we will move to the next number until the issue is resolved and you will retain the balance of your time. So members, you take the video option you will notice a clock on the bottom of your screen that will show how much time is remaining. A one minute remaining at one minute remaining the clock will turn toyellow. 30 seconds remaining , i will gently tap the gavel to remind members that their time is almost expired. When your time has expired, the clock will turn red and i will move to recognize the next member. In terms of the speaking order we will follow our traditional order beginning with Opening Statements from the chair and Ranking Members and then a full Committee Chair and Ranking Member. We will then hear from our witness doctor redfield. And then we will proceed to questions. Members present at the time of the hearing, the hearing is called order will be recognized in order of senior ready. And finally members not present at the time the hearing is called to order. Now i would like to move to my Opening Statement. Before i make opening remarks, i want to reflect on today. This afternoon there is a Memorial Service for george lloyd. For the last few months, around the pandemic, we have been talking about how to get back to normal. However, what we can hear and the chance for justice and the cries for the quality is that going back is not good enough. This tectonic moment exposes so many wrongs. The inequalities andracial wrongs. And that as we fight. The virus, before us now. We must also fight the virus of injustice. Good morning. Welcome to the labor health and Human Services and education operation subcommittee. This is our second hearing to oversee the federal response to the coronavirus. And it is bipartisan. Let me commend my colleagues on both sides of the aisle including the Ranking Member, congressman tom cole. With us this morning is doctor robert redfield. Director of the centers for Disease Control and prevention area the cdc. Doctor redfield for joining us today area 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 has been inconsistent and incoherent. A major focus of todays hearing is getting a better understanding of what has gone right and what has gone wrong these past five months. We need to learn from mistakes, not repeat them. We cannot stop the rest of this virus overnight. But in the months to come, we can spare the American People from unnecessary misery, illness and death. In a typical Public Health emergency , and systematically, the response would be led by the cdc. Our nations for most Public Health agencies, based on science and Public Health expertise. I am alarmed that this administration has sidelined the cdc in our response to the pandemic and chosen political expediency over Public Health. As a result, the us has had the worst response to coronavirus of any country in the world and it is particularly egregious because our Public Health system should have been better prepared than almost any other in the world. Over the last three years on a bipartisan basis this subcommittee has increased annual funding to the cdc by approximately 1. 1 billion. Increase of 17 percent since 2017. That included the first year of a new Public Health Modernization Initiative which will transform how the cdc collects, uses and analyzes Public Health data. We also created an Infectious Disease Rapid Response reserve fund to enable the cdc to respond to outbreaks quickly to protect Public Health. Ranking member cole and i have worked closely together, understanding the challenge to create that reserve fund and it was critical to funding early response activities at the outset of this pandemic. Since march, the congress has provided 7 and a half billion dollars in emergency supplemental funding directly to the cdc. And i might add in bipartisan fashion. But instead of Public Health expertise driving our response to the pandemic it appears cdc has beensidelined for political interests. That is dangerous. The stakes are too high. There are projections that Going Forward, 30,000 and more could die each month. That would mean another 100,000 dead over the summer months. Yesterday, the New York Times released a powerful and well researched expose of the consequences of the will lapse in the work of the cdc. Of these open with a quote, long considered the World Premiere Public Health agency the centers for Disease Control and prevention has fallen short in its response to the most urgent public emergency in its 74 year history. From the moment this pandemic restart sure, President Trump and his administrations response has been woefully inadequate, and advocating all responsibility. There was never any coordinated plan to address the pandemic and under this dangerous lack of leadership our nation surpasses 100,000 deaths from covid19. The most of anycountry in the world. It comes to Crucial Detail like acquiring tests and supplies, setting goals for how much of the population should be tested, facilitating Contact Tracing and isolation efforts and ensuring community that have been hit hardest and given the support they need there is no National Coordinated 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 and their countries say. It appears as if the United States is just admitting feet. Is that acceptable . By simply accepting the preventable deaths of hundreds of thousands of americans to covid19, if the administration is asking us to accept that, in my view the answer is a decisive number for us to keep our people safe, our response needs to be led by the scientists and the Public Health experts at cdc. Our response needs to be based on reliable principles, not political appointees in the white house. It is our expectation that public expertise must be at the forefront of our national response. We need answers to vital questions, why has the administration accepted the world worse outcomes in the level of preventabledeaths that would have been unconscionable a few months ago . How is our country going to reopen when there is not a coordinated nationwide effort to test Contact Trace and isolate cases . Why are states disregarding cdc guidelines to reopening business and for social activity mark what are cdc guidelines not at the forefront . Why did cdcs guidelines on reopening come after states started to reopen or were already reopening . We are asking the cdc to lead the way and uphold its mission and i quote that mission, as a Nations Health Protection Agency cdc save lives and protect people from health threats, to accomplish our mission he conducts Critical Science and provide Health Information that our nation against expensive and Dangerous Health threats and response when needs arise. That is the highest mission and it is the right mission so let me say affirmatively that this Committee Supports the scientists and the Public Health officials at the cdc. Like doctor Nancy Messier and others who aretrying to provide sciencebased guidance to thecountry. What went wrong . Why has the cdc then left behind . When there was an early declaration of a public emergency by hhs on january 31st . When doctor messenier said its not a question of if this will happen but when it will happen. She said destruction to everyday lives may be severe but people might wantto start thinking about that now. Cdc produced high quality indepth publications. You need to take note of this. The cdcs morbidity and mortality weekly report, cdc experts have published evidence about universal testing at skilled and certain nursing facilities to interrupt transmission of covid19 as well as critically important work about super spreading events which are responsible for transmitting the majority of cases of booktv. Org. They eyed theyidentify the cause of some of the super spreading events , the larger events. The exposure and choir practice with the one people left to 32 confirmed and 20 probable cases, attendees at a church in arkansas. Workers in meat and poultry processing facilities. We cannot have a cdc that ails the public high quality specific technical guidance. We cannot have a cdc that has reports shall, edited , not scientifically driven or redrafted to suit political purposes. We cannot have a cdc that provides faulty Data Collection and reporting that we cannot have a cdc that fails in that transparency. We need federal leadership that is guided by Public Health. Ive expertise, realtime rigorous and transparent area that we need a cdc and we need it scientists and Public Health experts leading the way or all of us. And i am angry their experience and commitments have been pushed aside for a political agenda. That must change and i believe the congress has to change it. And we have to redirect our own course to set us on the path forward. I look forward to this important conversation and appreciate doctor redfield youre being here and i appreciate thanks for all of my colleagues and now i would like to recognize the Ranking Member of the subcommittee , congressman tom cole for any opening remarks that you would like to make. Iq madam chair and i want to argue for holding this hearing in the middle of a difficult time and you are to be commended for it, certainly doctor redfield being here and i want to associate my remarks or myself with your remarks about the tragic death of mister floyd and frankly the Health Care Disparities that this tragic pandemic has shown a bright light on this committee has worked on for many years and i know it concerns doctor redfield as a concerned everybody here and thats going to be clearly a major task for our Committee Going forward as it has been in the past butprobably with a higher sense of urgency. Good morning doctor redfield and i want to thank you again for coming to testify before us today. First id like to thank you for your Public Service. The director of the cdc is no easy job leading your agency once in a century event compounds the challenge. We let that agency with a steady hand in Uncertain Times and i want to thank you personally for your leadership. Im going to depart from my remarks a little bit because i think sometimes when were in the middle of something its hard to keep it in context but our performance has not been the worst in the world and depending on how you want to measure performance, quite frankly im sitting here looking at literally todays latest statistic and if you want to measure it by the basis of fatality or million population in the performance of the United Kingdom has been worse, italy has been worse, the performance of france has been worse, spain has been worse and the performance of belgium has been worse, performance of the netherlands has been worse, those are all advanced countries with sophisticated Healthcare Systems. I dont think you can take the chinese numbers quite frankly on face value and then beyond that and i say this with no criticism of the countries involved but i do worry a lot about india and pakistan, that part of the world. I worry about a lot about Subsaharan Africa and i think when this is done i worry about our friends in latin america and when this is all said and done going to see the numbers are probably worse in those places than they are in the United States simply because we have a more sophisticated Healthcare System though i have no problem with being critical or putting a flashlight on anything. We learn lessons that way but in america we always seem to think we are the first or best or worst at everything and in this case we may not be the best but i think were better than most and were certainly not the worst. The numbers simply dont bear that out area i hope today we can focus on future steps we can take together to ensure a sense of safety as our nation returns to work and school area after more than two months of staying inside, the American People need the guidance of the cdc more than ever to help us navigate the path ahead efforts to reopen our country and reignite our economic engines should be approached with caution and designed on each states unique circumstances based on sound data. This pandemic has caused unprecedented disruptions to our families, communities and economy and it will continue to do so for some time. The strain on our supply chains and devastating Economic Impact two hardworking americans have created challenges that will take months and in some cases years to address. However im encouraged to see state and local economies slowly and cautiously beginning to reopen and i also welcome the renewed focus on the need for usbased capacity and resilient supply chains area i look forward to working with my colleagues across the aisle to address these challenges and i also want to acknowledge the robust bipartisan congressional response in a deeply partisan climate, im pleased to see congress and the Trump Administration Work Together across party lines to deliver Critical Resources for the American Public in supplemental funding and resource programs like the highly successful paycheck protection program. We set aside our differences and delivered legislative actionto address the pandemic , passing record sums in record time and the consensus is clear, congress is capable , is as capable as ever or decisive action. The fight against transport is far from over. I hope the spirit of bipartisan cooperation can continue as we assess our past efforts and determine what more may be needed. While the federal government has provided some shortterm relief to help individuals, households, businesses and communities stay afloat during the training of extreme social distancing, our economies need to get moving again and americans need to get back to work. However any such efforts to reopen must continue to keep the health and safety of americans at the top of mind and not undo previous progress in slowing the spread of this coronavirus. This will indeed be a delicate balancing act and until there are working treatments Effective Therapeutics and ultimately a vaccine to control covid19, the rest and danger of the disease remains. Fortunately i seereal progress in all of those areas. Returning to more regular functions and operations requires gradual action, completed in phases based on data read President Trump and a Coronavirus Task force established based in and database recommendations on criteria for states on reopening efforts read the administration recognized now is not the time for a onesizefitsall model or each state. They are leaving key decisions to each owner to make as appropriate for the circumstances of their communities based on their needs, their supplies and local capacity and the states develop their plans, the administration is fortifying supply chain for testing applies and ensuring each state has access the supplies needed for reopening. Often getting testing supplies directly to each state finally its critically important that the federal government learned from this crisis and actively prepared to face down another pandemic in the future. While im proud that congress has generously invested in were the tools and response resources to strengthen our readiness in recent years, it must be an even higher priority in the days ahead. Oh the United States was prepared to face an emergency , you can never be fully prepared or what you dont know is coming. In the future we must not just prepare for the emergency hand but leave our nation better prepared or the emergencies ahead. Sustained, predictable, robust funding for dessert we search for fairness and usbased capacity are vital components to this approach and something this committee in a bipartisan fashion has worked on well over several years i want to thank the chair again for holding this important hearing at this critical timeand i yield back the balance of my time. I want to thank my colleague and take a moment to say that the award for traveling the farthest once again is our colleague , congresswoman from arizona, thank you for being here and with that id like to recognize for an Opening Statement the chair of the Phillips Corporation committee congresswoman need a lowly. Thank you chair. Im assuming this is working and you can all hear my voice, is that correct . Weekend, loud and clear. I do want to thank you. My friend chair and toggle bring us together. Its a pleasure for me to join you remotely doctor redfield, welcome back beforethe subcommittee. As the nation faces the greatest Public Health crisis of the past century, americans have never needed the cdc 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 again. The president pushed aside medical experts including the cdcs expert on respiratory diseases doctor nancy messonnier. Because a legitimate warning rattled the stock market. The president encourage the use of hydroxychloroquine even though studies showed that users were more likely to die. He even suggested ingesting disinfectants causing manufacturers to warn of the danger and leading to a spike in calls to poison controls and throughout the country. This is not normal, my friends. This is dangerous. We have lost more than 100,000 souls. Nowhere more than in my own home state of new york and in the absence of the strong federal role, new york has been a leader in testing to contain covid19. But this virus does not recognize state boundaries. To succeed against the coronavirus a federal Public Health official must take charge. To combat this information and get this right. With many states beginning to reopen, the cdc must remain vigilant to combat the continued increase in cases as well as the expected second wave this fall. The president s preference of a patchwork from 50 different states writing covid19 on their own will not stop these levels of destruction and will lead to more suffering and death. We need a National Strategy on testing and tracing and my friends, we need it now. We dont need a democratic plan, we dont need a republican plan. We need a United States plan and we need it now area and we ready to support the cdc. In recent months this committee has provided 7. 5 billion in emergency supplemental funding to cdc to respond to this Public Health crisis and the house path heroes act which provides an additional 2. 1 billion and we will do everything we can, working together, democrat and republican. We have a responsibility to protect the public. I only wish the president would do the same. Humana chair. I think the gentle lady and now doctor redfield again, thank you for being here and thank you again for your Public Service and for not only in the United States but all over the globe as well really you understand your full testimony will be entered into the record and youre now recognized for five minutes. Like you very much chairwoman, thank you also for the opportunity to testify beforeyou and again, thank you for your longterm support of the cdc. The covid19 pandemic is the most significant Public Health challenge to face our nation in a century and as we sit here today this novel virus is weaving its way through our social consciousness. Our outward expression and our grief. Im deeply saddened personally by the many thousands of lives 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. Today i call on the American People to remain vigilant in our collective obligation to protect the vulnerable. To protect your community, your grandparents, loved ones who may be at risk for severe complications. And we must lessen the impact of covid19 on africanamericans, hispanics, Latino American indian and alaskan natives are being disproportionately affected by this disease. This nation is not only hearing a wakeup call, rather we are hearing a clamoring for equity and healing for positive permit change to help the social disparities persist in our nation. As communities make plans to cautiously reopen, this means that we need to continue to embrace the now familiar social distancing handwashing and Face Covering. These actions will allow us to move forward and contain the outbreak along with readily availabletesting , comprehensive Contact Tracing , timely isolation of known cases and self orangey to break the chains of transmission. Cdc is providing communities with Public Health tools and information to confront this virus personally i cant tell you how proud i am of the men and women and the dedicated Public Health professionals at cdc and how grateful i am for their service and their families sacrificed. Cdc has deployed 5000 personnel to the response, field teams are on the ground providing local Health Officials with expertise in equity ideology, surveillance and prevention and control, lab science and Community Mitigation. We published or than 1500 specialized information and guidance documents far and the covid19 website has been consulted more than 3 billion times. Cdc has responded to 10,000 inquiries for clinicians and hosted calls that have reached over half 1 million more. With your support cdc has been able to award nearly 12 billion dollars to states, territories, tribes and localities. These funds are being used to enhance Healthcare Worker safety and the other important Public Health measures that i previously mentioned. Through our partnerships with cms and Indian Health services we are deploying teams to the needs of population at the highest risk, specifically those living in nursing home shelters andcorrectional facilities. This outbreak has shown a bright light on the true heroes of the response they are the Public Health and healthcare professionals, the First Responders and Critical Infrastructure workers but unfortunately this pandemic has also highlighted the shortcomings of our Public Health system that has been under resourced for decades. Never has been more clear that our nations Public Health it infrastructure requires modernization to support and collect reportable reliable comprehensive and timely data. When we confront any disease at the cdc and the Public Health departments must make realtime decisions on realtime data. Data forms the roadmap and informs policy. Data is the backbone of any Disease Threat response. As a neurologist and physician i know the importance of medical laboratories. We must equip our laboratories with advanced technology and the ability to adopt new platforms required in emergencyresponse. We must exponentially grow the necessary workforce to address covid19 in perth Teacher Health threats. Sustained investment in our Health System of this nation is an investment not only in health and prosperity for today but for the future generations tomorrow. Preparedness will be critical when influenza and covid19 its the doorsteps this winter. I want to encourage all americans to be prepared and face the flu vaccination with confidence for communities to read this single act will save lives read as a person of faith and good conscience i ask all of you to see the possible area we must resolve , we can and we must lessen the Health Disparities in this nation. I leave you with a reminder from our mutual friend the late congressman cummings. When he used to say the cost of doing nothing isnt nothing area for cdc director and a grandfather i ask you to continue to work with me to build a Public Health system our nation not only needs but deserves. Now is the time and i want to thank you for thisopportunity and i look forward to your questions. Thank you doctor redfield area let me begin. Many americans say politics are driving our nation rotavirus decisions. March 15 President Trump declared a National Emergency. Our nation had 556 new cases and seven deaths. Four days later he urged the American People to follow stayathome guidance. He said we are asking everyone to work at home if possible forgo unnecessary travel, limit social gatherings to 10people. Let me show youthis chart. June 2 as this chart shows, there were over 20,000 new cases and weve had more than 1000 new deaths. And the President Trump is telling the American People that we are reopening the economy and everything is okay. Our policies dont seem to makeany sense. And we had fewer than 1000 new cases we went into a National Emergency. Now we have 20,000 or more new cases today, yet we are opening up. Based on those inconsistent responses ive come to a conclusion. In march we made decisions based on Public Health expertise but now we are making decisions or making these decisions based on interests of politicians in the white house. My question these facts and i have several questions so im going to try to move quickly. These charts show the crisis isnt over. Instead it appears the white house is trying to convince americans to accept more risk and death. You run one has been the worlds preeminent global Disease Detection center, how does this make sensefrom a Public Health perspective . Im going to ask you to besix and because there are a few more questions and a whole lot of folks who want to ask questions. Weve experienced this coronavirus pandemic and are learning every day. I think probably the most critical thing that weve learned is to understand whos most vulnerable to this infection and clearly weve seen in the Nursing Homes, the elderly, weve seen it obviously in africanamericans, hispanics and American Indians and really design our policies to protect those vulnerable individuals. I think thats one of the fundamental lessons that we have learned in the last several months and i think thats really essential to the policy that we have Going Forward is to continue to protect thevulnerable. So yes, sir no, does it make sense for us to be doing what were doing when we are looking at a 20,000 cases in june 2 and over 1000 deaths . It leads me to believe that we are not following what is based on Public Health expertise but rather making decisions based on what are more political interests, let me ask you these questions and this is ayes, sir no. We have avaccine yet . We have candidate vaccines on the development. But we dont have one yet. We dont have one for deployment. Are we close toachieving her community . Know is there evidence the virus has become less contagious or is becoming tired of infecting us, yes, sir no . No. Are all these deeds states the meeting basic white house guidance laid outfor reopening , downward trajectory, documented cases within a 14 day period and downward trajectory of positive tests . Chairwoman of course these were guidance as we put out and to answer your question, not all the states have met those. When understanding is weve had a number of states. Let me ask you one concrete example and show youthis photograph. This is the lake of ozark. I have the same visceral response doctor redfield. Look at this. Look at these folks. This is unbelievable. And youve got is happening in the state of missouri, the white house guidance says states need to have the ability to trace the context of covid19 results. The state of missouri where this has happened does not have the capacity to do contact. Is the cdc tracing everyone who was there, yes, sir no doctor redfield . I will say because of congress we are building enhanced capacity across the country to do Contact Tracing and get it operationalized by the fall of this year when we will needed to maintain containment as we get into the fall and winter of 2020. Let me look at this photograph. The ozark photo and this is a photo from last weeks space x launch. People gathered on the bridge and would you put yourself in these types of situations . I think the important thing, as you pointed out, is not just to the individuals but to the risks they are putting the individuals they go home to. That is what is happening. I will try to close with this. Two and half months ago president started the process of shutting down the economy and fewer than a thousand cases a david since then the missed rations failure to respond confidently to squander the opportunity to bring the virus under control, protect the health of the american families. We are being told its safe to reopen and over 20000 new cases over a thousand deaths. We do not have testing, tracing resources that we need to prevent more deaths. It is no wonder the worlds leading medical term demands that just this past week the federal response was called inconsistent and incoherent but the president wanted to get used to this and pretend it is business as usual. Let me say this to you, doctor redfield, i have such admiration for the work that you and cdc do but if you and the cdc are driving this bus and taking us in a dangerous direction. From everything i can tell, the cdc isnt in the role you have had in the past, not only are you not driving the bus but the president seems to have left you at the curb and that is wrong for the cdc but it is deadly for our country. Thank you very much. I have a different question but let me start with this. Our other countries in the world based on mortality rates doing less well than the United States . There are countries as you pointed out in your Opening Statement that are not doing as well as the United States. Are those countries re opening for . There are countries reopeni reopening. At some point we put 40 million americans out of work, literally, in the matter of the last few weeks. We have done will began as a congress and in a bar fighters in basis try to help those people. We think we are making a lot of progress on both therapeutics and vaccine but people do have to go to work. You do have to have a functional economy at some point and again we did the shutdown and a lot of this was to try to make sure we do not overwhelm our own health care system. Could you give us some view as to whether or not we are close to that or how has that worked out in retrospect . Thank you congressman. I think that was fundamental. There was enormous concern that i and others that this pandemic would have overwhelmed our Healthcare System, particularly in our major metropolitan areas such as new york, connecticut and northern new jersey. And so, there was and we saw that happen in italy. We saw that in wuhan, china. They overwhelmed the Health System so when it did overwhelmed the Health System not only the mortality rate was up but that mortality rate for being in the hospital was up. That was the greatest concern and thats where you saw the an attempt to expand healthcare capacities. It is we were able to get through that and in a sense with some augmentation but in general in most jurisdictions we were able to get through that and i think thats significant to see change. Its not just health versus the economy. It is health versus health. They mentioned that 85 of the children have now missed their immunizations around the world, 120 million kids have missed the immunizations of measles but there will be more deaths from measles in children than for flu but its trying to find the balance as we come back and be able to make sure that we can begin to operationalize not only our employment but our Health System. When you think of the cancer screenings that have been missed, that will have consequences so i do think its important to get back, not only our economy back but the Health System back but to do it strategically and prudently. We have learned a lot in the key to us right now is to protect the vulnerable and to focus our energies on that. This pathogen doesnt, in general, because a lot of disease in young individuals but it can be deadly in those with chronic medical conditions and the elderly. Let me ask you this and then i want to go to a topic we discussed many times before and i want to pat this committee on the back because in the last five years we have increased funding for nih by 39 and four cdc by 24 in strategic stockpile by 34 to head up the Rapid Response fund as my good friend and share noted, in other words weve done quite a bit and yet we were still overwhelmed by what happened. We are responding right now in a crisis mode with supplementals. Im concerned about what we do Going Forward. The Administration Budget was put together with no idea that this was going to occur so that budget no longer is applicable in my view. I want to ask you looking forward you reference this in your remarks but what kind of budget do we need in terms of sustained commitment in what areas do we need to focus on because again, i know we will keep passing supplementals and i dont think thats the real answer here but i think we really need this focus deal paid doctor, your predecessor, came and talked about the equivalent of what we call an account, off budget account for the military that allows them in extraordinary circumstances to finance military activity and not be limited by the budget. My friend and i have talked about the budget agreement and maybe cdc, nih, fda, food inspection, strategic stockpile, maybe a few accounts ought to be selected to get outside of that agreement and just do what we need to do because we will be dealing with i would welcome your thoughts as to what kind of investments we need to make Going Forward and how you sustain those investments because i dont like one and done supplementals here. I dont think that will ultimately help us in a crisis but it will not get us where we need to go. First, i want to thank the chair inner self and the committee for the consistent enhancement of our capacity. From the very beginning within the first month of being cdc director my assessment was the Public Health capabilities of Public Health that we need both the cdc and throughout this country and states, local, tribal, territorial is inadequate. That we really need to be over prepared, not underprepared for it when you asked me what kept me up at night i would say the pandemic flu because youre not prepared. I think this is highlighted even with all the improvements that i treasure and the data modernization that the chair put forward, fundamental, the reason were having trouble with the issue in Health Care Disparity and understanding how this virus is affecting the africanamerican we dont have the data and getting that data modernization is fundamental. I feel the same way about laboratory resilience in multiple platforms. The workforce we talked about. We need 30100,000 new Contact Tracers and we need them before september. The Rapid Response fund you all have put into place which is critical and continues to support and the Global Health security, which i think, is the big elephant in the room. If you think we werent prepared for this wait until we have a real global threat for our Health Security and i echo your concern that we have a real defense that and i think we do have to build that and bring in the longterm based budget and figure out you all to work to figure out how to get that done and the Public Health infrastructure of this nation, which you all no, significant portion of it goes to state, local, tribal, territorial and refund the 5070 of all Public Health infrastructure in the own state and communities. That needs to be augmented and truthfully i meant what i said at the end with my friend congressman cummings, the cost of nothing is not nothing. The time is now to do it and get that investment spirit thank you, madam chair but its difficult without the clock but i apologize. Everyone is here today. Absolutely. I got it. I recognize the chair, congresswoman. Thank you very much, madam chair. Doctor redfield, good to hear from you today. New yorks ability to scale up testing has been extraordinary and we are now testing about 15000 residents each day with more to come. We need every state to take the steps and to have a true picture of where infection rates are rising and mitigate the damage. Most states are not even close to new york states ability and could you tell me why hasnt the cdc established testing benchmarks for each state and maybe i will have you answer that in with all due respect the virus doesnt recognize state lines and we cant fully protect the population of one state so the states arent holding up their end of the bargain so federal response is needed to protect the public. I dont understand why cdc isnt taking a leadership role and establishing testing benchmarks for each state to meet. Thank you very much, chairwoman, for your question. Thank you for the recent resources that you provided to hhs of which 10 million, 250 million came to cdc and has already been mr. Beaded to the state to be able to do just that. We worked with each of the states to develop their independent plan and benchmarks and those plans are now under review and they were due on the 31st of may for through june and then from june 15 for the rest of the year from july until september december. It is important, youre blessed with one of the best state labs in the nation and as i talk about courts capabilities number two was laboratory resilience and i am personally saddened that there is a handful of state labs that have the capability to do what needs to be done but again as part of the core capability and vestment among all state labs to do that and i got to work with [inaudible] very early as new york state labs stepped up to develop their own tests and they were the first to develop the test not on what i call the slow platform that we had for flu but they put it on a rapid platform and le let lead the way. I agree with you and we are in the process of doing those plans with each of the states because of the resources from you all and congress but i would add that i think its critical time for us now to invest heavily in state labs so they have the resilience to do exactly what your colleagues in new york have been able to do and we could do that in each of the 50 states of this nation. Thank you very much. I just have a little time left. I want to say that this committee has the benefit of being briefed early on by doctor nancy [inaudible], the director for the National Center for respiratory diseases at the cdc and every 26 she said ultimately we expect we will see communities its not such a question of this will happen anymore but rather more a question of exactly when this will happen and how many people in this country will have severe illness. The doctors explanation was that correct connect. Yes. Then i want to add hes one of the outstanding lead scientists at cdc and she continues to run our center for immunization respiratory diseases and, as you know, she was the first leader of our im response to this outbreak when it was grounded at her center. I just want to comment in the limited time i have left that is she sidelined for telling the truth . It has been widely reported that President Trump wanted to fire the doctor after her comment and fire her for telling the truth because of the impact on the stock market and he removed her from any public role. What is the say to the Public Health professionals at the cdc who may be fearful of that for doing their jobs . I want to stress that the doctor remains one of our outstanding leaders preach she continues to run our center or immunization respiratory disease. She is a great scientific ally of the mine and other leaders. In addition i want to point out she is our lead on the project work speed in developing the vaccine. Shes taking the leadership for cdc on that task force. She is not been sidelined. She continues to use her expertise to lead one the most important agencies that we have at cdc spirit at this time, i want to thank you doctor redfield, weve known each other a long time and we are glad youre there and were glad that the doctor continues to be key part of this project. Thank you very much, madam chair. Thank you. Thank you, chairwoman. Congressman harris. Thank you very much. Thank you, doctor redfield for being here. First up, i want to draw the distention between march and june. In march the chairman brought up and it doesnt make sense that we had few cases in march and we have a lot of cases now but in fact china had a lot of cases by then and we really didnt know a lot about the disease by then. We know much more about it now and i would suggest that if we really wanted scientifically based actions we should use data and we have a lot more data. For instance, i remember sitting at a hearing in this committee where the death rate was speculated to be three4 . Last month the death rate i think cdc put at point to 6 . A lot has changed in the past time in to say this is politics is ridiculous. This is science and looking at data in dealing with science. Doctor redfield, i dont have time but you are all aware of the effect of un appointment on health. I hope. The landmark study in 2009 quarter of journal of economics looking at the unlimited rate following the oil crisis of pennsylvania in the 19 80s show that the death rate among men unemployed doubled in the year following their on appointment and when they tracked it for 20 years there was an effect that lasted 20 years with an average loss of longevity of oneone half years for other employed people. That is a pretty Serious Health effect. Were in the midst of reopening maryland and one of the things that in my district is very important is the Tourism Industry and restaurant industry. Our governor has decided in accordance with cdc guidelines that we have the phasing documents in our governor has decided we are ready for phase two and i look at the document that cdc has about scaling up operations for restaurants and bars and it is a step to where you have Indoor Dining and our governor has decided for some reason you can have Outdoor Dining but not indoor so i will ask you a simple question. In fact our government decide [inaudible] is there anything in cdc guidance that would say Indoor Seating is not appropriate to maintain social distancing . Good the governor states cdc guidance is holding me back . Once phase ii dating has been exceeded. No, you were not financed. As you pointed out the critical thing is to have these things cdc we are not an opinion organization but its got to be science based. I think the printable of the science we have right now on social distancing is that 6 feet, 2meter distancing and that is the key. Thank you very much. Thats my thought. Again, you want to talk about things based on politics and some of these delayed reopenings are based purely on politics because, as you suggest, theres not a lot of Scientific Evidence that at this point with delayed these reopenings consistent with cdc guidelines and social distancing. I have a question about masks. There is now a cult of masks and thats what i will refer to it as. We get criticized that im afraid to get a picture taken and be without a mass because someone could say how can you not wear a mask . In fact, we dont know a lot about whether a mask is better or a cloth base covering or a face shield but im going to ask you something specific about restaurant opening guidance because the cdc document says restaurant workers should wear cloth masks and not surgical masks. It specifically says cloth masks, not surgical masks. My understanding is surgical masks are more protective of the person in the room that a cloth mask. Is there evidence behind that and is it just that we reserve soldier cult for other situations but is there science financing a cloth mask is better than a face masks and face shields arent mentored in the guidance connect. Clearly there is Science Behind potential benefit [inaudible] in changing the amount of infectious virus that can go across the 6foot space or threefoot space. We have good data to show that. I thank you hit the answer yourself is that the real issues to preserve the medical surgical mask for the surgical First Responder community. That is the intent there, not evidence that there is one better than the other. That is what i imagine. Again, getting back to science, a lot of critique when the first people were told dont for a facemasks and then told to wear a facemasks and with a discussion about face shields, facemasks, bottom line is you should protect the other person that you are coming near in case you are in asymptomatic carrier. Thank you very much. I yield back, madam chair. Congresswoman. Thank you, madam chair. Doctor redfield, thank you for being with us today. I would like to follow up on the issue of masks. In early april the cdc reversed its initial guidance from masks being functional to advising the public to wear cloth masks at all times. In spite of this advisory u. S. Culture has been a barrier to universal acceptance of these recommendations. Masks 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 Renowned University scientists showed that when quarantines are lifted if 80 of the population wears the masks for social distancing the virus could be eliminated and unfortunately today only 15 states require the wearing of masks and communal places and our president continues to flaunt his opposition to this Public Health recommendation. Based on the science of why did you initially recommend masks as optional and what fears do you now have regarding the spread of the virus if states and individuals can be incentivized to wear masks in public, including these massive protests that we have recently witnessed throughout our country. Thank you much. From mental to this was the recognition of the importance of a symptomatic infection or presymptomatic infection. When this outbreak originally happened cdc had the original 12 cases in the first january february we did about 800 contacts through our contact followup and two of those individuals were confirmed to be positive, most symptomatic and both spouses buried we had the view from our chinese colleagues and their experience and our early expanse of this was a symptomatic disease like most respiratory viral diseases work but what we rapidly started to learn is there is significant a symptomatic infections and what we call precinct omatic infections and we learn that the amount of virus it sheds and individuals that are asymptomatic is just as high as the death and systematic and when that knowledgebase came we realized we had an important Public Health tool we needed to take advantage of and if people were asymptomatic or precinct omatic if they were wearing a Face Covering that they would have less ability to transmit to others and that is why we embrace this Important Health tool. I will say that we continue to see this as a critical Public Health tool and as i said in my Opening Statement that we ask the American Public to be vigilant about utilizing particularly as a major mechanism that we have to protect them all vulnerable. Could you also elaborate on what your concerns are then when you see these masks of protest and when you see things are opening and when you see people on the beaches and in Public Places who are not wearing mas masks . What is your concern of what the possible outcome of that will be in terms of spread of the disease . Obviously we are very concerned that our Public Health message is not resonating and 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. I can say that we will continue to try to message as well we can and we will encourage people to that have the ability to request or require masks when they are in their environment to do that. We 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 a bit i remarked when i go home in the Baltimore Area i dont see anyone without a masquerade but when i walk through washington dc i see a lot of people without a mask. There are different cultural approach to it but we think its an important Public Health message and we will continue to stress it and i think it will be key. The social distancing strategies we have learned are something we would like to perfect because we will need them to be our major defense in october november, and december. I hope that you can start convincing our president for advocating for masks to prevent the spread of the virus. I yield back. Congresswoman. [audio difficulties] on mute and then start from the outset tier. Thank you, madam chair. I appreciate the opportunity and doctor redfield, we appreciate your presence with us today. We want to thank you the 5000 members of your team that are helping during this Health Crisis and also 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 is a concern was the it infrastructure in one of my priorities on this committee has been to provide funding for the cdc, Public Health data Modernization Initiative and i think of this pandemic has demonstrated the importance of that. In fact, the early reporting said that the cdc response was hampered by an antiquated data system and a fractured Public Health reporting system across the United States but i wondered if you could speak to the early response as well as what you have done since that time and as we go forward what we need to do to really invest in the data modernization. I want to thank the chair and this committee, you i think, her those discussions i had in the first weeks of my directorship and we talked about the core capabilities. The one i sent was the most most important was data. We need data. We need it in real time and it needs to be actionable. I mentioned that i had a briefing the first month i was on with the opioid when they finished this was in april of 2018 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 we have and they said yes. I said i did not know i was becoming a medical historian and i shared that comment with the chair and we have a long way to go. Its not just the data system but throughout this nation and in some states they have decentralized Public Health and i have states that are still collecting data with pen and pencil. This data modernization you all started i to believe to get us over the goal line it will require substantial enhancement building a comprehensive system for this Public Health for our nation but when its a commish it will be a gold mine and we can do surveillance now and the twoyear lag that i had, three year lag i had for opioid tests we now consult in 48 hours. We sought with the syndrome we had with the ecigarettes and how rapidly we were able to detect that because we used drone surveillance. I want to encourage you to continue to accelerate the ability for us to modernize this nation system and get it done once and for all. It will have Enormous Health Benefits for us across the nation to be able to respond to that which we dont know we will need to respond to. Even in my short time we had unexplained hemorrhagic deaths from marijuana and we have now had this and all of these thinge flash of paralysis in children. All these things would be enhanced so much if we had a real time actionable data throughout the system. Doctor, we want to follow up with you along the lines of the Data Collection and talk with you about the Skilled Nursing facilities. It is no secret Nursing Homes and longterm care facilities have been among the hardest hit during this pandemic and data from cms suggests with 26000 nursing home residents have doubt from covid19, 60 thousand have fallen ill but these numbers will increase and to questions. How has the cdc been working with cms to ensure greater compliance on reporting of infections and deaths at Nursing Homes and also when do you expect that we could get this data reporting as close as possible to 100 . Thank you, congressman. This is a major priority. Cms, ourselves, our group are working closely together paid this is one of the key priorities to successfully combat the impact of this pandemic on Nursing Homes. As you mentioned, we have the ability now to have these Nursing Homes required to report all of their infections to us and as for us to get those into cms and for cms to face them forward so the mega public knows what Nursing Homes are doing well it went Nursing Homes arent doing well. We know which ones we need to go in and help them even more with infection control. I am hopeful that we will have this completed over the weeks ahead and this is a priority. Its a requirements now by cms that these Nursing Homes do report. It was just a couple weeks ago we were under 20 and recently its now 60 and then 80 and ive heard numbers today that it might be 90. I think we will get this done hopefully before the beginning of july. It is a priority to get it done this month. Thank you. I yield back. Congresswoman lee. Its very timely. First, let me say, you know and everyone recognizes, we have a pandemic upon us in the africanAmerican Community. Today i want to take a moment to offer my condolences to the floyd family as we mourn and grieve. We hope this justice is served. That goes right into the disproportionate rates of africanamericans and people of color who are dying from covid19. Doctor redfield, the ppp and healthcare enhancement act which became law april 25, mandated that the cdc divide us with a report on covid19 data based on race, ethnicity, socioeconomic data and within 15 days. Now, within 21 days, excuse me. We received a report on may 15 and of course you signed this report that it was two and half pages long and contain no new insights and what it did was contain link to website that would data that was outdated and very limited on testing and demographics. In short, the cdc and the Trump Administration did not complete the assignment at all. Doctor freedman, what is your plan for how you will target resources and the federal sponsor to black and brown communities which is disproportionately being hit and, as you said, the impact is greater in the disproportionately with people of color . How would you target the federal response if you dont have the data and you said that you would provide this and i called on mas and asked for some of this data, as it relates to where African Americans are being disproportionately hit and i was told the cdc did not have the data to illustrate these disparities and must make assumptions. I want to know how are we going to get the actual data and the report quickly so we can target the federal response and secondly, a cochair of the Asian Pacific american caucus task force. Im concerned about the fact that the data, as it relates to the aap i community is not just aggregated which makes it challenging to properly allocate resources and to ensure positive outcomes. In one of your reports the community designated as other. What is or what will you do in terms of collecting data as it relates to the atapi community and cases of mortality and how will you make sure we get the reports, your next report which i think is due on june 14 that tells us where we need to target these resources based on race, ethnicity and socioeconomic status . Congresswoman lee, i want to thank you for question but first, i personally want to apologize for the inadequacy of our response. It wasnt intentional. Unfortunately it is reflective of what i tried to say is that we didnt have the data we needed to be able to answer that in a responsive way. That data comes into us obviously from the state and local tribal and Health Departments. That response is not adequate. I apologize and unfortunately it was under my signature. I take responsibility but we are correcting it and i think there will be an announcement today that would because of what you all have done with the cares act is now going to be a requirement for all Laboratory Tests to be reported to cdc to include the type of test, zip code of the test, the ethnic, racial demographic and the age and the sex. Its as i said before, in my opening speech that data is the roadmap. Its fundamentally the key. We need to do to address the Health Disparities that you so correctly have highlighted. I think many of you know i spent 22 years practicing medicine in urban baltimore and i understand firsthand the disparities of healthcare in this nation print this is why congresswoman congressman cummings and i became Close Friends but i have every intent to get that data so we can begin to understand. Clearly, increasing access and knowledge of infection and vulnerable communities is critical and getting that testing more available in there. I do think doctor redfield, what report will release today so that we can have or so we know in advance what we can expect . It is not a report, congressman. Its a requirement that the report to the cdc now 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 will know exactly where this virus is occurring. The next report that congress is june 15 it will be have that data . Based on the cares act requirement. All i know is whatever data i have and i am pushing to get it in a way that yours and mine goal, im not going to be able to promise it will be perfect on the 14th but it will be a lot further along than it was in the last and i think we will get this solved, if not by the 14th but by the next one. I know my time is up but will the atapi data be this aggregated . They need that otherwise we all have a true picture of where to target resources. We will try to make sure this data is forward facing down to the zip code level, congresswoman. Im asking you this aggregation of data based on the community, for example, we say that in the chineseAmerican Community this is the data in the Filipino Community this is the data and in the Japanese American Community this is the data. You know, this disaggregating. Okay, that will i have to look into but i will take your concern and recommendation that we work to see how to account set. Thank you very much. Thank you, madam chair. Congresswoman herrera butler. Thank you, madam chair. Thank you for being here. I have a difficult question for you. I think it is really important to understand what we can do to not be in this place again. I value, so much your work, and your many sleepless nights in the works of your adc because i know they have been on the frontline. I was reading an article and i saw an article from the wall street journal in april and on the time today about cdc and testing. One of the things quoted two former officials in the cdc said the culture locks the agencies in place into [inaudible] if i could fastforward over to whery whos im not trying to take a figure down despite what everyone probably is thinking. I want to understand this. I understand one of the Public Health emergency was declared on january 31 and state labs or any labs had to get permission to get approval to do our own testing. Basically it was about a month later before tests started flowing and we knew early on the control of the situation was aggregated and whoever made the decision that it was aggregated and cdc would produce the first test and send them out to the state but what we now know is those tests did not work. They were sent to Washington State, Washington State had to send them back. Ultimately what i feel like happened was we have to have diagnostic testing abilities and we had to ramp that up quickly in order to stop infection. Now, we are at the place of limiting new infections for reopening and we are broken through some of the barriers and thank goodness the private companies were able to step up. We broke down some of that bureaucracy and they were able to step in and fill in holes. In my community and southwest washington my local health i spent months trying to get capability and i know relationships within the vancouver clinic and selfless washington are able to use their relationship to get their testing capability and it was like everyone was doing their own thing to make that move forward and we are try to break down the bureaucracy. The wall street journal says this is back in april that an fda official flew to the cdc headquarters in atlanta, visited the lab that prepared the test and levels quote, a mess. It became clear that the pest test had likely been contaminated that one [inaudible] the cdc distributed or disputed the lab was unethical to back its tests and theres been an investigation and i have not seen the investigation results yet. I know that your heart and soul is to protect and promote the Public Health of the people in this country. Theres no question you have a long distinguished career which we are grateful for. In recognizing these problems my question is and i keep hearing we just need to put more money to the Public Health and i want a realtime active data system but this committee in a bipartisan fashion has increased funding for cdc Strategic National stockpile and weve instituted Rapid Response and we say yes to Public Health requests. We really have. And yet, here when it all counted some people in some places made decisions that all this would be constricted by the federal government paid the federal government would be the one that innovated and ticketed it. I dont know if all the money in the world can fix what some have called a culture where, quotes against New York Times, the culture of the cdc is riskaverse perfectionist and illsuited to improvising in the crisis. When i read that i dont think ill of the cdc but i thank you are doing what you are doing in your lanes. What this wouldnt we all better be served if the doors of collaboration opened the very beginning and it wasnt Public Health or private because we got my challenges with how the private labs have done things with regard to labcorp but if we had thrown open the doors and said together we will move forward and i would ask you what you consider, i know you want your legacy to be building a robust Public Health system but could your legacy also include fixing some of what seems like a sideload approach within the cdc and that will require you, its upwards not just downwards, i realize, but is that something youd be opening to considering so that the next time we are plate in this place and i pray to god its not in the fall but would you consider that and could you speak to that . I appreciate it. I do believe this level the field here is the cdc developed within ten days a test for the time to sequence and that test is not a flawed test but worked perfectly and was available in mid january and it diagnosed the original case and its only limitation was to get the chance for the blood disease. There was never a moment in his station when any cultivar but cannot get the desperate they just had to have limitations been no question there were shortcomings at cdc i have to push back on that one. My Public Health apartment could not get the test. Insane if they chose to send it to the cdc they could get the test. Thats what i would say. We always had that capacity per the shortcoming is then we tried to manufacture the test in each Health Department would have their own. I dont think you will see the cdc and the manufacturing positions and in that time there was shortcoming. There was contamination and there is an inquiry to figure out what was there and what happened but i will say that in five weeks it was corrected and for me within five weeks of the sequence we had the testing now available in the Public Health labs which some people may think is a delay in as a philologist for the time of the new pathogen to have a new test for the Public Health that still in it, smith. Let me add in there though that six weeks, may i beg your indulgence, that six weeks was the six weeks that we had to get ahead of this virus. That six weeks, he said five weeks, on january 29 that will be shut down. And now were doing were digging our Small Business or digging everybody out. I know as a brawler just thats good but we have to get into the culture of the organization because that was the five weeks we had in our lead time. I could make one last comme comment. I thank you. I know time is up and i wont go through the other comments because we could talk on that but the issue that really has to happen in that one thing we have to correct is the day cdc got in the lane to make the Public Health test the private sector had to be in the lane to make the test for the rest of america. It wasnt cdc. Cdc makes the Public Health lane but it took unfortunately weeks before the private sector stepped up and developed what we now have, as you know, we now done over 70 million tested private sector is in the game. Public health is a small part of it but that has to change to. Thank you. Thank you madam chair. Congressman. Thank you very much, madam chair but thank you, doctor redfield for being with us. Doctor redfield, i have a lot of questions so if you can be as concise as possible i would certainly appreciate that. It was heard earlier by our Ranking Member that i thank you answered the question that we dont have the worst amount of cases, highest amount per per capita on the planet, is that correct . Yes, that is correct. However, according to your data, cdc gathered data we had over 1. 8 million cases of coronavirus and that is nearly a third of all the cases on the planet and as far the most of any country and is that also correct . Of those that had been reported, yes. We had 106,000 deaths by far the most of the world and is that correct . As has been reported, yes. Are death rate is 320 per 1 million which is six times the reported global average and is that correct . I would have to double check to that. I dont have that figure in my head. I have confidence you have and i would be glad to check that. There is only eight countries out of 195 or so countries that exist on the planet that have a worse ratio per per capita. Qatar, san marino, kuwait, luxembourg, singapore and chile. Altogether their populations are 33 and half Million People in about a tenth of the United States was not exactly impressive to say we dont have the words but for almost every country we have the worst amount of cases that are out there. Do you have to agree, doctor redfield, like germany with the rate of 220 out of 100,000 in new zealand, south korea 22 out of 100,000 have been more successful then the u. S. And controlling the spread of the coronavirus . Based on the reported cases we have, that would be correct. One of the problems we have in the United States unfortunately, doctor redfield, is back in mid april your agency was put together a stepbystep recreations for, childcare facilities, restaurants and other to reopen and that got sidelined for a month and in fact, i think it finally was on may 20 you release those guidelines then on may 14 you put out decisions, who made the decision to release the delay of the guidelines connect. All of these guidelines as ive specifically about who made the decision to delay spirit i was trying to answer, these guidelines was a reader of process so it wasnt a question of delaying the guidelines but completing the process and to make sure the guidelines had the input who made the decision specifically that they would be released on may 20 rather than anytime sooner . It would have been me, sir. Were you at all in competition with anyone in the white house and if so, who . We were working through the interagency groups so that has multiple agencies that have input when these guidelines cross over. As i mentioned, its a collaborative i could tell you that relief, doctor redfield, and states like wisconsin were states up in court forced us open and honest aides were opening they came after that and created chaos and we had a spike in cases after that. Let me ask you another question. We know that agents that are similar to teargas and teargas can cause people to cough which could spread covid19. Is that correct . Coughing can spread respiratory viruses including covid19. Do agree that teargas and chemical agents like teargas can cause people to cough . That has been my experience. Have you made any advice to the president or Police Agencies for the agencies do not use teargas with the recent protesters because obviously that could cause an increase in covid19 due to the coffee . I thank you raise an important point. We have advocated strongly for the ability to have Face Coverings and masks available to protesters so that they can have coverings but you raise an important question. Would you make that recommendation . I can pass on the comment at the next task force meeting. I appreciate that. The six seconds left i will get back. I think the gentleman. Congresswoman clark. Thank you, madam chairwoman and thank you, doctor redfield did as you have acknowledged in your opening comment yukon before us today in a time of National English and turmoil. This pandemic did not create inequities, disparities or racism but it has magnified the lethal effects of all of those. So true. We will only emerge through this public of crisis, this economic crisis and this moral crisis if we demand that our american ideals of equity truly applies to each and every one of us. Doctor redfield, the cdc website contains pages of information on the Spirit Health incomes for people of color, higher rates of asthma, heart disease, diabetes to name a few. I understand from your answers to congresswoman lees question that tomorrow you will have an announcement for today, later today, about mandatory demographic reporting but wasnt it eminently predictable that covid19 was disproportionately impacted black and indigenous communities . Congresswoman, i dont know but it is clear that once we understood that individuals with certain medical conditions were greater at risk once we stepped back and understood certain social factors in Living Conditions would be critical and it became rapidly selfevident. It played out very, very quickly and evidently in my district. I think that is true across this country and we have to do bett better. This plan you are putting forth, is it a written plan that you will share with the specific benchmarks and how you are going to collect this data . Again, the announcement is coming from the secretary of health and is not the cdc but you will highlight to such an important area and those of you who been able to visit cdc the whole area of Health Disparity in the whole area of social determinants of health, the whole area of making purposeful, meaningful progress in this, not just for covid but for, you know, all the Health Outcomes that we have, i did mean when i said when i said the time is now to get a purposeful program to address these inequities. I have visited cdc and i appreciate your commitment but in this particular case, with this pandemic reaction, there were public outcries and outcry for members of congress and pressure to have this information. Im interested in who wrote this plan that will be released today . Was at the cdc or someone within hhs . As i understand, its a response to the care act and hhs will announce it. Do you know who wrote it . It is meeting the criteria. If not a plan. I would request 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 rates of any race group in california. In many states Asian Americans have a case fatality rate significantly higher than the overall population. I hope you will do more than look into disaggregating of a api information that you will make it happen but i also hope you will add that lgbtq community, dudes pride month month and this is a great month time to add them to your forms, your surveillance forms, in particular the person under investigation form. Your website also states that a lack of Health Insurance is one of the reasons for the community of colors have disparities and in particular have been hardhit by covid19. Is it your professional opinion then that dismantling the aca and the Administration Proposed budget cuts of 1. 6 trillion to medicare and medicaid could actually harm people and in particular people of color in this country . You know, congresswoman, the way i can answer this is that, you know, i shared with you the deep commitment that all americans can access to highquality healthcare and that we effectively address access issues. I do know that is there a way to address the disparities of healthcare in this country without expanding rather than reducing access to quality, affordable Health Insurance . I think we clearly have to make sure all americans expand the access to highquality healthcare and the manner in which we do that, you know, im not here to comment on it. Im not asking you to comment on the manner but just saying is there any way, in your professional opinion, to address these disparities if we do not expand rather than contract access to health during this country. As i said, im firmly with you we need to continue to expand access to highquality healthcare in this country for everyone. Thank you, i yield back. Congresswoman. Yes, thank you, madam chair. I want to thank your staff. I hope i said her name right but she set up us well for this and i finding this meeting very enjoyable even though im sitting at home and it makes it better. [audio difficulties] thank you, doctor redfield for your service to our country. I have a few questions but first of all, doctor redfield, do you agree that the cdc might have learned more about the virus and necessary response had we had a greater Global Presence in the days and months leading up to the outbreak . Congressman, i think we wouldve been benefited enormously for having the greatest presence particularly in the cdc office in beijing. Thank you for that. In your written testimony you say that Contact Tracing is a core infectious Disease Control strategy and followed by implementation of an invention and i know you testified at the senate that Contact Tracing will be the difference between succeeding in containing those outbreak. So, first of all, a few questions in regards to Contact Tracing. Then few other things. How should a community determine the right number of Contact Traces they need to respond to the pandemic . Thank you very much. Ive spoken to tom about this. He estimated 300,000. I mentioned ive estimated between 30 and 100,000. It is sizable. I think we wont really know until we work statebystate. We have met with all 50 states and jurisdictions and some of metropolitan areas, cities we have also, and to work with them, to thing that out im happy many of the states have started to expand the number of them already added 1,000, 1500 contract tracers. Cdc made available through the foundation the ability for states we will allow them 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 this together. But temperatures redfield, like many of my colleague is know congress com clark brought this up, congresswoman lee did also. Im very concern by how covid19 is impacting our communities of color, and so id like to start there with my line of questioning withyou. So, im from the state of illinois. Africanamericans represent roughly 15 of the population, but nearly 0 are of covid19 deathed hispanics represent 17 of the population in illinois and 31 of the people diagnosed with covid19. So thats perspective. Im going to drill down to my own Congressional District. Live in downstate illinois, and want to look at pacific to my Congressional District. Winnebago county, africanamericans make up 13 of the poll layings there. And 25 of the covid19 cases. In peoria county, africanamericans make up 18 of the population and 36 of the covid19 cases. Rock Island County where if live, the Mississippi River is to my left here, hispanics make up 13 of the population and 22 of the covid19 cases. So, dr. Redfield, given these fact is want to ask you how storm determinants of health can fuel such statistics and the southern part of the city of peoria, africanamericans fate serious food desert issues. I heard a story of a resident there who literally would have to stop at 16 stops while riding the bus to be able to get to a grocery store. And thats the only way that person had access to fresh produce. So my question is this, dr. Redfield, 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 have hit on a critical issue, something i would loaf to work with congress. The social determinants of health as a laboratory scientist, i kind of shrug my shoulders and say i dont know if that it going to be relevant but obviously data is the key, and i happen to be data driven driven and of ive seen overwhelming data that show that determinants i would like to work with congress to develop the mechanism for the nation to understand longterm which ones are the most important. Ive talk about trying to set up a framing study over the next 20 years that allow us to nail down firmly is it the grocery store, the fresh air, violence in the home, the critical social determinants of health but theyre no question. Theres no question that the social determinans of health as pertain to access to quality food have enormous Health Outcome us. Part of this my line of questioning, i want to make the point and i think were on the same page here and i hope my kole legs are as well, but further, in theres a 2018 Regional Health Council Report that says two out of five black residents are below the 100 federal Poverty Level in the rockford region. Thats the farthest northeast region of my district. Can you talk how poverty can lead to negative Health Outcomes and can Poverty Level put a person ate greater list of contracting covid19 . Again, i dont think theres any question. What i would like to us be able to not me but hopefully my grandchildren or maybe in the next five years, ten years, 15, id like us to really understand exactly which social determinans of health are the most influential and get these things corrected. We dont have to wait for an answer to start correcting them pause some of them are just obviously intuitive but this is one of the Critical Health concerns of honor team, the social determinants of health. Thank you, dr. Inch my five remaining seconds i have a bill called the social determinants of Health Accelerator act and want to draw that to the attention of my colleagues and i hope this is something that not only will have at the base around it but also pass it this congressional session. Thank you very much. I yield back. Thank you. Congresswoman watsoncoleman. Thank you, madam chair, temperature in hearing and through dr. Redfield for all of your testimony thus far. Want to fall follow up on a come of questioned. Regard to the report coming out that is supposed to break down the demographics demographics we disease and is how it hits and how its affected certain populations. Will that information that comes out and the report on the 15th f positive cases by race, ethnicity, et cetera, the number of hospitalizations by race, ethnicity, et cetera, the number and percentage of deaths under those categories, will it be bren down that to that finite degree . Just to clarify again, congresswoman, this the beginning of finally get thing data we really need to do all that you just asked. So, there is now is that a no . No its not a no. Im saying this is the beginning of having the data to get the report in the manner you ask. The first step is to get the data. Thats announcement today that the data is coming to us and that gives us and unables to us give the reports in that granular detail. So, with that granular detail by in the report on the 15th 15th or later. Im going to give you all the data i have at that time. You are not answering the question. Ill fifth you the tata i have and thats really where ill thank you, reclaiming my time, doctor. When will testing be available to anybody who wants it and thinks they need it . Do you have any idea . I think the key on this testing is no it to be a decision between the individual and their Health Provider im simply asking is there any impediment to anybody getting tested who wants to be tested if they have a doctor that, and the doctor says yes, i any impediment, is there Testing Capacity that meeted that need. So spot be an impediment. If you dont have a relationship with a doctor, and you just an uninsured individual, how do you get tested . So theres a variety of different testing sites set up and i know i think over twothirds, 70 have been set up in areas considered socially disadvantaged. Those testing sites are there and available for the American Public. So, if were going to consider reopening up our economy, is there any science that informs us as to what percentage of a population needs to be tested and their information traced if necessary before we know that were really in a healthy mode as opposed to a leveling off of a curve simply because of the few numbers were testing . Is there a percentage of the population . I know each state would be different in terms of the number but is there a percentage of the population . Its an excellent question. What we have is estimates from the w. H. O. And others that the fresh hold of being adequate in your testing is when one out of every ten tests you do is positive. Okay. But thats how many based on how many youre testing. Im asking you, what is the percentage of the population that should be tested . I dont in the answer to that question at this moment in time. Are there people in the Science Field who think they have a handle on that and if so, would you find out for us and share that information with us . Yes, congresswoman. Thank you. Earlier on in response to representative lauras question you made in comment that if this were a Global Health threat. It this not a Global Health threat . Yet. You must have misunderstood me. Host should we not be connected to the World Health Organization . Have you any position on that in and have you given the president your wisdom, your advice on that . The w. H. O. Continues to be a close colleague of ours in the Public Health efforts. Were currently working on a number of outbreck ron the world, polio, ebola. Its not we continue to have a close collaboration with the w. H. O. Thank you. Doesnt seem to be a priority of the president s. Imgoing to ask you a question but the ozarks, the wonderful time they had on memorial day, and the launching of the space shuttle. Even though those states may not have asked for your help, because of the possibilities of additional infection or higher rate of infection because those people were so densely integrated into of what they were doing, is there a role for the cdc to be protechtive and reach out to them proactive to and reach out to them to get a handle on what could possibly be a problem before it becomes a big problem. I agree with you, we do retunely reach out routinely roach out to state Health Officials and off assistance and in those South Carolina have 38 teams assisting different states and territories with the different outbreaks particularly in the area you mentioned, Contact Tracing and well continue to emphasize that obviously to our colleagues in missouri and florida that were prepared to provide the assistance if they would request us to come in and help. Thank you. Chairman, just one last thought. Given your vast experience and interest in this area, waffles it not obvious to the cdc that the africanAmerican Community would be disproportionately negatively impacted by this covid from the very beginning . Again, congresswoman issue think we have worked and will continue to work to try to identify and help respond to develop interventions that can minimize the 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 be only two minutes. Dr. Redfield has a hard stop at 1 30. I want to accommodate people but we can only go two minutes. Try to be as leapent as i can lenient as i can because its a critical hearing and people have excellent questions they need to get aned. Let me start and what i want to do is talk but vaccinations and influenza vaccine campaign. Dr. Redfield, you said that in april, the need for an enhanceed vaccination effort this fall for seasonal flu. We were going to have a flu epidemic and the coronavirus epidemic at the same time, which will put tremendous strain on the hospital system. Yes or no, do you still stand by your april 21st question . Answer. Yes, i the think well have a difficult time. Given that, we have to be prepared to deal with that effort. We also are going to be having companies rope the world racing around the world racing for a vaccine. Theres funding that needs for infrastructure, medical supplies, work force, and a bunch of unknowns, which have to do with storage requirements, chain supply, et cetera, explain that aspect of a of massive vaccination campaign. What is already in the works, what is the funding capability . You cant deal with all the funding now issue want a budget because it women im will impact our negotiations when were dealing with the senate on the heroes bill. Chairwoman is that in relation to influenza i want to know but vaccine and want you to an the question on influenza and what we need do with regard to that. The Covid Vaccine effort operation warp speed run by the secretary of defense and health that is move version moving very rammedly. Its my expectation well have one or more vaccine available before the end of the year for covid which will the infrastructure, the infrastructure for putting this together. Thats right. And a budget for putting this together. We needed now. Well be able to work with hhs and get that back you, okay . Okay. I do want to emphasize the importance of flu vaccine and mentioned that to really get our nation accelerated. Only about 467 of the American Public take advantage of flew flu vaccine. Were happening the vaccine is one major way to help the nation get through the fall. Thats going to be a further strain on the system with this virus. Congressman coil. Thank you, madam chair, since my friendom wisconsin has questions but my numbers let me add. Some death rate in the its, 339 per million. United kingdom 5 7. Italy france 4 , 33, spain 580. Belgium, 835. 9. The neglect if happens 347. 6. Sweden, 446. Ireland, 341. 8. Those are awe advanced countries with first rate healthcare and frankly likely to produce numbers we can trust. Personally, for the record i dont trust numbers coming out of russia, china, or iraq, and i think a lot of the rest of the world, frankly, just dund have the infrastructure, the testing capability. I will say theres some real star i trust. Japan, 7. 1. North dakota, taiwan,. 3, hong kong,. 5. I say that 0 to say maces have done this better than us and we have lessons to learn from but i want to be clear that were not the worst in the world, and this data is very interesting to compare because its not the same data from the same source. So theres a lot of apples and oranges comparison. Let me move to something near and dear to my heart because i have a few seconds left. Recent data from the university of california says tribal nations where the five state width the highest infection rateness country would all be tribal nations. On a per capita basis, five tribes have more coves cases than the state of new york. Tribe with the highest raid the mississippi band of choctaw indians, infection rate more than double. Can you tell us the things i know youre working on this hard thatture doing to help tribal nations deal with this . Its really important, congressman. Clearly the native American Community has been disproportionately hit. We have been able to award as you know from what you have granted cdc, almost 60 million of the tribes with the total hopefully soon to be 205 million to Indian Country to give them the financial support. I think more importantly we have also provided a number of Rapid Response teams into Indian Country, to basically provide Technical Assistant pause they have had some of the more significant outbreaks. Helped them with Contact Tracing and Community Mitigation as well as some of the unique challenges theyve had in dealing with particularly water security. We will continue to augment the ability of the Indian Health service to support these trial tribal nations in terms of providing both technical asince stance and resources nice dis proportionately affected. Congressman [inaudible] congresswoman, can you unmute . Yes. Okay. Dr. Redfield, first of all let me acknowledge that under the leadership of both congresswoman rosa and coal efforted have been made to address the serious shortfall the centers for Disease Control funding but nevertheless still remains chronic deficit in state Health Department resources and cdc still has an antiquated infrastructure. Theres been discussion during the subcommittee you havent billionses of dollars to address the covid19 and also its anticipated youll be receiving more money under the heroes act. Can you explain to the committee what is the difference between what this supplemental funding pays for and the base funding you actuallied in to address the shortcomings in cdcs infrastructure and core capabilities, and then quickly, after you answer that, just please give your opinion with regard to what your predecessor, tom friedman said about the need to create a Health Defense operations budget designation that would exempt certain Security Budget lines from the budget control act, spending caps, so that we dont have the same situation where cdc gets money through supplemental during a Public Health crisis and then we go back to the erosion of funding cdc. Thank you very much, congresswoman. A majority of the fund we have received from the supplemental we have pushed out to the state and local, tribal and territorial Health Departments to give them the Immediate Response capability, and at cdc to support the more than 5,000 people that we have now moved out to help support this response. So its really been directed at Immediate Response activities. As well as building that capacity in the states we mentioned, for rapid ready testing, Contact Tracing, and isolation and quarantine. The issue is many states dont have the capable to effectively isolate panel that dont have adequate housing. It has to be built. The real challenge as has been alluded to by the chair and congressman coal as well as yourself is how do we get this into the longterm base funding so we can make sustainable progress in these core capabless and ill just say i dont know the best way to accomplish that but its going to be very important. I think the comment also that you have worked with the response fund, the ability to have emergency funding, when things happen around the world, is important. Thank you. Thank you very much. So, if im correct, despite reopening and greatly increasing number of tests so you can actually con determine more cases, were down 40 from the peak . 32,000 now down to 20,000. Yeah, we average 20,000 new cases a day. So were down 40 , again, despite reopening and despite anymore testing. So thats evidence that i guess that we really are on a decline and now this time think about reopening because we cant really stay shut down forever. Now, you brought up a point in response to a previous question, that is cdcs expected to be the foremost Public Health authority in the world but actually needs cooperation from other Health Authorities in world. Could you describe the cooperation between chinese authorized and the cdc in january when we really needed information about this epidemic that was going to become a pandemic . As you know, congressman, we have cdc office in beijing. Its limited in its staffing. I had augmented it by another technical expert. I had been in regular discussions with my counterpart, who is the chinese cdc director, in over the new year, and we did have discussions about what was then an unidentified pulmonary illness. We did request the invitation to come in and assist them directly and in particular after the coronavirus we reiterated that formally requested that at the level above him to grant the request. Unfortunately we havent been able to have that scientific interaction we requested. Is that because you think they also consider cdc the worlds leading expert in Public Health or was it maybe for political reasons . I know you cant it was rhetorical question. I assume that the release, for instance, of the Genetic Information on the virus was held back until it was actually reported outside public channels . The felony is you cant do your job if we dont get cooperation and we didnt get cooperation from the chinese. I yield back, madam chair. Thank you very much. Let me just see congresswoman lee. Thank you for meeting next whining the a very important meeting and we thank you so much for that. Secondly, let me just say one thing related to what congress mom bust os talk but im surprised to hear you response, dr. Redfield, because we have road map, the National Medical association i know all of the africanamerican doctors, the asiapacific americans, the Hispanic Community terms of the medical profession we have the road map on how to deal with social determinants of healthcare. Actually, super general David Thatcher in the day came forward with that ump was surprised and also disappoint at your response. It takes a political will of this administration to address it. And so we need to discuss that with you further bus we cant wait. We know what the social determinants are and we have a road map completed for many years on exactly how to address that. Let me ask you about Contact Traces. Because of the sensitive nature of this work, we want to make sure that Contact Traces are from the community, trained and provide the very sensitive type of work. Can you comment on protocol or the importance of having not people coming into our communities doing this and minority communities but the trust and message is being train, how they are trained to provide third type of work. Thank you for beth. Im very familiar with the thatcher report and i have high record for it and i think it was critical turning point. I was just trying to raise the idea of getting scientific proof for which ones influence but not waiting and i look forward to work with you on that. Secondly on the Contact Tracing couldnt agree withyou more. The same thing we discuss about the hiv in america, we nod to build trusted member owed the commune to be Community Workers with dont need outsiders coming into communities to do this work. We do have a significant Training Program and i do think that these need to be we have to expand the Community Base of trusted individuals in the community to do this work. I couldnt agree with you more. Thank you very much. Thank you, madam chair. Congressman. Thank you very much, madam chair. Let me ask you, dr. Field, question about supplies. We had problemmin wisconsin getting supplieses from the federal government. Fema said they would get us reagent and then we were told we would get them from cdc. In april we got less than one perfects of the reagent wed requested as a state. Last month of all the information we requested, we got less than 18 . I find it confusing that of all the ppe and other supplies supposed to be getting fema gets us some of it, but one out of every five item wiz actually need but that we have to go to another agency to get reagent and from cdc we can only get reagent for public labs which is a couple labs in the state when we have 60 labs doing covid test. Can you just address that real quickly . We need more reagents and need them for the hospitals and lippics and cant debt them from fema or from the cdc cant get them from fema or the cdc. Clearly the cdc irr which is longstanding we have supported our Public Health labs is that the mechanism for public halve labs. We have been transitioning to the private sector to be providing for the nonPublic Health enterprises but let me look directly into your request and see if can get better claire and bet back to you and your staff. I appreciate that. Then the 30 second its have left, mr. Harris said that cases are going down, however sky gottlieb this morning in the last hour tweeted out were low live commanding the number of cases and that is part of because theres still this no consistent standards for people reopening. Can you address what did we do wrong that were ninth worst in the country only behind iran and qatar . Well, i do believe we have enhanced our response, as i mentioned we have now tested almost 17 Million People. I dont want to get see the numbers because i dont think thats they real issue. Its how testing is used and the consequence but we have after the slow start that we had in getting the private sector engaged, we continue to build and thats not to say were at the end of the day. We still need to expand the access to testing across the nation. Its not where it ultimately needs to be. But i will say that each day, each week, we continue to make progress for that expansion. And we will continue to do that. Ill look into the specificses of your question related to where Additional Laboratory reagents are coming from for your state. Thank you. Yield. Yield to congressman graves and since congressman graves did not get his five minutes in the first round, he is recognized for five minutes. Congressman graves. Thank you, madam chair, and thank you dr. Redfield, im from georgia and thank you for your service over these [loss of audio] last several months. Its difficult but we are grateful for your work. I want to just change a little bit to antibodies and Antibody Testing and if you could make share with us a little bit about what we can fda approvals, if there are any fda approvals, and if you can give us a little feed back and insaying what to expect there. Thank you for your question. There are series of Antibody Tests that initially the fda allowed to come out a lo lot of tests came on the market and then had to show they were valid. A number of them have been pulled back there are series of Antibody Tests and i can get you the names of them that are really quality tests approved by the fda. The real issue is what does antibody mean . And right now we dont really know exactly what antibody means. If you have a valid antibody, it means that you have been infected at one point in time by the virus. Dont know how long the antibody last but we dont know the critical question, is when does the Antibody Test mean youre immune to the fliers and that is what were still trying to find. It does help us as cdc to understand the full extent of the infection in our nation. Our current estimates is 5 of the American Public got infected during this initial experience. That does mean that 95 are still susceptible, just for us to understand what might be coming. Some cities its much different, like new york, obviously in the new york metropolitan area but that is the key. Right now its a surveillance tool we have. Whether it has clinical implication or not we still dont know. The list you might recommend approved vendors. A lot of potential for fraud. Yes. But im sorry. I maybe you share with us what but the accuracy and reliable of the testing as well. Thinkure opinion is critical and i can get you the actual lest of the testing we know we do not recommend, and that the fda is asking to get off the market, and then theres another group that have really performed well and i can make sure you get that, ortho is one of the main ones that we have been using for Antibody Testing. And so i can get you that and make sure your office has it. Great. Thank you. As we talk about testing and the covid19 testing and the testing sites, any al view at the same time to testing for antibodies . A lot of individual goods to get tested because theyre concerned they may currently have the requires but any value in testing for both simultaneously and then do you believe that Antibody Testing is something that should be paid for by the government as we have previously with the covid19 testing . The challenge that i have there is just trying to understand what the Clinical Utility of Antibody Testing is, and cms will they recall all pay for if if its for a specific clinical indication misunderstanding they currently pay for it with the clinical indication being you have been previously infected by the virus. So that is the one part. I was going to Say Something else but im having an adult moment. This first part of your question. About should the Antibody Tests be conducted faultily along with the covid19 test when an individual goes to be tested in. I think the one area that it has a major clinical relevance is in the children. You have seen this hyperinflammatory syndrome were seeing in children. Luckily its very rare, but it really occurs post a Covid Infection and does help understand that is really the causation. So we do use Antibody Testing in trying to define the Case Definition of children who have this new rare inflammatory system but i think the answer to your question, just to be honest and transparent is i dont know. Thank you. So to sum on on Antibody Testing we really dont know what it means, if somebody tests positives, how long might i last and is it protective and those results are yet to be determined. Thats correct and it is one of the critical things well learn between now and january. Thank you again and thank you, madam chair forks herring me jump in a little late here. Thank you so much. Want to go back for one minute to the disparities in and outcomes and ask you if the cdc has made any effort to ensure that public test sites are installed in communities of color . Is that going to be a focus . Yes. That really was orchestrated by the assistant secretary of health, and i dont have never exact number but 60 2070 of them were put into years that had were basically in areas that had social disadvantage sites. Can get you exact number because there was a direct intent to open the sites, and the testing sites being developed with cvs and i can get that exact information to you but its substantial and the answer is, yes. Because there have been some recent investigations saying that these are showing up in more wealthier and whiter communities and we want to make sure that we are putting our scarce resources where they are most needed, and that we also remember that not everybody has a car for a drivethrough site. I agree, very important. I want to go back to what my colleague mentioned previously which is World Health Organization who. On april 15th you said we have long history of working together in multiple outbreaks throughout the world and im heartened to here you say today that you are continuing that relationship. Do you standby your comments in april . Too you feel this is an important partner for us at this time of a Global Pandemic . Yes, and that actually inclass. Of days wag chelling the chairwoman before the hearing started, unfortunately we have a new Ebola Outbreak and no in the western con go and we jumped right in with w. H. O. And the ministry of halve to confront that. If this administration completely severed our ties and demand you did as well are you worried about our imeffect develop access to vegas vegas nation. I dont want to get hypothetical. I feel confident that the Public Health partnership we have, although it may be modified in some way in a political level i dont think its going to be modified in terms of our Public Health efforts. Thank you. Congresswoman frankle. Thank you, madam chair. Doctor redfield, i have a softball question for you. Overalled adults a represent a High Risk Group for covid19 as higher with a higher hospitalization, more tall rates and mortality rates rates anc correctly is telling them to stay home and we see this isolation is exacerbating loneliness, stress, Mental Health challenges, more difficult to obtain food or prescriptions, be physically active. So my question to you is, would cdc benefit from an increased collaboration across agencies during the pandemic as well as the pandemic to meet the Public Health needs of Older Americans . I think you raise really critical questions. As you said, many Older Americans who have stayed at home have been also have negative consequences of isolation, lack of human connectedness, obviously other issues in maintaining the critical activities of life, also necessarily maybe not gotten the preventive medical care for their chronic illnesses they need. Were commit evidence to continue to work and figure out how to maximize the health and wellbeing of these americans, and any way we can assist. I know this an important issue for you and were prepared to learn and assist to help. Prove that. This is the crate critical target group for this particular virus is those of us and im in the group. Im over im 68. Older americans. Thank you, madam chair, just to remind you, we talk about this, that i have filed in fact we filed a Bipartisan Legislation that would establish a national covid19 Resource Center for Older Americans within hhs and establish a Healthy Aging Grant Program at the cdc. Good. Thank you and i yield back. Thank you. Congress momos. Thank you. Across the country our community, prison staff, inmates are being put at additional risk because the bureau of prisons continues to transfer inmates without first test egg them for covid19. This is in part because the cdc guidelines do not recommend testing inmates before they are transferred, even from facility with covid19 cases. So your guidance note this is a quote if a transfer is absolutely necessary, perform verbal screening and a temperature check. End quote. So, as a result of this, few week others thing bureau of prisons transferred 19 inmate from the chicago prison to the thompson prison in my Congressional District where there were zero cases and did thats without testing all inmates. Now two inmates tested positive for covid19 another our prison in thompson, illinois, which by the way there are no hospitals in the county where that is located, and so for those inmates that have tested positive for covid19, we have that, and then for weeks, because of all of this going around, i have been pushing the bureau of prisons to test all inmates before theyre transfer. What they told my office is they cannot test inmates before transfers because they dont have adequate testing supplies. So, couple questions. What this cdc doing to increase Testing Capacity at the bureau of prisons, and should inmates be tested for covid19 before they are transferred especially from facilities with cases of covid19 . And im hoping you will end this by saying you will update your guidance. Thank you, congresswoman. You raise a very important critical issue. Obviously i think we all know that were learning as we go along. One of the areas we prioritize for surveillance and when we talk but the 10 billion for each of the states to couple up with a testing strategy, the priorities we have given. The, one is a comprehensive surveillance strategy, all nursing home residents to be tested and then weekly testing for the workers in nursing home, to develop their prison guidelines and again thats being debated book and forth put i think theres a strong sense oven getting everybody tested in the prison and obviously new people coming nitch cant tell you where thats going to land but were hotly discussing that now and obviously encouraging states to use these new testing resources to accomplish that and obviously the same guess for homeless and shelters. These are critical areas that and in Certain Industries leak meat packing plants and where have congruent congregate aliving and were on board. I have to wrap up. Okay. I yield back. Id love to know more but we can talk offline. Yield back, madam chair. Watson coleman. Thank you, chairman. Dr. Red field, i want to concern my concern about opening up various states and ask you that question but what is the safest percentage of people that need to be tests as a fungs of the population a function of the population. Some states may be testing more than other states and some states may have more row than data as to what the situation really is because theyre testing more, whereas the state next to you may by testing only a fraction of the people that i needs to test. Is there not any kind of goddance on what percentage of the population needs to be tested to make sure that were at optimum opportunity to open up . I think you raise an important point and i know the first threshold was at least 2 . I know we have some states that are over 10 . I think you have raised this earlier and raised again. I think this an area well go back and have the subject Matter Experts discuss because its clear that the benefit from this guidance. Thank you. And lastly, i just want to point out that when the aca was passed ten years ago, there was a section under 43. 02 where the cdc had a responsibility to develop a form to collect information and then have the demographic dat requirements that boast congresswoman lee and hi other colleagues asks for and ive asked for. Its not really creating something brand new. It is something that really already been in operation and so is that does that mean that your form is out of compliance with the requirements of the aca and the law passed ten years ago . No our form that we do for case reporting is has that information. Where the challenge has been is the reporting of the actual Laboratory Test results. The historically thats not something that was necessarily independently reported to cdc. We would get race report forms and that data we do have good racial ethnics, and sex distribution. We nowhere its coming from and now were getting reporting of test results, just the test results and they come in nonname linked without that information, and the difference is now every test result, every positive test result, every negative test result, going to have those fields of that we discussed and i think its going to beer helpful for us to get even additional sets of information based on testing. Thank you, doctor. Yield back. Thank you. Metaled now to congressman coal for closing remarks. Thank you very much, madam cheer. Thank you for holding this hearing. Very informative and i want to thank all the members on both sides. I thought the participation and questions were extreme hi good. Doctor, want to thank you for being here. You have one of the most important jobs in the United States but probably one of the toughest, too, and i appreciate your giving our committee this much time and i want to thank the president s chief of staff who helped make that possible, mr. Meadows, our chair talked with him democratically and cooperate have been more helpful in making it possible for you to be here so were grateful for that. We covered a lot of ground today and i thought again it was very good and i think appropriately so, a lot of the focus is clearly driven by coronavirus, clearly on massive supplementals where we have disease voted much moore money to this than your normal entire budget would be. We have entrusted alet of money and i think youve done a tremendous job honestly moving this how to the chain at decide through the chain at cdc and getting it out into the country and state and local and tribal partners to deploy the resources really well and i want to thank you for that and acknowledge the hard work of your staff. Want to close by saying, im really confident that the congress will continue to work on these supplementals like i suspect the chairman im worried about the longterm funding here and capacity, and you certainly talk but that in your opening remarks and in your testimony. Dont want to lose sight of that. This committee and frankly the congress are dealing with a budget agreement that again was done in good faith, nothing wrong, not critical of anybody for it but it doesnt apply now. Just as i told somebody the other day, the defense bug was one thing on december 1, 1941. It was something very different in january 1, 1942. Theres an intervening event called pearl hash porch this biomedical pearl harbor and we need to recognize that and need to not just deal with this thing but build the capacity, the phrase ive used is not popular, but i think its right, it is smart thing to spend billions to save trillions. We know what the cost of this event has gone our economy and our country. We need dish hope our leadership on both sides ill be working with my friend the chairman on this. Need have to the adequate permanent investments, what we ebola, the supplementalsing be helpful and the capacities erodes when the supplemental money runs out. We need the longterm thinking because we know will re be dealing with in the fall and foe foreseeable future and just got a heck of a lesson from at the biosphere and i just pledge to my friend the chair well be working with you to try to make sure that you have the resources and this committee has the resources to invest to give the American People the protection that they deserve and they require and the toe work with our friend around the world because we do this for ourselveses and we also work with others and appropriately. So this is a Global Pandemic. There are no isolated countries we are going to need to Work Together, and i just thank you for your leadership in that area, doctor. You have been a visionary on this for a long time. We talk but this many times before. We were dealing with this crisis so thank you for being ahead of the curve on that. Madam chair, thank you for the hearing. I thank the gentleman, and the gentleman and my friend and its a good to partner with you on these evers and thank you, dr. Redfield for being here today. Want to make one competent. Representative harris said we have been successful in reducing cases by 40 from the peak of 32,000 a day to 20,000 per day. So, we are ready to reopen. And i just reiterate that it wasnt what we talk but in march and we declared a National Emergency when we had 556 cases. Virtually all other developed countries have cut their cases by 90 or more before they reopened. The federal position seems to be, the our governments position seems to be that we cant do what other countries do so we just have to live with 20,000 new cases per day. That puts us all in danger in my view. I agree with my colleague, congressman coal cole we need to have long term furnishing and capacity but i say this to you, dr. Redfield because you made a comment that it was had some league role when the response to this pandemic was grounded in your center at the cdc. That is no longer the case. You are no longer at the center. Be point of the spear on this issue. It really has gone to fema, its gone to the white house. I will be very honest with you up want to build your capacity. I want to get youll the data. Want you to be sciencedriven, 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 might just add that we have talked about this at this hearing. Your guidance, changes, delays, the duplication, the National Healthcare Safety Network by hhs shows a message from this administration in my view that cdc is being undermined. The administration violates every rule in your 450 page manual, all of the time. Talk about lysol. Talk bow low sol. We need credible messages, we need credible guidance, we need to hear more directly from cdcs experts, and the cdc Media Briefing i want i hope you will just one more again from you one more thing to say but your briefings stopped. You had daily briefings. And they stopped. And those briefings need to continue. I hope let me just say is. Will you continue to the daily briefings . Thats a yes or no answer, doctor . We had them weekly. We did our weekly briefings and we do have our briefings back. Did one last friday. Right now theyre going to be every other week and im working to get them every week. We need to have those briefings back online. Just want to comment on yesterday. The publication, the nature. The published a study that analyzed the Economic Impact of lockdown and rpiings. The conclusion was that to protect our economy, we need to focus on Public Health. And we are not doing that. I make a reference to these photographs. As i showed earlier on. We are not doing it. Reopening before the virus is under control will put our economic recovery at risk and until we get that and its loud and clear from the science community, from the Public Health community, we are not going to succeed economically. But most of us do not. What we do here is to provide the resources that allow you and yourcolleagues at the cdc to do what you do. So we have reliance on that science. Let me just say to you, dont be afraid. Stand up. Talk about what your sciences do give us that direction and i will tell you that we will provide the resources that you need to do your job without that and without it in there will be a great reluctance for myself and my partner to go further if theres not a partnership in Going Forward. Thank you for your service, thank you for what you do as i said domestically and internationally. I knowwhere the that is where your heart and soul lies is in the science. Thank you its adjourned. [inaudible conversation] im truly delighted to be here this evening to welcome Darren Walker to duke. He serves as president of the Ford Foundation and will be our 2020 Terry Sanford distinguished lecturer. I have to say, given all of mr. Walkers extraordinary accomplishments, whoever tr