Transcripts For CSPAN3 Federal Health Officials Testify On Coronavirus Response 20240713

Coronavirus. Well have live coverage here on cspan3 wednesday afternoon at 2 30 p. M. Eastern. It will also be online at cspan. Org and you can also listen live on the free cspan radio app. Today, federal Health Officials answered questions. Good morning. The committee on health, education, labor, and pensions will please come to order. I have one goal today and that is Accurate Information. Accurate information that can help americans understand what they should do about the coronavirus and Accurate Information to help members of congress to decide what else we ought to be doing about the coronavirus. Around the world, the spread of the Novel Coronavirus is alarming. 90,000 cases in 65 countries, 3,000 deaths according to the World Health Organization. But most people in the United States are at low risk. Here is what the New York Times said on its front page two days ago on sunday in describing the situation in our country. Quote, much about the coronavirus remains unclear and it is far from certain that the outbreak will reach severe proportions in the United States or affect many regions at once. With its top notch scientists, modern hospitals, and sprawling Public Health infrastructure, most experts agree the United States is among the countries best prepared to prevent or manage such an epidemic. Thats from the front page of the New York Times two days ago in describing where we are in our country. Today in our country, while there are 90,000 cases around the world, there are about 100 cases in the United States, maybe a few more, and about half of those contracted the disease overseas and have been brought back here to be quarantined and monitored. There have been six deaths in the United States. In addition to the human suffering the virus is causing, its disrupting the global economy. More than 20 of everything we import is from china. Medicines, car parts, cellphones, televisions. China has shut down factories and locked down 16 cities where 760 Million People live. Think about that for a moment. 760 Million People is more than twice as many people as live in the United States. And theyve been lockeddown in china as china tries to grapple with this. In the short term this could disrupt our American Companies ability to buy and transport goods and materials in the long term. The production of these materials could shift and there would be implications on jobs there. The first goal of the hearing is to provide the American People with Accurate Information. Todays witnesses are respected professionals who have a lot of experience in what were talking about today and who know what theyre doing. And i want to take a moment to emphasize their backgrounds. Dr. Ann schucat spent 30 years at the centers for Disease Control and prevention. She is the Principal Deputy director there. Her work has been with these kind of epidemics through democratic and republican president s and Health Emergencies including the 2001 anthrax attack, the 2003 sars outbreak, 2009 flu pandemic. Dr. Anthony fouauci has held hi position as chief of Infectious Diseases at the National Institutes of health since president reagans time. Hes worked for reagan, bush, clinton, bush, and now president trump. He led the response to hiv in the 80s and 90s, the emergence of the west nile virus in 1999, Ebola Outbreaks in africa in 2014. For these professionals, this is not their first rodeo. Congress created the position of assistant secretary for preparedness and response at the department of health and Human Services. Dr. Robert cadlic helped draft the bill and now holds the position that was reauthorized by senator casey and senator burr. Not long ago dr. Cadlic had previous work assisting the fbi and air force in biological threats. Finally, dr. Steven hahn is the newest to the federal government of these respected professionals. Shes had plenty of experience before becoming commissioner of the United States food and drug administration, the fda. Most recently he was chief executive of the university of texas md anderson cancer center, a Large Organization of 21,000 employees. The reason i go through is if were looking for Accurate Information, these four ought to be able to provide it. Now, in addition to getting Accurate Information for the American People, we want it ourselves, to know what else we should be doing to limit the damage of the coronavirus to the American People and the american economy. And before we talk about what else needs to be done, i want to briefly summarize what weve already done. Lets start with congress. Its not the first Public Health threat weve faced. Theres some senators and Staff Members who are here today who were here 20 years ago when the anthrax attack occurred. 2003, sars. Another coronavirus similar to the one were seeing today. 2009, flu pandemic, killed an estimated 151 to 575,000 people worldwide. Then there was the Ebola Outbreak in 2014 and 18. So following the anthrax attack, in the bush administration, congress created project bioshield in 2004 to develop and stockpile new treatments and vaccines. After the sars attack in 2006, also in the bush administration, Congress Passed the pandemic and all hazards preparedness act that guides the fell government in how it prepares for and responds to Public Health emergencies. It gave the department of health and Human Services the authority, for example, to prioritize funding for the development of vaccines and treatments for Infectious Diseases. It improved our Public Health Emergency Fund. The Senate Passed the most recent update of the pandemic law led by senator burr and senator casey. Senator blount and senator murray worked to fund the programs. We all know president s and their budgets, this includes all the president s i know about, sometimes underfund these programs. But last year, congress provided more than 4. 5 billion for Public Health and Preparedness Programs. When a crisis occurs, we often need money quickly. Thats why congress has created two funds, the Public Health Emergency Fund and the Infectious Disease Rapid Response fund. For example, secretary azar has already used 105 million from the Rapid Response fund and using Authority Congress has given him, hes transferring 136 from other programs in his department to respond to the coronavirus. And the Trump Administration has requested an additional 2. 5 billion. Others in congress have made suggestions and were likely to vote on that in the senate this week. In aio. In addition to what congress has done to get ready for pandemics like this, both democratic and republican president s over the last 20 years have used their executive authority during Public Health emergencies. President obama sent the military to west africa during the Ebola Outbreak. President bush sent cdc experts around the world to investigate and respond to the sars epidemic. President trump similarly appointed a task force on january 29, he put the Vice President in charge, he moved ambassador birx from the state department who has had years of experience in dealing with Infectious Disease, to be a Principal Deputy leading that effort. On january 31st, at a time when there were only six cases confirmed in the United States, the administration for the first time in 50 years announced they would quarantine americans who had been exposed to the virus while in china and imposed travel restrictions on foreign nationals who travel to china in the last 14 days. At the same time, the state department warned americans not to travel to china and the cdc recommends americans reconsider cruises in asia. A couple of days ago the state department added italy and south korea to the countries that americans should reconsider traveling in. Under the authority of the immigrati immigration and nationality act, the administration said foreign nationals who traveled to china in the last 14 days cant enter the United States. On saturday the president updated this to include travelers from iran. Dr. Fauci, who is testifying today, has said if we hadnt taken these steps, we would have had many more cases right now. A third example of executive action is developing a test to diagnose the coronavirus. The fda authorized that on february 4th. Its been made available to 46 labs in 38 states and washington, d. C. Two days ago the fda authorized a new test developed in new york. It is working with 65 other private Sector Developers including Academic Medical Centers and commercial labs to increase the availability of these tests. Fourth, dr. Fauci has said that were developing the vaccine for coronavirus more rapidly than weve ever developed any other vaccine. And drug manufacturers met with the president yesterday to see if treatments and vaccines could be made available more rapidly. Finally, scientists at our national laboratories, oak ridge, argon, livermore, are using their super computing and imaging capacity to try to understand this virus better. Of course in addition to the impact on us in our individual lives, there is the impact on the global economy. The trade representative says about 20 what have we import comes from china. As people get sick and cant go to work, that slows down whats sent here and has an impact across the board. 13 of facilities that make active ingredients for drugs are in china, according to the fda. Some people have said that 80 of the ingredients for drugs are produced in china. We should evaluate that figure carefully, it appears to be based on a 1998 report that may not have a source. But ive discussed with a number of senators how we can inquire into whether we should explore the dependence we now have on other countries, not just china, for medicine and health supplies. Most businesses in the United States that need supplies have more than one source for what they do. Perhaps we need to take another look at that. And its just not medicines that are affected. In tennessee we have eastman chemical. They have nine manufacturing plants. A ceo said that the recent phase i china trade deal caused orders to go up in his company but the coronavirus problems in china have caused them to go down, and that has an effect on jobs in tennessee just as it does on jobs in other places. So todays hearing is an opportunity to listen carefully to four respected professionals who have decades of experience and are the right people to give the American People and members of congress Accurate Information about the coronavirus, both what individuals can do and what else the federal government needs to do to respond. Were going to finish by noon today so that dr. Schucat and dr. Fo schltop of fauci can joi president. Im grateful to all the women and men out there who are working now to keep our country safe and i hope you pass it along to all of your teams as well. Mr. Chairman, this is really a frightening team. At least six people in my home state have already died from the virus. I am told we should expect more. We expect the number of infections to continue to grow and the people across my state and im sure across the nation are really scared. Im hearing from people who are sick, who want to get tested, are not being told where to go. Im hearing that even when people do get tested and its very few so far, the results are taking way longer to get back to them. The administration has had months to prepare for this and it is unacceptable that people in my state and nationwide cant even get an answer as to whether or not they are infected. To put it simply, if someone in the white house or this administration is actually in responding to the coronavirus it would be news to anybody in my state. And ive been on the phone with all of our local officials for days now. This is unacceptable. We are now seeing Community Transmission of this virus. Families deserve to know, and fast, when testing will actually be ready to scale up. What they, the families, should be doing. And most importantly, what we are doing. And unfortunately i have to say that while i am profoundly grateful for the work public Health Officials are doing, im very frustrated at the steps the president has taken, from repeatedly contradicting experts advice to downplaying the seriousness of this threat and to appointing a politician to lead the response. So im really glad today, mr. Chairman, that we have the opportunity to hear today directly from the experts and get answers to the questions that i am hearing at home. I know people want answers, and one of those is, where we going to scale up this testing, especially now that we are beginning to see Community Transmission in the United States. After all, its only after a long, frustrating delay that we are finally able to Start Testing patients for this disease at state labs across this country. And the last few days seemed to confirm what experts have been warning, that this is likely to continue spreading. We now have more than 100 cases of coronavirus that have been tested in this country including repatriated cases. Theres a lot were still learning. There are a few things that are abundantly clear about how we need to respond. First of all, we do need to be listening to the experts and making sure facts and science drive our response. In particular, the public needs to be able to trust the information theyre hearing from exper experts, and that the federal government is in no way influencing considerations with ideology. And the policies are about how to keep our families safe, not fear or prejudice. Dr. Fauci, i was glad to hear that contrary to reporting, you have not been muzzled by the administration. Its essential that that continue to be the case. We cannot have an Effective Response without Accurate Information and transparency from the administration. And i will continue to be very focused on this. Secondly, weve got to provide adequate resources to meet the needs of our federal, state, and local Health Officials because we know resources that come through programs like cdcs Public Health Emergency Preparedness program are absolutely critical. But also they were never envisioned to be sufficient to respond to a threat like this. So we have a lot more to do. Congress, as you know, is now working on a bipartisan emergency supplemental Funding Agreement that will reimburse costs state officials have incurred. It will guarantee resources are available to outbreak hotspots. It will support development of vaccines and therapeutics to test and treat this virus and keep us prepared to respond to future emergencies. I do want to thank and recognize all the democrats and republicans who came together to work quickly on this package and i urge the senate to pass it very quickly. Im very glad were working on that agreement that goes well beyond what trumps inadequate request for 1. 25 billion in new funding. And i really, again, urge the senate to take this up as soon as the house does, get it passed and get it to our local communities who are dealing with this. Im also very encouraged by this committees strong bipartisan record in responding to Public Health emergencies as well. Just last year this committee strengthened and reauthorized the law underpinning so many of the federal efforts and resources we are seeing employed today. So i especially want to thank you, mr. Chairman, for our work together. Senator casey and burr for their efforts on that. Third, we have got to be sure we arent just responding to the latest developments but staying ahead of this crisis by planning ahead, because this is not likely going to end anytime soon. We are already seeing some of the challenges that will come next like the strain this will put on our Health Care System. Were seeing that in Washington State. We need to make sure our hospitals have the capacity to address this virus without overwhelming their ability to provide other care that people need. We need to make sure that those Health Care Workers caring for coronavirus patient are safe from infections themselves including by making sure they have a sufficient supply the protective commitmenequipment. We expect demand for some supplies and were already seeing that skyrocket. And how much drugs and devices are manufactured in countries where an outbreak could interrupt production . Something that we, again, are already seeing. We also need to give adequate attention to our Public Health in an age where disinformation has been recognized and falsehoods and rumors gain traction as we all know faster than ever we cant let conspiracy spur discrimination or undermine us. The bullying and harassment that is motivated by stereotypes and fear. We have to account for some of the ways the Harmful Health care policies have made threats. Its not required to cover diagnostic tests or vaccines are expanding. Those actions make it much harder for people to get the care they need to keep this crisis under control. We have to make sure that every one who needs it has access to diagnostic testing Going Forward. While a vaccine is still likely over a year away, we need to make sure costs is not barrier for that as well. Its not just our Health Care System we need to be considering. Communities and families right now are facing difficult decisions. What measures should our schools take to keep our students safe. What can parents do . When should schools close . Employers and workers in my state and im sure others are facing similar questions about whether their employees should go to work or stay home. I will be pressing secretary devos later this week about how her department is helping to prepare for these issues and ive written to the secretary about this as well. This Public Health threat will have hidden and higher costs for those who are low wage workers who dont have affordable child care, who dont have Health Insurance and who are experiencing homelessness. In my home state people are being told to stay home for two weeks if they are sick. There are not tests so we cant get tested. Guess who cant stay home if you dont have child care, if youre a low wage worker, if you dont have sick leave. When those needs are not met they cannot make choices to protect themselves which means they cant make choices to best protect others too. One person getting sick has repercussions for all of those around them. We are all a community in a very real sense. We all have a stake in one anothers well being. When we talk about the impacts of this health threat, this is not just about changes in the stock market but we need to develop plans response ifr to t response ifr ive to the dayy experiences. I lack forwaook forward to hear our witnesses. I will continue to work with all after you to keep those informed about what were doing and to keep them safe. Ill keep pushing to make sure as this situation continues to develop, we keep listening to the experts providing our Health Officials the resources they need and planning for the long term. Thank you. Thank you senator murray. We have hosted four briefings for senators. Senators could be sure there werent any secrets. Each one will have nooifr minutes to give his or her testimony. Then well go do a round of questions. Shes had a variety of roles dealing with responses to sars, to anthrax, to influenza over the last 30 years. Dr. Tony is the top person at the National Institutes of health of Infectious Diseases. Hes in position since 1984. Hes worked with six president s and led the institutes efforts on hiv, aid, ebola and other diseases. Finally, dr. Stephen hawn who is the commissioner of the u. S. Food and drug administration. We look forward to your testimony. Thank you very much. Cdcs role in this whole of government, whole of Society Response is Public Health workers at the state and local level living in your communities. Two months into this response to a novel virus, cdc has learned a lot. We have acted in the United States and around the world but we do so with humility about the work ahead. There are many things that each of us can do as individuals, business, communities and organizations and were thrilled to see the website posted behind the senators. Cdc is responding with the following strategy. Our goal has been to slow the spread of the virus through a multilayered aggressive containment and as needed mitigation effort. Were using evidence based Public Health interventions that have included early case recognition, isolation and Contact Tracing. We have issued travel advisories and dealt with targeted travel restrictions as well as the use of quarantine for individuals returning from Transmission Hot zones, including through funneling of flights from main land china to 11 airports. We worked with the cbp to get data to ensure appropriate follow up could happen through the state and local health departments. We have been working the World Health Organization and ministries of health around the world underscoring our leadership in global Public Health and the power of our investment investments. More than 1500 staff at the centers of Disease Control and prevention have been responding to this. The situation today is evolving and dynamic. In two months this outbreak has grown from a cluster of pneumonia in one city to affecting 70 countries and territories around the world with 90,000 cases and 3,000 deaths. Were now in the United States, seeing in addition to the travel associated cases, we are seeing Community Transmission in a few areas and tragic outbreak in Long Term Care facility in Washington State. Our hearts go out to the people affected by this virus and every one working hard to counter it. While the immediate risk to the general American Public remains low and the u. S. Government is doing everything we can to keep it low, risks varies by exposure and some areas of the country are now experiencing Community Spread. State and local jurisdictions where Community Spread of the virus are occurring is intensely investigating and assessing community interventions. Cdc has staff on the ground in washington and california and elsewhere to provide technical assistance. Our role in this type of Community Measures is to develop principles and tools based on our updated pandemic planning play book and based on what we learn from other areas that have been experiencing the outbreak including in singapore where they have done a good job of managing it. A key planning principle is to protect the most vulnerable. I trust you as Senior Leaders in your communities to help us with our mission to provide clear information to you and your constituents by urging people to get the facts from cdc. Gov, can which you can see up there and i look forward to answering your questions. Thank you. Thank you. Both therapy, mainly treatment of a person who is already infected and the other is in the area of vaccines or prevention of infection for those who are not infected. Its important to point out that the time lines for each of these are fundamentally different and id like to take a moment to kind of explain why when we talk about and the American Public and the Global Public understandably want to know how quickly we can get interventions to them. Lets start off with therapy. As we know from the data thats come out from china, if you look at the now 90,000 people that have been infected and the number of deaths that have occurred, about 80 of individual who is get infected do really quite well without any specific intervention. Mainly they spontaneously recover. However about 15 to 20 of individuals, usually those who are elderly in risk groups wind up getting serious disease requiring support ifr care. That could be oxygen, intensive care. We want to have a therapy for these individuals. There are a lot of candidates that as i speak to you today are being tested in randomized trials. One of these was developed by the giliad company. Its being tested in large trial in china. Its being tested here in the United States and an nia sponsored trial in collaboration with giliad. We should know within a period of a few months, several months, whether or not this particular drug works. If it does, the implementation of that would be almost immediate. The timetable for treatment is different from the timetable for a vaccine. Thats why i want to see if we can clear up any is understa misunderstanding that are sometimes out there. The technology we have has allowed us to go from the time, the sequence of the virus to the time we stick a candidate into the arm of someone, has gone down to the fastest that we ever done. I expect that at least one of those candidates, its not the only one would likely going to Clinical Trials in a phase one study within about two months or maybe even six weeks. That will be a record. However, that is not a vaccine because it will take about three months or more to show that it is safe and then if you show its safe, youve got to put it into whats called the phase two trial to show that it works and the reason is is a medical, ethical and other consideration is we give this to normal people to prevent infection. You must be sure the edic of medicine, first do no harm. You need to make sure its safe and make sure it works. That entire process will take a year or year and a half. Its going to take a while. We have Public Health measures. The issue is in addition to those Public Health measures, interventions are going to be critical. We hope that well be able to get good news to you and that well be able to say, in the next x number of months that we have candidates but there will be no guarantee of that. The only way to know that will be to do the kind of clinical testings that im talking about. Hopefully well have the opportunity to update you on a regular basis about where we are with that. Thank you. Thank you. Thank you. I really appreciate the opportunity to testify before you today and ill ask the support of the hhs and whole of the government response to the coronavirus situation. I think you heard of how were trying to address this from a point of strategic intervention. A four pronged approach to manage and the domestic preparedness. Were working very closely at mih to see what kind of they are pu their purapeutics and diagns we can use. Were looking at areas that would allow us to do point of care diagnostics which i think senator murray talked about. Looking at two potential vaccine candidates, one that was a product of the investments that were common vaccine that is licensed by the fda, and another one that is candidate vaccine thats developed for the ebola crisis. Those are very important. Were looking at how do you support americas Health Care System through the hospital Preparedness Program, working in coordination with the Preparedness Program that cdc add ministers, we have been looking at how can we work better to improve collaboration among hospitals and the Public Health sector and other entities like emergency services. I want to highlight one area that congress was very crucial in developing and deploying during the ebola crisis. Thats proved to be vital in terms of our ability to manage this not only through the repatriation of americans taken from huwan but also from the diamond princess. That was vital in terms houf we could do that. The other issue is around how are we doing management. Since this started we have been working with fema to put in place an Incident Management Network that really is based ong t on the National Response frame work. This is the first time we have done it formally. Its a means by which we can leverage fema and the support functions that may be necessary by states when asked to employ responders to assist them in dealing with this crisis. In the last area, ill just highlight is around the direct support of state and other entities. We have been working two years in advance for hhs and with our japanese colleagues to prepare for such an event. With the state of washington we used it to protect Health Care Workers, highlight with was said. Lastly, to employ and deploy some of our National Disaster medical system personnel as well add other federal Health Personnel to assist at the evergreen Long Term Care treatment facility. Were doing this as a team to respond to this. Thank you. Welcome. Thank you, chairman. Really appreciate the opportunity to speak to you today about these efforts. On behalf of the 15,000 fda employee, our hearts go to those affected by the coronavirus v coronavirand those that have lost their lives. Please remember some of this information that i can share now does change quickly. Its my hope this information will help the members of these committees. Not only ri mind them of the recording requirements but to ask them to assess their entire supply chain and much of what were asking manufacturers there to tell us. They have been forts cohcoming. They did tell us about a shortage related to the Novel Coronavirus. It was reported and disclosed to the American Public through our drug shortage list. The good news is were working close with our manufacturer and expect that to be resolved in a short period of time. I know theres interest in Additional Details surrounding this drug but i can provide the name because its confidential commercial information. We do not have the authorities to require devices to tell us about shortages. They have been very cooperative with us as have the Drug Companies with respect to giving us this information we need. Please be assured that if other shortages or disruptions are identified by the fda we will be very transparent about this. We will quickly share that information with you. A Fast Breaking bit of information that we just found out this morning is that india has restricted the export of 26 active pharmaceutical agreements for export that represent 10 of their export capacity. We are working very closely to look a t that list to assess how that will affect the medical supply chain. Weve been aware of no shortages of this device although we understand on the demand side on personal protective equipment and masks theres significant pressure and demand. Were working closely with those manufacturers. What we have found is that some of the manufacturers in china have reported disruptions in the work force as you might expect. Fda issued an emergency youth authorization to allow the use of approved disposable filtering respirators and increase the supply within the nation. Regarding diagnostic tests, the fda issued an eua to enable Immediate Use of diagnostic test developed by cdc. Since that time additional labs in the west coast, washington, california have notified they have begun testing using this emergency approach. Weve had a lot of contact with both private and public and Academic Centers with respect to the development of these tests. The ability to perform those tests. We have one manufacturer working closely with the cdc to expand that over this upcoming week and we expect that to be available. Those kits provide by the end of the week and that expansion will continue. Thank you for the opportunity to update the committee. I look forward to answering your questions. Thank you. We have very good attendance by senators. Were going to continue the hearing until 12 30 in hopes that every senator will have a chance to ask questions. I know the witnesses have been asked to go to senators lunches with the Vice President but thats us. Wed like for you to stay here until you answer our questions and then go to lunch with us and answer our questions further. I think we can complete that by 12 30. Im going to ask senators to keep the total amount of time for each one on questions and answers to five minutes each so every senator has a chance to ask questions. Dr. Faucci, im going to ask you a series of questions. What do we mean by Community Transmission . When there are cases that are in the community in which the original source is not known. If you get someone that travels from huwan to the United States and you know they are a travel case and one of their contacts gets infected, you know the source. If all of a sudden were talking about person to person. We know who it is. Person to person but you dont know the original source. I thought there was a difference to person to person and Community Transmission. No. Any transition of an infection is from a person to person. What if you know it is . Thats not so called community. Theres a cluster in the community. If senator murray has it and gives it to me. What do you call that . Thats person to person transmission. If i get it and we dont know who caused it. You dont know the original source. Are we at the peak of the flu season . Well, the answer is likely and maybe on the way down. Were just over the peak. It went up, it went down. It went up. Talk about the ordinary flu you have every year. About how Many Americans have flu this year . Probably around 30 plus million infections. A couple thousands hospitalizations. In the United States . In the United States. How Many Americans die every year from what we call the flu . It ranges from a low year of 15 to 20,000 to the high year in 2018, 18, which was about 70 plus now people. About 70 p 070,000 people. In one of the worst. The flu is a respiratory disease like coronavirus, is that correct . That is correct. How do you know if you have the flu as opposed to coronavirus . Well, the definitive test would be to get a test for the flu or the coronavirus. So you need a test . Theres an overlap in symptoms. Its fever and a lower respiratory infection as opposed to an upper respiratory infection and you might get a pulmonary voinvolvement which i the flu. Whats a lower . Lung. When you have lung involvement you can get that with flu but usually its upper respiratory. Fever and a cough. Either of them. What should you do if you have fever and cough . It depends on the circumstances. If youre in the middle of a flu season now and you have fever and a cough, obviously, if you have a cough you should see a physician. If youre a person in a risk group. Elderly or underlying condition. During the flu season, you should see a physician because we do have antivirals for flu. You can be helped by doing that. Should we all be Wearing Masks . No. Why . Because there isnt anything going around in the community that is calling for the broad use of masks in the community. Why do Health Care Workers wear masks in the hospital . Because a Health Care Worker who is taking care of someone who is known, infected with a virus, thats different from Walking Around in the streets wearing a mask. Are children getting coronavirus . To a much lesser extent than adults. For reasons that are still unclear. It may be they are getting infected but symptoms are so low they are not being recognized. In the number of reports that have come out from china, theres very few clases, less than 15 years old. Most of the cases are of about 50. What can we do or wa can our family dos to protect ourselves . Whats the most effective thing in. Right now, i think the question you can about flu is important. Right now we are still in the flu season. What you can do to protect yourself against the possibilities of coronavirus is the kinds of things you would do to protect yourself against flu. Obvious lip you get a flu shot. You can protect yourself against flu but also things like we always say it sounds simplistic but its true. Washing of hands, if possible. Staying away from people coughing and sneezing. If youre inif he canned, stay out of work. My time is up. Thank you. Im going to yields the first question to senator jones who has the lever to take a flight. Ill take the second round. Thank you. If somebody right now in alabama presents if they didnt get the flu shot and they have fever and coffer, thugh, they get a f. If they dont have the flu but have coronavirus, would that test come back negative . [ inaudible question ] they should be concerned if they present symptoms for flu and that comes negative. Follow up question on that is about testing. I didnt hear a lot about the testing. We have had some concerns in this country about testing. What capacity do we have to do to testing as you sit here today and how are we working to expand that and when will that all happen in. The cdcs piece in this is to supply the Public Health lab with tests and we are rapidly doing so. We developed the test very quickly and then detected some problems after the Quality Control steps were measured. By the end of this week, the state labs should be able to do testing. Clinical labs tested 40,000 respiratory specimens for influenza. So far the Clinical Labs have tested almost a million respiratory specimens and 200,000 were positive. Public health labs tested about 62,000. Public health labs are a tiny piece of the testing world. That said, most people with influenza dont get tested. Then right now were really keen with the fdas assistance to get the Clinical Labs up and running. How much more capacity we have been the end of this week versus two weeks, three weeks for now . We work with the cdc on their test. Were using their network but the outside Manufacturers Private kpans are using their platform right now to further develop the tests. Our expectation in talking to the company that scaling this up is that we should have the capacity by the end of the week to have kits available to the laboratories to perform about a million tests. I would urge to please continue, please get information out there. Were about to head into the al e allergy season as well. People are so scared that the first time they sneeze with an allergy, they will think they have this. We need to make sure we educate folks so those tests we have are for the right reasons. Second question i have, it concerns rural areas. We have another rural hospital closing this week many the state of alabama. Are there specific things you guys are doing to make sure that rural hospitals, who are living from paycheck to paycheck have the resources they need, the Financial Resources and tools they need to make sure theyir communities are protected as well. Thank you for the question. We have been monitoring that situation very carefully with our Health Care Coalitions that are funded by hospital Preparedness Program. The majority of individuals with the coronavirus dont need care. Individuals who may be at risk for severe disease should seek hospital care. I had a question on that but i would encourage you to get with cms and have them allow reimbursements and they dont do that now. Its weird conversations. Perfect. Thank you. All members if they want to enter a statement for the record, they can. Just remind members in 2050, when senator kay and i passed, we had this day in mind. We would be faced to a pandemic and were close to that determination. I would only say the temptation is to do legislation are grave. Before you do it, read what the statute says. Read what the latitude is our responders have. Let them do their jobs. Well take unanimous consent and put that in. Thank you. I heard you say youre rapidly trying to reach testing. As of march 1st, cdc website had total testing up on their website was 472. What im curious about is why on march 2nd, did you take the total number of testing off the cdc website . Thank you. Theres a lot of numbers out there. Theres a difference between persons under investigation who have been tested and all the tests we have run. For instance, an individual case, the first 12 cases that we saw here we did serial testing on them to understand how long the virus was present and when it was safe for them to leave the hospital for when they no longer needed isolation. We collected multiple specimens so we understood is it the upper respiratory or lower. We collected other specimens from them. The other 3,000 tests run is correct. We tested way more than the 500 some persons under investigation. We also tested some of the hot risk coherts like the repatriation individuals. How can we have a situation Like Washington state where we have known for up to six weeks reaching probably 1500 individuals yet we experience what we have with this Long Term Care facility and clearly a cluster that we dont know the magnitude of. How can that happen when we have invested so much in being there early on and understanding . Cdc very rapidly developed a new pcr for a new virus. We posted the instructions on the website so other labs, academic labs, commercial labs, Research Labs could similarly develop tests. The situation in Washington State is tragic. An outbreak in a Long Term Care facility is one of the things we have been worried about from day one. We learned from the sars experience in 2003 that super spreading individuals could cause very large implications rapidly. The concern about Health Care Settings has been foremost in our mind. Ei believe you. Im only looking at were we better prepared for this happening. It doesnt seem we were. The Laboratory Activities for the coronavirus are one of the largest parts of our program. We havent built our response around our influenza capacity which has grown with the generosity of people. Its relatively small. We really appreciate the support from congress to sprentsen the public structure at the cdc and stats. Im shocked and i like to think im fairly knowledgeable of everything that we instruct or provide. I was shocked to find out the normal appropriations, this 150 million that can also be used for cdc facility construction. Its a little misleading to say this went for surveillance when the flexibility exists for some of it to go for facility construction. Do you know what portion of 150 did not go directly to funds surveillance. Im not sure what the 150 line is. I think i will need to get back to you on that. Lets make sure it goes to response and not instruction of a campus at this time. I yield back. Thank you, senator. I have people in my state who may have been exposed. They cannot get answers about where to go and Health Officials are fearing this virus has been circulating for weeks undete undetected. Within days there were validation issues with the tests leading to inconclusive results and cdc began to work on remedying that. It wasnt until february 27th that cdc began distributing new test kits. Fda asked labs to submit information about 100 tests at a time when only 15 people in the u. S. Were known to be infected. Press reports indicate the publication of this guidance was delayed within hhs. We now believe well do a million tests by tend of the week but im hearing from mof professionals that is unrealistic. I wanted to ask you what happened at the department that created these delays and how can you clarify that estimate of a million tests is accurate . Thank you, senator. Theyre able to develop a test based on the identification of that sequence. They moved rapidly to develop this pcr based test as it was just described. We received the validation. We issued the emergency use authorization to allow that test to be used. During the scale up process which occurred in the week or so afterward and sending it to the Public Health labs, it was identified some of the Public Health labs. Not all of them that they werent able to reproduce and validate the tests. Cdc heard that information, came to fda and we worked to correct that issue. I understand but was the publication delayed or guns delayed. Was it yes or no . No. It was not delayed . No. Do you believe a million tests will be available by the end of this week . Let me explain that one. The companies that were working with have the capacity to develop enough test kits to send out by the end of the week. Every day were hearing from additional manufacturers that they can do this. 2500 test kits by the end of the week. That should give us the capacity in the lands of laboratory, once they validate it to perform up to a million tests. 2500 kits. And 500 tests per kit. I heard the doctor say the point of where someone goes in to get a test for rapid, we are months away from that. Yes. Im hearing from a lot of people in my state that are concerned about what they should do if they are infected or know they within range of someone with coronavirus. Right now the cdcs website says if you suspect you are infected, you should stay home except to get medical care. Right now, we know that 27 of private sector work force in the u. S. Do not have the ability to stay home from work without losing pay or if they have a loved one to help. The u. S. Doesnt provide paid pay for illness. If were telling people to think home, think about the facility impacted. Seennior center, low income workers there. All of them are being asked to stay home for two weeks. Would it be beneficial to have policies in place to make it possible for people to stay home from work without losing a paycheck . Absolutely. I think thats something we need to consider with this. The staff were not appropriately trained to handle this type of Public Health emergency or how to wear protective equipment. They were not quarantined, monitored or tested for the virus and some have since taken commercial flights and returned to work. Its not clear that hhs took necessary steps to protect stap a staff and the public. I can speak for cdc that we take health of our work force very seriously. The health and safety and have free deployment and postdeployment guidance. This is a totally new virus. Were learning as we go. When we identify problems we want to resoever thvrresolve th. Is that consistent with the protocols . I dont have the full information. Were looking into that very closely. This is not to echo what was said, we take the protection of our Health Care Workers in hhs very seriously. I would say we need people to speak up on these situations. Its unacceptable any of these workers on the front lines are intimidated into staying silent or believe they will be retaliated against these issues. We have to keep the protection of public first and foremost in our minds. I want this looked at and i want to make sure anybody who speaks up is protected. Thank you, senator murray. Senator paul. Im intrigued by the fact they say its affected against mars, mers and mrsa. Do you think its effective in humans too . I do. With regard to the children i think its fascinating there arent many cases. I would expect its improbable if they arent affected and they have some blanket immunity. Maybe putting a better look would be if we had numbers. There are some data that it might be as zero in children but they may be asymptommatic. Theres data in a few places looking at that. We had a group that was under the auspices of the w. H. O. That went to china. It was an individual from the cdc and an individual from the nih who have now returned and will soon get a good look at the report of what theyve had. That is one of the questions we asked. Seems we sort of tried to fight off the cause of the infection as well as the bodys response. Are they finding that steroids, in addition, are they using steroid treatment in real severe cases. They have done it in noncontrolled way. Thank you, senator paul. Senator casey. Thank you for the hearing and the witness and their expertise and the work each individual here for many years. I have two individuals in the executive branch. The president and the Vice President. The obligation is real simple about every elected official. Every one of us is charged with working constructively to the following. Slow the spread of the virus and taking steps to do that. Working with all of you and folks who work with them and number two local preparedness efforts and number three provide complete and accurate, always Accurate Information to the public to address their concerns about this challenge. I know this committee worked in a bipartisan fashion on a range of things for years. Were continuing that today. We have to make sure we do our job even as were indicating what should come next. I want to start with regard to the tragedy thats unfolding in the state of washington in Nursing Homes as senator murray outlined. I want to start with that venue for this challenge. We know the early indication suggests that the virus pose a significant, even deadly risk to number one, older adults, number two, people with disabilities and three, folks with Underlying Health conditions. The risk is heightened in Nursing Homes. Residents and workers dont have the option to distance themselves. The residents are in their home. Theres no staying home to avoid it. Obviously, the workers have a challenge. Tell me two things about what the administration is doing. What is the administration doing to protect the residents and number two the workers. As we learned more about this outbreak and last thursday, the chinese posted a fairly significant report. It gave us a pretty good understanding of the risks, about 20 to 15 people over the age of 70 are at risk. We can warn and inform people with vulnerabilities and we have actively worked to reach out to them specifically through mass calls and briefings to inform them of those risks and guidelines they can follow the cdc guidelines. We have been very proactive and trying to respond to this as we learn more in a way we can ensure, warn proprietors but its not just Long Term Care facilities. Its dialysis. People who are at risk can be taken care of and shielded from this virus. Just to say cdc has issued a number of guidance documents and for the past several weeks its been doing out reach with clinicians and health systems. Through the weekend i spoke many times with cms and assets that cms has including inspectors and so forth is being directed to help us with this challenge. Obviously, individuals in the Skilled Nursing facilities and acute hospitals have lots of other things going on and the best we can do to protect them from infections is our responsibility. Just making a comment and i have one question. We had a debate about health care and ive been working as many have to combat the use of these so called junk plans. We got a report where a guy got tested for the flu to make sure he didnt have coronavirus. He finds out that his insurance is one of those Short Term Limited Duration plans. Doesnt have testing. These junk plans are problems. I hope this challenge were facing will convince the administration that junk plans or the advancement of junk plans are really dangerous especially when we face this kind of a threat. I hope they would rethink their regulatory strategy Going Forward. How many people this week can be tested in the United States of america, this week . Senator, that depends upon the deployment by the manufacturer to private companies, Academic Centers, et cetera and their ability to validate it and do the test. The capacity will be there by the end of the week but those are the necessary steps to get that deployed to the American People. I hope you can get a number on the people. Thank you, senator casey. I have about seven or eight questions. If i interrupt, its not to be rude. Its to get to them. Cdc, we discussed before hand, i discovered the canadians have not been as strict with people returning from the huwan province. You mentioned theres screening at the u. S. Canadian border but what percent of those folks coming from canada in Washington State are being screened as the travel history, exposure and or temperature . I dont have a percent but we worked closely with the u. S. Public health service. Can you give me a ballpark, 10 , 50 . Theres a protocol that is assessing everybody who is crossing at the key borders to alert where the flights are coming in. It could be as low as 5 . It could be. Yeah. Secondly, are you using the cdc google location data or something similar in terms of tracking contacts . Not for contacts. We have for let me ask, going t nursing home in seattle. Clearly somebody came who had been exposed to the coronavirus. Law enforcement at the scene of a crime will get a warrant, will ask google to give this data. Weve been reviewing the statutes. So just to be clear, cdc is not currently using that same sort of thing Law Enforcement is to track contacts . You have to recognize that right now the chances that a person with a fever and cough have coronavirus versus influenza are very low. So exactly what my point is, if somebody went to that nursing home and you can follow their their location data. Mmhmm. And it turns out they had contact with somebody who had traveled, perhaps in canada, they had gone back and forth, then theyre obviously a candidate for being the vector. So i would encourage, because i think the answer is no, that you do use that location data. It seems as if that would expedite the epidemiology of how this is being spread among the community. Next. Dr. Hahn, those 26 apis that india is not allowing to be exported, are any of those the active pharmaceutical ingredient for any of the candidate therapeutic drugs . Senator, i dont know the answer to that question. Were going through that list right now to actually assess the effect on essential medications. Okay. Next, one of the recommendations that senator murphy and i had in a request in a drug shortage report from fda which was released last year, recommendation number two, was to establish a Quality Supply chain rating system. Now, should Congress Enact this quickly . Because clearly if weve got supply chains overseas we cant inspect and or they are interdicting the flow of that active pharmaceutical ingredient to the u. S. , again, should we now enact that recommendation . Number two . Senator, we stand behind and are working on the development of this rating system. We also have some legislative proposals as part of the president s budget that relate to this. Okay. Next, as regards the weve we have a problem with antibiotics in which you have a very expensive antibiotic for some terribly resistant drug, its difficult for us to currently pay for them with payments to hospitals. We can have the same situation with antivirals, whereby the antiviral might be very expensive and that would blow the lid off a drg you see where im going with this. So, again, i would Like Congress to act up on this quickly to create some sort of carveout for these essential but expensive drugs to develop. Your thoughts . So, we have implemented the authorities given us to in the g. A. I. N. Act and also the c. U. R. E. S. Act. I think this would be a payment policy on part of the cms. We have to give them authority to do an epi payment, if you will, for the use of such drugs. Know we have a Pilot Program with cms. I defer the payment questions to cms, sir. Dr. Fauci, were looking for quick diagnostics. Obviously a pcr takes a little bit longer than a swab or a blood test for an igm or an igg. How close are we to having an igg or igm blood test that can be turned around in a Community Hospital . I think pretty close. Thats clearly one of the things we want to get. It will be important for broader surveillance of people in the country of exposed people who never come for medical care. As i look at this, we need expended health with expanded use authority. We need to give appropriate reimbursement for that. Granted thats all cms. But we also need home health. Ms. Murray was saying how we got to send people home. I think we need to do something there, and i think these are those those are my questions. If you need authority from us, please, let us know. It may be the expanded authority that senator burr already referred to. We need to know what else you need. I yield back. Thank you, senator cassidy. Senator murphy. Thank you very much, mr. Chairman. Thank you so much for your service. Thank you for being here today. Dr. Fauci, thank you for your very clear articulation this morning about a realistic timeline for treatment and vaccine. I do think its worth saying that it is pretty extraordinary that we have to have our medical and Health Professionals countermessage the president of the United States, that they have to spend their time trying to correct the record. We have become normalized to this administrations, to this president s Loose Association with the truth, but it becomes particularly dangerous in the middle of a pandemic response. Thank you for being here and sharing facts with us here today. We all have lots of questions, so ill try to get in as many as i can. Dr. Hahn, let me follow up on senator cassidys questions about new authorities. One of the things you said in your testimony was that while you feel youve gotten good cooperation from medical device and equipment companies, theyre not required to tell you when theres a shortage. Senator rubio and i sent you a letter. Thank you for your response. About trying to catalog the shortage areas. It sounds like it would be helpful to have a simple, easy legal requirement that they alert you ahead of time when they see a shortage coming. Senator, thanks for the question. We have sent several legislative proposals as part of the budget, and i think one of the things weve learned from this and other shortages is its a very complicated supply chain. The most important thing is redundancy and also an effort around advanced manufacturing. We have had great cooperation, but this is complicated. For example, the one drug that is currently in shortage related to this isnt actually related to an api or the final drug form. Its related to a chemical thats before the active pharmaceutical agreement. So the whole supply chain is complicated and more information would be better. Great. I think senator murray asked you a question you might not have gotten around to answering, and i think its an important one. The right information is key, but also setting realistic expectations is key as well. And your estimate by the end of the week there are going to be 1 million tests out there does sound a little aggressive, given the fact weve only tested 3,000 people, and new york state is saying their goal is to do 1,000 a day. Tell us why you think by friday of this week were going to have 1 million tests when thus far weve only done 3,000 . Again, i want to distinguish between the ability to get the test kits out to the laboratories with the ability of the labs to actually do the tests, but we have been working very closely, senator, for the last three or four weeks with all manufacturers, private, academic, et cetera, cdc, to build on this platform that cdc has developed. We have been in touch with this particular manufacturer over the last three or four days. We have reiterated this. Weve worked with them closely. We know them well. Theyve estimated theyre going to be able to scale up to deliver 2,500 kits by the end of the week to providers of the test. Dr. Schachat and others can let me ask you, how do we make sure those are in the right hands . Yeah, thanks. Cdcs been providing the Public Health labs with kits and expects by the end of this week that there would be sufficient for 75,000 people to be tested. But as you say, not Everyone Needs a test, and we dont want to go through all our tests on lowrisk situations and not be able to really address the care and the contacts that are going to be critical. So we have guidelines for this kind of thing for influenza about who, you know, who needs to seek care, who can stay home, and have adapted them for this. Weve also broadened our definition of who we think is what we call person under investigation. That really needs to be tested. Not just related to travel to china but all the other areas. Also to say people with severe respiratory disease who dont have an obvious decisiiagnosis d be tested. Many of the cases in Washington State are detected through that or because there was an outbreak being investigated. I think the question of where these tests end up and making sure theyre in the right hands is going to be a really important one for us and you to have oversight on. Finally, dr. Schachat, let me ask you a question about protocols that were recommending to School Districts. One of the biggest disruptions that can happen in a familys life is the closure of a school. And as senator murray pointed out, given the fact that many families have two parents working, thats really difficult for a day, never mind a week. What are the recommendations and protocols that we are telling School Districts about what they should do if they have a child who tests positive, a family member, a teacher who tests positive, whats the best protocol today . Yeah, thank you. We absolutely recommend a child who is ill should stay home, whatever they have, so they dont they dont spread, but we have worked closely with local and state Public Health on this issue, and essentially decisions about school dismissals, School Closures or changes in School Policies are very much lookcally driven but provide guidance. What is the guidance though . The general principle is to minimize disruption. You have this balance between the earlier you act the more impact it can have slowing the spread. The enormous disruptions in School Closures. You may remember in 2009 we saw hundreds of thousands of students sent home in the first couple of weeks of the pandemic. As we learned more about the virus and its spread, we realized that was too disruptive. The virus was relatively mild in compared to what we were expecting and we dialed that back to instead shift to staying home when youre sick, perhaps cancelling assemblies, changing the patterns of whats done in class, but trying to keep classes going because so many depend on School Lunches and other services that are at school. So its a local decision. If theres too many people sick, of course, you cant keep going, but really trying to protect the vulnerable and reduce the spread but not disrupt families and all those parents who will be staying home if their kids are home. Thank you, mr. Chairman. Thank you, senator murphy. I let that go on because thats such an important answer. I hope everyone will try to stick to five minutes so that we can allow all senators to ask their questions. Senator roberts . Mr. Chairman, i think i can do that. Right off the bat, you asked my question and got a pretty good answer. And senator jones stole my rural question. Bob casey summed up where we ought to be. The distinguished Ranking Member said, look, we ought to get this money appropriated, get to the president. The president , by the way, said whatever figure you give me, ill take it, well work with it, and i just want to thank you both. You indicated we needed information. I think this i think were doing that in this process. Largely because of the wonderful job these witnesses do. And i want to thank senator murray for that. This is a very unique committee, along with the sometimes powerful Senate Agricultural committee. We are bipartisan. There is a lot of partisan elbows out there right now. We dont need to politicize a pandemic. I would recommend that we monitor what people say and i would yield to the chairman for that decision along with the Ranking Member, and maybe we ought to quarantine people for 14 days if they just shut up about the politics and, you know, tossing around the partisan things. We can do better. So i think we need to get the funding to the president and then lets get these kits out, 1 million at the end of the week, thats good progress. Dr. Schachat and dr. Kadlec, i do want to underscore again our rural areas. We have 83 critical access hospitals in kansas. Probably that will be produced just simply because of whats going on. Were older. A lot of Nursing Homes. A lot of longterm care. Enterprises. Thats just ripe for this kind of thing. I might point out, in the senate, we have quite a few people that have reached that ab age as well. But i hope that we can follow the chart here that the good senator cassidy has suggested. I think its an awfully good thing. Id say one other thing. I think part of our job is to stand with you when youre taking the boos and stand behind you when youre taking the bows. All of you should take a bow. And i think we ought to have this situation where we have your back, not so much to criticize. Were trying to work with you. Were going to get this done. We are going to get this done. I would say, mr. Chairman, that in todays wall street journ journal, last summer for 7 bucks, 7. 85 where is that . Get this for 7. 85. If you want to go to amazon today, its 114. 97. Ill give it to you for 50. [ laughter ] if you bought a litter a litter a liter of this, it was 14 bucks, now its 229. Thats ridiculous. I guess thats the supply situation that amazon thinks that it would be the case. I want to ask one other thing. The term that i was and i think a lot of people are confused about is Community Spread. Spread is a verb. But it doesnt say that the whole community is going that this disease will spread throughout the community. It just indicates there is one person where we dont know where the source was, is that correct . Yeah, thats right. Were really differentiating it spread from a close contact or travel associated. It doesnt mean the whole community is affected, and what it really means is that if if we threw enormous resources at it, we could probably map out each of the links, but its more important to go from man to man to zone when you start to see that community recognition, to use put the most effort where it can be the most impactful and perhaps less on the individual Contact Tracing and more on the readying the Health Care System, readying schools and so forth. I thank you very much. I yield back. Senator roberts, you did a better job of asking your own question than i did, so thank you for doing that. Senator kaine . Thank you, mr. Chair. Mr. Chair, i express condolences about the tornados in tennessee yesterday that were devastating. Thank you. I want to thank the witnesses and actually thank the chair and ranking. This committee has had a number of roundtable sessions and these witnesses have been here and presented to us. The first was on the 24th of january, thats positive. I will say, when we had that briefing on the 24th and weve had briefings since, and then the white house appointed the special committee on the 29th, it made me surprise when i looked at the president s budget that came to us on the 10th of february to see that in that budget there was a 52 proposed cut to the World Health Organization and cuts between 5 and 10 to the nih, the cdc and the overall hhs budget. It does not seem to me to be a wise time to take a scalpel or a meat ax to the Public Health infrastructure. I hope for not only coronavirus, but also looking at the pieces of the budget that fund the Public Health infrastructure so we dont do damage to that at this time similarly. The budget contains significant cuts to medicaid. Although its described somewhat euphemistically, its pretty clear that the medicaid cuts are going to cut people in states that have adopted Medicaid Expansion under the Affordable Care act, and the administration is right now in courts, as theyve been every day during this administration, trying to eliminate the Affordable Care act. The Supreme Court announced yesterday that it will take up a case later this year. It is not a good time it is not a good time to take a meat ax or a scalpel to the Public Health infrastructure. It is not a good time to scare people about whether or not theyre going to have Health Insurance. Im not sure there is a good time to do that, but you could not do it at a worse time when youre doing it as people are concerned about a pandemic. Dr. Fauci, i want to ask you a question. Like senator alexander, i was looking forward to your presentation at the senate lunches today. But during the middle of this hearing, i got a notice and i dont know if its accurate, that you will no longer be presenting at the democratic lunch. Is that accurate . To my knowledge, no, i mean, im planning of leaving here and being at both lunches. This is what my right . Yes. What . Im just told its changed but i dont know why. So i just want to be clear about this. You it was notified yesterday that you and the Vice President would be presenting to both the democratic and the republican lunches. I got a note from the democratic leader that came into all of us at about 9 25 that you would no longer be presenting and ambassador burks would be presenting instead. Thats the first of it youve heard of this, right now . What you just mentioned is the first ive heard. Do you have any idea why youve been disinvited to the lunches . I dont know. I will say, that is not a confidence building. It is not a confidence building when the person who let me finish. When the person who we have a lot of faith in in really knowing this stuff, who has done it for president s of both parties for decades, who is advertised as coming to advise us at lunch, youre not coming to lunch. One correction. It took me my surprise. Im sorry. Am i going . Im going. Youre going. I thought your staff told you you werent going 30 seconds ago, so what is the answer to this . I am . I am invited. Yes. So, why did why tid your staff tell you that you were not invited and then 30 seconds later change it . Am i that persuasive . Well, well see what happens at the lunch. Its not a confidence builder, i will say. Its not a confidence builder. Let me ask about a population that is of significant concern in virginia, and everybody here, which is the military. We dont have a dod person here, but i know you must be working in tandem we have a lot of virginians who are deployed in italy. We have a lot of virginians who are deployed in south korea. We have a lot of virginians in sicily, italy. Just thinking of two of the countries mentioned where there is significant coronavirus. My understanding is at least in the vicenza base, families are being urged to stay on base. Talk about your interaction, any of you who deal with this, your interaction with the d. O. D. Are we likely to see more of this, quarantine on the base in germany . Thats the last question that i have. First of all, we basically have a call at 12 00 with the entire enterprise of the department of defense, officers of secretary of defense, so what theyre doing is basically abiding by cdcs rules and guidelines in these circumstances. Obviously a base circumstance is different, particularly overseas where you have the means to basically isolate the population on there are we doing onbase, you know, please stay on base other than in vicenza right now . Sir, i dont know the particulars of that base, but we can certainly get the Defense Department to answer. Ill ask. They conform with cdcs guidelines and what should be done to protect their dependents and military force. My time is expired. Thank you, senator kaine. Senator romney . Thank you, mr. Chairman. I appreciate the work that has been done by the Public Health community in our country to delay the arrival of the convened covid19. Whether its italy or iran, south korea, japan, that weve been able to delay. Clearly you cant keep it away forever, and we already have the Community Transmission, which you predicted. I want to turn to another issue, however, which is the whether we as congress and administrations, republican and j izuhp hc prepare protective equipment for for our public at large. 0 i dont want to point at anybody. Funding. Which is, given the fact that our medical professionals need masks, gowns, gloves, so forth, what percent of what would be needed by medical professionals, if we were to have a fullblown pandemic, and i hope we dont, but if we were to have one, what percentage what we need for our medical professionals is in the Strategic National stockpile. I can give you a rough magnitude. 10 of what we need for severe pandemic. We would need 3. 5 billion n95 respirators. So about 10 . Thats the scenario ive been more concerned. It strikes me we should have substantially more than 10 of what would be needed for a substantial pandemic. We should have that in stock. I cant believe that we, congress, im not blaming the administration, this is congress and appropriating and prior administrations as well, that should be in place. Do masks help for the general public . Lets say we have a major pandemic and people are concerned, theyre going to the grocery store, they know other people there might be infected. Do masks actually help . Do they prevent or reduce the likelihood of being exposed to the disease, dr. Fauci . It depends on the mask. If you look at the n95 masks, theyre much better than those sort of floppy masks. In general right now, i think the question youre asking im really asking if we were to have a major outbreak of some kind . The most important thing for a mask would be if someone is infected to prevent them from infecting others. The other is the Health Care Provider to protect them. Of course. The general public who can wear them, that could certainly prevent gross droplets from going when someone sneezes and coughs on you, but it doesnt provide the kind of protection that people think it does. So, therefore, there are some downsides because people keep fussing with the mask better than nothing . Yeah. Do we have masks in our Strategic National stockpile for the general public . We do not. Okay. Turn to aircraft. If someone on an aircraft is infected and sneezes, how many people are going to be exposed to that disease . Is it just a couple of people, people sitting next to them . Is it the whole aircraft . For this kind of virus, were thinking just the couple of rows around it. For other types of infections, it might be broader. Should our flight attendants not in our instruction tell them not just to fasten your seat belt, but if you cough or sneeze, cough into fabric or your sleeve. I keep going on an airplane, someone coughs or sneezes and i hear it barking out. Just the general condition we have the flu going on and colds, should we not be telling people on airplanes, you may not cough or sneeze unless youre covering your mouth . I think i know the answer to that. And let me ask just another question, which is lets say we do get a vaccine that tests positively and so forth, and goes through phase one and phase two Clinical Trials. What does it take to get a major production done . How long does it take to actually kick the production up and how long does that take and who does that . Who is doing the manufacture once we know this is a vaccine that works . Thats a very good question, senator, and that was really one of the things that was discussed yesterday when the president and the Vice President brought in the ceos of a number of companies. And thats really important because what i was talking about a year to a year and a half, if you dont have the Production Capacity to make tens and tens of millions of doses, it may take even longer. And the ones who can do that, essentially, are the pharmaceutical companies. The federal government is not going to be able to make hundreds of millions of doses. Its going to have to be partnership with the private sector. Right. Do we have that capacity in the United States . Do we have is this capacity outside the u. S. . I guess the question im looking for is whether legislatively or from an appropriations standpoint we should provide funding to have the capacity to make large numbers of vaccines we should have that capacity in the u. S. And have it ready at the go in case if this isnt the pandemic that were worried about, if another one comes down the road, is this something we should actually have ready to go . Yes, sir. In fact, right now the only capacity we have is egg production, which wouldnt be relevant to the vaccine candidate or the candidates that we are pursuing. So wed have a longer than a sixmonth wait to basically produce vaccines on scale. Yeah, okay. I think i want to underscore that is an area we ought to consider making an investment in. Thank you, chairman. Thank you, senator romney. Chair alexander and ranking murray, i want to thank you again for being here today. Also, please extend my thanks to your amazingly hardworking professional staff, who i can only imagine have just been going nonstop for months now. So, thank you. I want to start by asking a question about sort of the misinformation and flatout falsehoods that have about the coronavirus that has been circulating and amplified i worry that its been amplified for political reasons. To the point of senator roberts and others that we dont want to politicize this. My question is, what is the impact of this misinformation and what should we do about it . Im sort of looking at dr. Schachat and dr. Fauci in particular. I mean, its embarrassing to go through all the things said on national media, including, honestly, by our president. Dr. Fauci, the its not true, is it, that this is just like a common cold and that we can expect that this is going to be gone when the weather warms up. Is that true or not . Let me explain. In general, respiratory illnesses such as the prototipic influenza virus is seasonal. That when the weather gets warmer, as will happen in march, april and may, you will inevitability see a markdown in influenza. The same holds true for respiratory viruses, including some of the common cold coronaviruss. This could happen with this, but we dont know it. We dont know . And the reason we dont know it is because this is a brandnew virus with which we have no experience. So even though the concept that when warm weather comes, many respiratory viruses diminish, we have no guarantee at all that this is going to happen with this virus. And it might come back again . It certainly might. Its not like were going to we dont have anything to worry about once the it is conceivable given the degree and the efficiency of transmissibility of this virus that we might have a circle. It might come and be seasonal and come back. Yeah. Thats quite possible. We dont know that, but thats possible. The reason, you know, weve heard so much misinformation. Its been said that this virus was developed as a tool to wage economic war on the United States. Its been said that, you know, its been said that this is, you know, part of a strange to try to bring down the economy. I mean, its ridiculous and its harmful. But could you as Public Health professionals comment on why this makes it more difficult for us to address this this epidemic, and what we should do to combat this kind of misinformation. I think we need to speak out often and loudly about how much nonsense this is. This is not new with coronavirus. There are always conspiracy theories when there is a new disease that people are afraid of, and that is really novel to them. I have to say, im thinking back now about 35 or 37 years ago, i sat in this room trying to explain to the committee then that hiv was not a virus that was developed by the cia to essentially eliminate certain populations. Its crazy, but this is what happens when you have outbreaks. Theres a lot of misinformation. My point is that there is consequence to this misinformation that makes it more difficult for public Health Officials to respond and to take care of the population in the ways that we need to, and thats thats what worries me. I want to just i know i dont have much time, but i want to ask another issue that is extremely important to my folks at home. Im very proud of the Minnesota Department of health. They do great work. Theyre very worried about whats going to happen, the capacity pressures that theyre going to be experiencing as they try to address the coronavirus on top of Everything Else that theyre addressing. So my question is, first, not only a question of getting the diagnostic tests out so that people can respond, but also these these labs need to have people in order to do the testing because theyre already its not like theyre sitting around with nothing to do right now, right . Absolutely. The Public Health labs are short staffed on a good day, and so this is a very big challenge. And that is one of the reasons that we are keen to get the Clinical Labs up and running with the test. And i think you bring out the point that its not just the Laboratory Capacity for Public Health, but its all the other things they do. Theyre very busy with Contact Tracing. Theyre busy with following up on the people who traveled, who theyre supposed to follow. Theyre spread really thin, and i think it illustrates the principle that in this type of evolving situation, we really need to put the most effort where it can do the most good and not get distracted with smaller things. And its also why its so important as we work on these emergency appropriations that were making sure that these departments at the local level are reimbursed for the work theyve already done, right . Yeah, absolutely. Absolutely. And that they have sufficient dollars so theyre not dipping into money they would have gotten anyway to do the work they dont really have the money to do the work right now. Thank you, senator smith. Senator scott . Thank you, mr. Chairman and thank you to the panel for being here this afternoon, almost. Quite amount of time with us. The one thing im not concerned about, frankly, is whether or not congress will provide the necessary resources in a timely manner to deal with the challenges that we face with the coronavirus. Im not going to ask you questions that have been asked several times by several different senators as it relates to what will happen if. I do think what we have not had a lot of conversation about is putting this virus in context. Context for the average person in this nation can digest very quickly and understand the actual risks that are associated with the virus. So, whether its the 2003 sars, the 2009 swine flu, whether its the current flu season, the number of americans that have died because of the flu. Whether its the even overnight tennessee lost 19 people because of a tornado. I would appreciate it if you all would take just my time to help us put in context what 80 of the people would experience if they were infected by the coronavirus, which seems to be a fever and a cough. Maybe thats downplaying it. If it is, please, let me know. And then the 20 of folks who are elderly that may have disabilities andco morbidities that might be at a heightened risk. Use my three minutes after im finished with my opening comments to help me and the rest of the folks in South Carolina who are seeing this issue on every screen and often times seeing it really from my perspective hyped up in a way that is not helpful. Ill close with this. I think there are those who are alarmist who are really painting a picture that is very difficult to digest, and then there are those who are acting with a sense of urgency. I think the four of you are acting with a sense of urgency but not being alarmist at all. Can you now use 2 48 to help me understand the situation . Ill start with dr. Hahn and maybe work my way through. Senator scott, i can address the regulatory issues. We have worked with urgency. Weve issued two euas to facilitate masks and diagnostic tests in support of the terrific health colleagues. Sir, im going to yield my time to dr. Fauci and schachat. Ill let them talk about the real case. Senator scott, you really bring up a good point. It really has to do with, you know, what you consider relative risk and how that relates to the unknown. Yes. The thing about whats going on now is that since it is a new virus, we dont really know exactly where its going to go. If you look at the disease burden, morbidity and mortality, every single year influenza does a significant amount of health damage, not only to our country but to the rest of the world. The thing about influenza is that although there are many things about it that are unpredictable, we kind of now the bracket of how many people are going to get sick. Right. And how many people are going to die. Its tragic. Its death. Its suffering. We dont like it. But we kind of know. When youre in the area of the unknown, you have to walk a delicate balance. Yes. Of not overshooting and having panic, but not also undershooting and being in a situation where you dont respond as aggressively as you should. A sense of urgency. Yeah. Yeah. And just to add, that while in a large population, most people who get infected will probably have very mild symptoms. Some will have severe illness, pneumonia, and be critically ill. And whats unknown right now is what that full total will be. You know, will we have many more cases a year than we had with flu, which would be very difficult to handle. Or will we be able to slow the spread and protect the Health Care System . And its this balance that dr. Fauci mentioned of not overreacting but not underreacting. Because the risks of underreacting could be that we have second and third order complications. We dont want to have the Health Care System flooded with people who dont need to be there, but we really need to build it up, because if this is going to be like a really bad flu, were going to need to build up that Health Care System. Seems to me out of the 90,000 known cases weve had how many deaths . Right now its about 3,000. 3,000 . And there are biases in the early yes. Information. Some countries have good information about very mild disease. A lot of countries. And other countries can only keep up with the severe disease. I would just end my comments, mr. Chairman, with the fact that i think 3,000 deaths should get everyones attention and we should be acting with a sense of urgency, but not buying into the hysteria that will make it even more difficult for Health Care Providers my mothers worked at a hospital for about 45 years. Make it more difficult for Health Care Providers to have the resources and the equipment necessary for them to take care of those folks walking into hospitals and needing assistance. Thank you. Thank you, senator scott. Senator hassan. Well, thank you, mr. Chairman and Ranking Member murray. Thank you for the panelists and to your entire teams. You all have been working tirelessly and we know that and we are very, very grateful. I wanted to start to get at the issue, dr. Schachat, with you of diagnostic Testing Capacity. I know the administrations ordered an independent review of the cdc lab about problems that arose in the manufacture of the diagnostic tests kit. What is clear at this point is that the domestic Testing Capacity has been significantly lower here in the United States than what weve seen in countries like south korea and italy. So, doctor, are you confident that the policies put in place by cdc and fda over the past few days will allow states to test for coronavirus at a level commensurate with what this rapidlyevolving outbreak requires . I am optimistic, but i want to remain humble because we see an emerging emerging Infectious Diseases surprises. Right. And one of the things that were dealing with right now so, for instance, my state which had its first confirmed case yesterday has a dwindling number of kits, and they tell me they have to do two tests per patient. Because if you get a negative then youre going to retest the next day, and were still having to send tests intosts into cdc confirmation, even when we do them at the state level. So when do you expect to reach a point where cdc will no longer have to perform confirmatory testing on samples from state labs . Yeah, that should be very soon state by state as they verify their procedures. And weve worked very closely with fda to expedite that. Okay. Has a lack of federal resources or personnel within cdc played a role in what appears to have been a lack of ability to scale response efforts in order to meet the demand for diagnostic testing across the country . Not to my knowledge. Okay. To dr. Fauci and dr. Kadlec, im concerned that the delays in making test kits widely available means we dont yet have a full sense of the scope of the problem. I mean, its if we cant test everybody who has these symptoms yet, we may not know what the full scope is. And having an accurate accounting of the problem we face is critical for your ongoing preparedness and response efforts. So dr. Fauci and then dr. Kadlec, how has our limited diagnostic Testing Capacity impacted your response efforts and what steps are you taking to mitigate those challenges . Thats actually not something that im involved with, but id be happy to give you an opinion of that. Sure. I mean, obviously you would want to have as many tests as you have as you need. Right. To be able to do and thats what the cdc right now is ramping up in collaboration with the state and local health departments. The first level is to get individuals in multiple states they started off with six and it will probably be more if im not mistaken. To be able to test people who come in with symptoms that would be suggestive of a respiratory illness, either flu or the coronavirus. If they dont have the flu, to determine if, in fact, it is coronavirus. As we improve and get better and better at that capacity, well have a much more accurate assessment of what is going on in the community. Thank you. Dr. Kadlec . Briefly. Yes, maam. I think the thing is two elements there. One is a trigger in terms of action. How do you respond in Early Warning . I think one of the things that cdc has been doing ill let dr. Schachat comment on this. Using its influenzalike network and using the tests to broader surveillance. The more important one, i think, in terms of understanding what is circulating in terms of this virus being able to detect antibodies in peoples blood broadly to understand what is the denominator of people who may be asymptomatic. Both of those have a significant importance. For our part with barta, weve been funding commercial laboratories and trying to develop point of care diagnostics to support dr. Schachat. Just quickly. I have another question. Were doing that Community Surveillance in the six cities and hope to expand it broader so we see what the tip of the iceberg what the bottom of the iceberg really is. Thank you. I wanted to turn to commissioner hahn for just a moment. The fda has such an important and wideranging role to play in our ongoing response efforts. As you know, your announcement last week regarding an unnamed drug shortage that was attributed to disruptions in china due to the coronavirus caused some confusion among Public Health experts. And just now you said you couldnt name it. You know, for those of us who either ourselves or have loved ones who have multiple medications, the notion there is a shortage but we dont know if its ours is a really difficult thing for the public and for people who depend on pharmaceuticals. Yesterday you stated that the u. S. Labs could perform up to 1 million tests this week while Public Health experts have said they hope to see u. S. Labs complete 10,000 tests per day, and tests take time, and they take staff. So i understand its fast moving, but it does seem to me like fdas messaging has been confusing and at times contradictory over the past few days. I am over time. So i actually wont ask you to respond right now, but i would urge you, and perhaps we can have this conversation offline, to get a process in place so that you are making sure that your communications are clear to the public and that you and that theyre integrated, and id look forward to having that conversation with you at a little bit later. Thank you, mr. Chairman. Thank you, senator hassan. Senat senator . Thank you, chairman alexander, Ranking Member murray. Chairman alexander, i want to express my condolences to your state for the loss in the tornados this morning. I know were all monitoring that situation. And thank you all for your time here today. If you look at where we are now in terms of the capacity for preparedness for response, weve obviously come a long way. However, the evolving nature of Infectious Diseases means that we need to continue to innovate. Your agencies have taken significant strides to improve our National Health security capacity, but in america much innovation also comes from the private sector. I commend your steps taken with this administration to address this emergency. What can we do, however, to ensure that the private sector supports the response and in these situations Going Forward that they can quickly thoif these innovations can quickly reach the American People . Sure. I can start. You know, weve been taking steps to reach out to the business community, the private Sector Community and just yesterday i was on a call with over 1,000 companies about what this epidemic means to them and also how they can help. We we also a few of us met with the pharmaceutical industry yesterday. A number of Big Companies about both drugs and therapeutics. Knowing that youre from georgia, we have a really phenomenal collaboration with Georgia Tech Research institute to help us modernize some of the data challenges that plague Public Health. I was very encouraged by the enthusiasm of the ceos of the pharmaceutical companies yesterday than when we met in the cabinet room of the white house. It was really very gratifying to see the fact that they really wanted to do anything they could to help with us. As i mentioned in response to a previous question, were not going to get the kind of production of interventions unless we partner with a pharmaceutical company. Maam, id like to comment on one thing. Two programs that are looking specifically at innovations around medical countermeasures and other things that would enhance our responses. Basically met with 1,500 Companies Looking for particular things, diagnostics to work on this and looking particularly on the supply chain issues as it relates to pharmaceuticals. So, weve been working with diagnostic companies with vaccine biologics and with drug manufacturers both around the shortages issue, but the development of products to address this this outbreak. Thank you all. Thank you, senator. Senator baldwin. Thank you, mr. Chairman. So, i want to start with the idea of the fact that we have an emergency spending bill going through the congress quite rapidly. And some of the issues that have been raised, im hoping that we will properly address those in this appropriations bill, but also then be able to follow up and make sure that the right policies are in place. So, i want to start with the discussion weve been having about Domestic Production of things that are essential in fighting epidemic. I remember in my former life as a member of the house of representatives an instance where one of the manufacturers of flu vaccine in england was shut down. And there was a shortage. And there was a lot of worry and we rationed the flu vaccine that year, changed the standards of who should seek one and who should not. I remember also in the year that i believe we were fearing a very serious strain of flu, inquiring about our domestic Production Capacity for the flu vaccine and we had none. None. And i asked, should we assume i think i might have even asked this to you, dr. Schachat, all those years ago, that should we assume if we had put in an order with a foreign manufacturer for however many doses, but there was a huge breakout in that foreign country that they will commandeer that for their own Public Health purposes . And i think the answer i got at the time was, yes, that was would be a prudent and safe assumption on the part of policymakers. So as were moving forward with very significant, i hope, appropriation of funds to address this emergency, i hope that we assure that we dont make those misstains mistakes again. I think ive heard all of you testify that having domestic capacity is very crucial in this, am i correct . Everyones nodding. Okay. The second thing i want to get into is, weve talked about lab and Testing Capacity in the u. S. Im not sure were all agreeing on the meaning of the words and things. So, for example, when i heard the interchange between senator and dr. Cassidy, there is a lot of initials. And so i understand pcr to be polymerized chain reactionbased testing. Igg to be imunoglobin. Igg, igm and iga. He was talking about can we have that test soon . So thats a blood test, if i recall. Cdc is using a threesample test, that is correct, that has a nasal swab, a throat swab and a blood sample . There is a difference. Were recommending a throat swab and a nose swab for that chain reaction. Okay. We have been developing a test for those antibodies that senator cassidy was talking about, the igg or the igm for the population level to understand who is already immune. How much disease that didnt come to care. That test isnt there yet. Since i want to get in a couple of more questions, can i just assume were going to have a pcr test for a while . That we rely on. Right. Pcr is a key tool for a while with the private sector and public sector. Okay. Potentially point of care some months or years ahead. I just want to get into the lab capacity. Weve talked about Public Health labs, Clinical Labs, theres been reference to academic labs, private labs. I dont know if those are four separate classes of labs. I want to if they are, i want to add one other idea if we need to surge our capacity for testing. And that is, im aware of veterinary labs that look at these same sort of tests but theyre not usually looking at humans, theyre looking at either pets at veterinary clinics or a domesticated animals. They also study zoological infections. If there were an emergency, i dont know if you ever thought about tapping into that capacity, but im thinking particularly of the Skilled Workforce that deals with, you know, level iii labs, et cetera, that may be a crazy idea. If its not, i hope you discuss it and think about it if we need to have a surge in our capacity to surveil the transmission of this disease. Thank you, senator baldwin. Senator collins. Thank you, mr. Chairman. Dr. Hahn, im going to follow up on the first question that senator baldwin raised with you. The fda reported its first coronavirusrelated drug shortage last week, and this morning you indicated that india had restricted a number of active pharmaceutical ingredients. The fda has testified previously that only 28 of the manufacturing facilities making apis to supply the u. S. Market are located in our country. By contrast, the remaining 72 of api manufacturers supplying our American Market are overseas and 13 are in china. You and i have discussed previously the legislation that ive introduced with senator smith, the mitigating emergency drug shortages or m. E. D. S. Act. Which has been endorsed by over 50 organizations. Our bill requires new reporting requirements that would help the fda gain far more visibility into the drug supply chain, including where certain critical drugs are manufactured, the source of active pharmaceutical ingredients, and manufacturing contingency and redundancy plans. Given the problems that were already seeing, do you believe that the concepts including included in our legislation, our m. E. D. S. Drug shortage bill with senator smith would be helpful . Senator, thank you for your question. We really appreciate your leadership on this issue. This has been an ongoing problem prior to the coronavirus outbreak and continues to be. And just as highlighted by what weve seen over the last several weeks. The agency totally shares your goal with mitigating and increasing redundancy for manufacturing, particularly in the area of advanced manufacturing. We look forward to working with you on that. With respect to your particular bill, you know that were going to be generating a written response to that so that we can provide the technical assistance, and we very much look forward to working on that bill with you, senator. With respect to the one drug that you mentioned that we last week announced was in short supply because of the coronavirus outbreak, we, and ive mentioned this before and again this morning, we have already listed that on our drug shortage list that is available to the American Public and the american providers and have done so since the beginning of the time when we identified that as a shortage. Thank you. And mr. Chairman, im hopeful that we might be able to move that bipartisan bill. Dr. Schachat, in mainland china, the coronavirus case fatality rate among older patients is significantly higher. The estimate ive seen that 15 of inpatients 80 and older do not survive, compared to just over 2 in the general population of patients. In addition to the figure from china, there is the tragic situation evolving in Washington State regarding the spread of the virus in a longterm care facility. This is of particular interest to me because i represent the state that is the oldest in the nation by median age, and i also chair the senate aging committee. I know senator casey brought this up generally with you as well. My question for you is, what is the administration doing and what is the cdc doing in all aspects of response to ensure that we have best practices in assisted living facilities and Nursing Homes or longterm care facilities . Yeah, thank you so much for that question. Ive been speaking regularly to the administrator from cms, seema verma, who is incredibly concerned about this issue as well, and we are they are sending a liaison to our emergency response. And we are using our guidance adapted to the situation. Theyre using their field staff to make sure that practices around the country are best practices suited for this concern. Infection control is always an issue in the Different Levels of health care. And the elderly are very vulnerable to respiratory viruses. We see that same differentiation in mortality with influenza as well. The elderly are vulnerable. Thank you. Thank you, senator collins. Senator rosen will ask our last round of questions so our respected professionals some of them are going to go have lunch with United States senators and explain more. Well be able to finish by 12 30. Ill call on senator murray for any questions or comments she has and well wrap up by about 12 30 so you can leave. Senator rosen . Thank you. Thank you all for bringing this hearing here. Thank you for the i know around the clock work on this. We are so very grateful for a lifetime of work and care in this avenue. But i want to speak about the issue of access and capacity and how we can use telehealth in our evaluations to potentiate our response. Many of our constituents are worried about the spread of coronavirus. They have questions about their own health. Since the symptoms of coronavirus can present like a cold or the flu, i can only imagine with what people are seeing in the news that theyre going to seek out care. People are a little nervous, needless to say. And so in nevada, we have large areas of rural population far away from city centers, and an increase in those seeking care and having to travel is not only hard on them but creates a burden on the system. So, depending, of course, how easily this virus spreads, how can we use telehealth as a First Response to help people in their own homes . This could contain the virus, relieve a burden on our emergency rooms. So what are your recommendations . I have a twopart question on addressing the barriers to access telehealth. And do you have any plans potentially to operate a National Hotline or a web portal for initial screenings through some kind of telehealth hub and then people could be referred to their local care or further out if needed. Please. Yeah, weve made a lot of progress since the 2009 pandemic where this was a huge issue. Just getting a nurse triage line developed in one state, we had more lawyers than we had Health People trying to figure out how to do that, but most of the health plans have actually worked out some of these kinks, and weve already been contacted by a number that are adapt their nurse triage lines, the hot linhotlines that you talk about really for their state or for their clinically covered individuals. We also have been working with telehealth together with other parts of government to understand what kind of approaches are appropriate in the rural areas as well as what the coverage will be. Thats one of the other things that the cms is looking at now. Maam, one of the things weve been doing for the last two years we funded two Pilot Programs called the Regional Disaster Health Response system. One in mass general and the university of nebraska. In nebraska looking at the nuances of how we can use telehealth to expand outreach to not only nebraska, but to other parts of the region in that way. In evaluating whether both the legal and practical limitations to that. Can i ask a question about telehealth . Because this would have to do with insurance and telehealth. Considering that this could be a Global Pandemic or we have other issues, regional issues, rural issues. I wouldnt want insurance to be a barrier for someone being able to the least access a telehealth hub or get the care because germs do not care whether you are insured or not, democrat or republican, old or young, et cetera, et cetera. So how do we address this issue of people feeling like they couldnt call or use this because of insurance limitations . Yeah, i can just say the strategy that were thinking through at cdc is really trying to identify the right level of care for the right situation, whether its telehealth, urgent care, nurse hotline or emergency room or office. In the circumstances that we could see keeping people out of the Health Care System physically could be in everybodys interest. To preserve it for hose who need it most. The insurance issues in a pandemic would probably be somewhat different than in routine times. It looks like dr. Kadlec wants to Say Something there. I just would like to add in declared disaster, stafford act, we have the ability to declare patients as National Disaster medical system patients where they or the provider gets reimbursed to 110 of medicare rates. That would be an interesting way to look at how you can evaluate it in a pandemic or something of this sort. With err in initial conversations with cms to understand if that could be utilized in this way. It could be really impactful negatively or positively if we dont address this in the right way. So understanding that what Additional Resources or what should we be looking at as were going to be voting on funding and resources hopefully this week, next week, that you would need to address this issue . Anyone . Maam, can i get back to you on that . Yes. Thank you. Perfect. Thank you. I will yield back. Thank you very much, senator rosen. Senator murray. Mr. Chairman, first of all, thank you for having the hearing. I do have to ask each one of you because this is a very serious challenge, were seeing the impact in my state, even though it may not be a serious illness or each individual that has it, they can come in contact with somebody who is medically fragile. So containing this is absolutely critical. So i just think its really important right now and im concerned that people trust the information that they are hearing so they do the right thing for themselves and their communities and our country as this moves forward. I mean, where do you turn for trusted information . Its the experts like all of you and thats who people need to be listening to. I think you have heard the concern expressed here that the president has made some statements contradicting all of you. Our nations top experts have even criticized the media for covering this. I think its really important for us to hear from all of you yes or no, can the American People account on you to be 100 transparent on this virus and the governments response, even if you have to contradict a tweet or something that someone says . Yes. Absolutely. Yes. Yes, senator. Thank you. And we need to count on that because this virus is moving quickly and were seeing it in my state, we will see it in others and i think thats so important. Mr. Chairman, families across the country watch the latest news and worry about the threat of this coronavirus, im really glad that we are taking the opportunity in this committee to ask some of these urgent questions that ive been hearing from home and were all going to continue to hear and to talk about what we are doing as well and how we can prepare for the text. I would tell all of you that since we have been in this room in this hearing since this started, we have now learned of the first full closure of a federal facility due to this virus. Its a dhs center in washington in my home state. It was just closed a short time ago. So it really is clear by the minute just how serious this is for people in my state of washington, as well as the rest of the country. This administration as you all know owes some answers about the coronavirus and theyre going to keep hearing from me until i get the answers, including apparently from Vice President pence shortly and several of you. This is really critical and we need to stay on top of it. I want to say again thank you to senator alexander, as he said, he and i have been holding bipartisan meetings on this, we want to continue to work together. Having that information i cant tell you is so important for the people in my state of washington. We need to get these tests out, people need to know the answers. There are real time decisions being made right now in my home state about School Closures, about whether to go to entertainment, what businesses should be telling people and as these numbers continue to grow this is only going to be more intense so we are counting on all of you. Thank you, senator murray. At a time when we are not in the middle of a of what we are in the middle of now i want to have some more discussion about the extent to which we rely on other countries for our medical supplies and medicines and what we should be doing about it that we are not. Its an interesting twist. We have debates in this committee about importing prescription drugs and ive often thought that our the way we talk about that is all mixed up because we import a lot of drugs as we now see, but the difference is theyre manufactured under fda super vision and they have a supply line that fda super surprises to make sure theyre safe and when we do that we have lots of drugs that are made overseas. So maybe the National Academies should do a study on this. Ive talked to some other senators who are concerned about it, but i think one of the areas that this committee should look at and several senators have mentioned it is the extent to which we rely on other countries and sole sources of supply. Chickfila sells mac and cheese it doesnt have one source of mac and cheese, it has at least two to make sure it doesnt run out. We should we should certainly do the same with lifesaving drugs. Also i want to endorse what senator murray said about our appreciation for your telling us the truth and giving us Accurate Information about whats going on. We believe you do that. Thats why we have such respect for you and your professionalism. Thats why you are here today. This hearing has been all about how do we provide Accurate Information to the American People so they can know what to do and how do we provide Accurate Information to congress so we can know what else we need to do. We expect you to tell us that, whether its unpleasant news or not. We thank you for your professionalism, your extra hours during this period of time. Thank you for coming today. I read at the beginning of the hearing the comment on the front of the New York Times sunday that ended that said most experts agree the United States is among the countries best prepared to prevent or manage such an epidemic. Your Performance Today suggests why that is true. The hearing record will remain open for ten days. Members may submit Additional Information for the record within that time if they would like. Thank you for being here. The committee will stand adjourned. The fed made a pretty dramatic decision before their next regularly scheduled meeting to pursue and make effective a 50 basis point cut. Now, anyone who is an investor or involved in wall street will look at that generally as welcome news, it obviously has a stimulative effect, especially 50 basis points. And while that might be the reaction on first blush, i have to say i find it concerning because this does have echos of the 2008 great recession. While the fed is understandably and appropriately independent and should remain independent from any potential attempted interference from any political actor whether congress or the president , i do wonder if there is data the administration might have showing that perhaps this we already know that the affect on the worldwide economy is much more severe than is currently being led on. So i would urge transparency and if theres anything that you could add to this and also just basically your reaction on the decision of the fed today. Well, i very much support the feds decision. I think they did the right thing getting ahead of this. Obviously theres limited data because this is something thats literally occurred over the last several weeks, but, you know, i would say this is no different than any other severe situation. This is going to have an impact in the short term on the economy. Now, i would say its very different than the financial crisis because the good news here is there will be an end in sight. This will have an impact on the economy, but i have confidence in our Health Professionals that they will develop a viral medical treatment and vaccines. So this will have a time period, but i think the fed we had a coordinated call, as i said, with the g7 finance ministers and Central Bank Governors and even in the last week i was literally last week at the g20 in saudi arabia, the difference in one week on peoples reaction of whats going on is enormous. Treasury secretary Steve Mnuchin was asked about the Trump Administrations Coronavirus Response during todays house ways and Means Committee hearing on the president s 2021 budget request. We will show you the entire hearing tonight starting at 8 00 eastern on cspan 3. The senate commerce, science and transportation subcommittee holds a hearing on mitigating the spread of Infectious Diseases such as the coronavirus. Watch live wednesday at 2 30 p. M. Eastern on cspan 3. Online cspan. Org or listen live on the free cspan radio app. Watch our Live Campaign 2020 super tuesday coverage of the president ial primaries and caucuses from 14 states, including alabama, arkansas, california, colorado, maine, massachusetts, minnesota, north carolina, oklahoma, tennessee, texas, utah, vermont, and virginia. With candidate speeches and results. Coverage begins today live at 7 00 p. M. Eastern on cspan and cspan. Org or listen from wherever you are with the free cspan radio app. Our cspan campaign 2020 bus team is traveling across the country asking voters what issues should president ial candidates address . The issue most importantly to me in campaign 2020 is foreign policy. I know the candidates have addressed it already but i think its important for the candidates to focus on issues that they constitutionally have a lot of control over. I think its just important because compared to other people in the government its one area they have a lot of direct control over. The issues that are most important to me for this election cycle theres actually three of them, when im looking at candidates im looking for their stance on the second amendment, their stance on immigration and their stance on abortion. So the most important issue for me in this 2020 campaign is health care. So many of my families and friends have struggled to be able to make ends meet with all of their medical bills and medical debt. Being able to get medical care for all would be really beneficial to pretty much everyone i know. Thats the main issue i have for this selection. My Biggest Issue is probably Climate Change and how we can address it while also addressing economic disparities and kind of rebuild our economy to be more sustainable. The issue i would like the candidates to address are native american rights and what their stance is on preserving those rights. Im a native american currently here in utah. I am from arizona. So i would like the candidates to dive a little deeper in where their stance is in regards to native americans. Voices from the road on cspa cspan. A federal court heard oral argument with two cases challengingel legality of the Trump Administrations public charge rule. It aims to limit green cards to immigrants who are likely to need government assistance programs. This Second Circuit court oral argument is an hour and 45 minutes