Transcripts For CSPAN3 CDC Director Redfield Testifies On Coronavirus 20240713

It has been several years, march of 2016, since our last hearing on the budget of the nations leading Public Health agency. And before i do a formal welcome and so forth, i want to i was made aware of this issue, which is really very, very troubling, and that is that the administration has ordered the Immigration Courts to immediately remove coronavirus posters. And it just says that the Immigration Court staff nationwide have been ordered by the administration to take down coronavirus posters from courtrooms and waiting areas. The executive office for immigration review, which falls under the department of justice, told all judges and Staff Members in an email monday that all of the coronavirus posters, which explain in english and spanish how to prevent catching and spreading the virus had to be removed immediately. I just want to say that whatever ones view is on any issue that we face in this nation, whatever your personal views are, whatever your ideology is that we cannot, we cannot, in this Public Health crisis, play fast and loose with peoples health, no matter what we believe. It is a moral responsibility for us to make sure that everyone is protected. So, it just came to my attention and [ inaudible ] Public Health. Dr. Redfield, we welcome you, to have you here, and your colleagues who are with you. Associate director for public and science, director for approximate the National Center for injury prevention and control. Sherry berger, chief Strategy Officer and chief operating officer. I might say i also want to acknowledge dr. Messiner who is not here but helped to provide us with a briefing in february and sorry not to see her here as well. In fact, before we provide to cdcs fy21 budget request, let me start where we are all probably starting today and thats with covid19. I first want want to commend the thousands of Public Health experts on the state and the federal level who are working so hard to keep us safe during this outbreak that. Includes you, dr. Redfield, as well as all the cdc staff. Thank you. We are in a crisis. There are questions about our preparedness and ongoing response efforts. Im very concerned, and i think we all are, about our nations testing capabilities for coronavirus. As opposed to an accurate account of the prevalence of coronavirus in the United States. My understanding is that the testing kits are now being distributed across the country and commercial firms are involved as well. But the delay has been unacceptable. The initial test kits were faulty and there were weeks of delays before additional tests were sent out. Cdc maintained a narrow testing criteria that makes us ask if the health of our country was put further at risk because of these actions. I expect there will be a lot of questions today about testing and those delays. Another concern is Emergency Funding. The congress came together last week and we passed an 8. 3 billion emergency supplemental on a bipartisan and bi cameraal basis. It includes 2. 2 billion for centers for Disease Control and prevention. It will support cdc, state and local Health Departments who are critical to responding to this outbreak and to saving lives. But when this crisis arose, the cdc had only 105 million available in the Infectious Diseases Rapid Response reserve fund. The supplemental added 300 million. Ive been a leader for years on the Public Health Emergency Fund and have repeatedly introduced legislation Public Health emergency act to provide 5 billion in mrnl funding for the Public Health Emergency Fund so that you can act with flexibility. We can only imagine where we would be if we had had 5 billion at the outset instead of 105 million in the Rapid Response reserve fund. Former Shadow Health minister of south africa wilmont james, global Public Health expert has said, and i quote, why do we lurch from crisis to crisis and lapse into complacency in between . This outbreak say reminder of the importance of a wellprepared, welltrained, welltrusted, wellfunded Public Health system. Because beyond covid19, professionals at cdc, day in and day out, are working to combat foo foodborn illnesses, influenza, to promote healthy lifestyles, to produce and prevent the use of Tobacco Products and on and on. Its important work. And its why we are proud of what we were able to do in this committee, in increasing cdcs funding by 636 million, 9 above the 2019 level and was done on a bipartisan basis. Some of those highlights include for the first time in more than 20 years, funding specifically to support firearm injury and mortality prevention research. The first year of a multiyear effort to support modernization, of data service and analytics. In the first year of the Multiyear Initiative to reduce transmission of hiv by 90 over the next ten years, establishment of a Suicide Prevention program, tobacco prevention, specifically given the ecigarette and vaping epidemic among our young people. Increases for global disease detection. Thats Global Health security, as you have outlined in your remarks, dr. Redfield, Global Health security is critical to our national security. And the Infectious Disease Rapid Response reserve fund. Unfortunately, the president s 2021 Budget Proposal reverses this process. The budget proposes to cut cdc by 396 million, 9 below the 2020 appropriation. Despite the presentation of the president s budget, which claims Infectious Disease, Global Health and preparedness were prioritized in cdcs request, key programs would be cut. Public health Data Initiative, Public Health workforce program, Infectious Disease Rapid Response reserve fund and that allowed cdc to quickly respond to covid19. This subcommittee will not be pursuing the administrations proposed cuts. To cut from our Public Infrastructure during an outbreak is beyond comprehension. Instead we plan to invest in the cdc and Public Health system. We will not lurch from crisis to crisis and lapse into complacency in between. We cannot. This coronavirus outbreak makes that clear. I will stop there. We look forward to your discussions in the budget and other policy areas under your jurisdiction and appreciate you all being here today. Before we turn to you, let me turn to my colleague, the Ranking Member of the subcommittee, my colleague from oklahoma, congressman tom cole. Thank you very much, madam chair. Let me make a few remarks off the cuff before i actually get to my prepared statement. This is an area that i think my chair and i certainly strongly agree on. You know, i am never critical of someone here that comes and presents the president s budget. Its your job i always call at the ombs budget to be fair. Ill state for the record, im quite certain we wont be cutting the cdc any time soon. I suspect quite the opposite, that we will be building on things that this committee has been doing the last five years. I had a discussion with omb director mulvaney and made the point, whatever budget you send up here were going to increase and later on we added Rapid Response Infectious Disease fund, an idea that our chair had been championing for many, many years. I think those were all really good decisions and were seeing the benefit of them now and i suspect well stay on that course. What you do and i thank all of you for doing it. The plenty of professionals you lead are absolutely indefensible excuse me, independencible. Have to correct that one write away. Indispensable in defending the people of the United States. Dr. Redfield and i have had this discussion before. I think of you as the biomedical equivalent of the pentagon. What we do there protects American People in one way. What we do here protects them in another way and a much more immediate and much more impactful way. Much more likely to have a problem were dealing with now than we are to have the kind of threat to the lives of americans. So, again, thank you for what you do. And i suspect this committee on a bipartisan basis will continue to make these investments going forward. Good morning, dr. Redfield. Thank you for coming to be with us this morning. Im going to do what i did with francis collins. How has your week been, i wonder . I think about you guys a lot. We know this has been an extraordinary stressful time for you, and one in which youre doing great work for the American People. Coronavirus is at the forefront of everyones mind this morning and you and the Public Health experts at the cdc are front and center to defending our people. In addition to hearing about coronavirus this morning, im hoping we can discuss other priorities i know we all share, such as produeventing opioid ab and deaths and problems associated with chronic diseases, all critical Public Health issues for our country. As the United States continues to monitor and respond to coronavirus, im encouraged that congress and the Administration Work together across party lines to deliver critical resource force the days and weeks ahead. Such a highly polarized, partisan environment, im very encouraged we could set aside our differences and quickly deliver on such a high priority item for the health and safety of the American People. It took just nine days for the administration for a supplemental appropriation need and bicameraal appropriation. I hope you can continue i suspect you can continue to count on bipartisan robust support to aid your efforts to keep our communities prepared and able to respond. Fortunately, long before the coronavirus ever infected its first patient, congress was already preparing for this sort of Public Health emergency in a bipartisan way. Five years ago, congress began shaping policies and prioritizing investment in our readiness, including boosting funding year after year for the National Institute of health, Disease Control and prevention and Strategic National stockpile. Perhaps our greatest life line these past few weeks was the prior establishment of an investment in the Infectious Disease Rapid Response reserve fund, which was immediately available to you, the cdc, our number one Public Health defender. Indeed, because congress had the tools in place, ready to deploy at a moments notice, the administration has been able to direct a swift and decisive response from day one, not losing any time in protecting our citizens. I would like this fund to be larger. We recently proposed 300 million. In reality, we would have liked to have done more. Im pleased that congress did the 300 million in the supplemental and going forward, i hope we can build on that, given what we have to work with. We have many priorities here. But again, the outcome we got was the creation of our reserve fund. While its unfortunate we had to use the fund im glad resources were available and i hope more available in the future. Theres still a long road ahead with many unknowns, im encouraged that its not whether the funding will be there for our public defenders to be there,n we need to prepare for, prevent and respond to coronavirus, im proud that the supplemental response replenishing the Rapid Reserve fund of 300 million to help us respond quickly to any future threats. As we, unfortunately, have seen, and are continuing to witness, a deadly new disease is just a plain right of way. Global Health Security is also such a critical component of preparedness. Having our Public Health experts deployed all around the world, an idea you actually first raised with me, dr. Redfield, a number of years ago, its a response to new Public Health threats where they exist in the country of origin before they reach our shores is a really good idea. Were likely to never know where the next threat may appear. Ensuring a strategy covering all regions is necessary. I look forward to hearing more about your plans for Global Health security. Many other topics i would like to address today. Among them, influenza, combating the opioid epidemic, progress toward treating chronic diseases, threat to our most vulnerable populations and reducing antibiotic resistance. Ill end my statement here and look forward to continuing our conversation. Yield back my time, madam chair. Thank you. Yield to the chair of the full appropriations committee, congresswoman of new york. Thanks to chair delauro and Ranking Member for holding this hearing. Dr. Redfield and distinguished panelists, thank you for joining us. First, dr. Redfield, i want to thank you for meeting with me last week. We spent more than an hour together and i appreciate your commitment and expertise. Two short weeks ago i planned to raise the trumps budget continued neglect of cdc. Its backward and misguided recommendations to cut Chronic Health resources and the harsh impact on Health Outcomes of americans. After working for more than two decades to restart federal investments and gun violence research, i was eager then to conduct the types of research that may be funded. We would like to hear progress on other important investments in the 2020 spending bill, including the child sexual abuse prevention research, and combating the epidemic of youth vaping. By the way, thats an issue that is pervasive. I first learned about it from my 15yearold grandchild that 60 of the class was vaping and its not getting better. Its getting worse. But, unfortunately, today we have a new epidemic on our hands. One week ago, my home county of with westchester, new york, had its first confirmed coronavirus case. Today we have 98, with a total of 142 throughout new york state, more than 700 nationwide, including, tragically, 26 deaths. The stunning increase requires every level of government to Work Together and aggressively to contain and stop the spread of covid19. With the recently enacted 8. 3 billion emergency supplemental, the federal government can aid state and local governments to help mitigate the extent of the virus. However, due to the administrations failure to treat this threat seriously, initial faulty test kits, the administrations slow approvals for laboratories, slow distribution of working kits, more people are likely to be infected and sadly were hearing those statistics. It is imperative that the federal government have a multiagency approach to ensure tests are available for all who may need one without delay. Cant go backwards. Unfortunately, there was a real delay and thats why it was spreading. Earlier this week, i sent a letter to secretary azar, commissioner hahn and yourself, urging you to use all powers at your disposal to quickly approve qualified labs in new york. Had a conversation with the governor of new york. Theyre ready to move. They need you to approve these labs, including hospitals, private labs, other state facilities and to permit both automated and manual processing. I want to stress that again. If its taking more time for the federal government to catch up on the state level, this real Solid Movement and we need you to approve, obviously all these labs and facilities have to go through the process, but as quickly as possible. There are labs in new york awaiting approval that could greatly expand Testing Capacity by thousands per day. I dont know why theyre waiting approval. Maybe you can address that in your comments. But that could expand capacity by thousands per day, as may be the case throughout the country. If only the federal government would get off the sidelines and approve these facilities. So, in your remarks, i would be most appreciative if you could tell me why its taking so long. Do you not have enough people to check the facilities . I dont get it. Are the facilities not adequate, not up to your standard . We need to know. If the word im getting from the governor and his staff and the people involved in this issue, that theyre ready to move, why arent they being approved . As covid19 becomes closer to pandemic status, we must move forward. I thank you for the personal interaction weve had, appreciate the opportunity and look forward to hearing from you, all of you today. We look forward to the facts so that we can move as quickly as possible. This is an emergency. Thank you. Thank you. The comment i made earlier, dr. Redfield, and my colleagues, because i want to be accurate. Just a while ago, the miami herald, after they published a story right now the department of justice spokesman contacted the herald to say, and i quote, the signs shouldnt have been removed. Its now been rectified. So the outcry against that really moved things around. But i wanted to, you know, make sure that the record is accurate. Dr. Redfield, your full, written testimony will be entered into the hearing record, and youre recognized for five minutes. Thank you very much, chairwoman delaura, Ranking Member cole. Thank you very much for letting us here, and all the distinguished members of the committee. Thank you, let me first thank you for your support of the cdc to protect the health and safety of the American People. As were seeing with covid19, Infectious Diseases can emerge anywhere and spread everywhere. We have slowed the spread of covid19 to the United States. As a consequence of the positive that have been there at the local, state and tribal level. Securing Global Health in ensuring domestic preparedness, eliminating disease in any epidemic is our top strategic priorities. Weve also identified core capabilities that support the entire agencys problematic efforts, including modernization of surveillance and Data Analytics systems, state of the art of laboratories, building of the maintaining premier Public Health workforce, Rapid Response fund that you mentioned, as well as building a Solid Foundation around the globe to address our security threats. Cdc has leveraged every one of these capabilities so far in our response to the covid19 outbreak. The president s fiscal year 2021 budget provides 7 billion of cdc to support these and other important Public Health priorities. When it comes to Global Health threats, though, i believe the cdc is the tip of the spear. As with the defense department, having four deployments in strategic regions across the globe, cdc will build a longstanding, sustainable regional footprint. This will increase cdcs ability to meet public challenges wherever they occurred. The world depends on cdcs expertise in the state of the art laboratories, including 10 million to help maintain these Laboratory Capacity equipment and specialized training. The budget also supports the Infectious Disease Rapid Response fund, which has enabled cdc to respond immediately to the covid19 outbreak and help to provide us sustainable response to ebola in the drc. Like covid19, new influenza virus strains can emerge from animals and spread quickly through humans. Today, surveillance is being leveraged to ramp up covid19 surveillance. Severe influenza pandemics can disrupt our military operations and our economy. 40 million is included in the budget to protect americans from influen influenza. 13. 6 million to address the growing threat of tickborn disease, cdcs ability to prevent disease depends on accurate, timely data, and the Public Health workforce that can use that data to predict the next outbreak. During my time at cdc, we focused on bringing the reporting time to real time. This request supports data health modernization, strategic Multiyear Initiative that brings Public Health at a tima into the 21st century. Cdc relies on data for every important Public Health issue we attempt to address. Loss of a young mother due to pregnancy complications is another devastating occurrence in the family. Budget includes 12 million to increase and improve our Maternal Health in america, where every Maternal Death will trigger a Public Health response to understand what caused that death, to try to identify important interventions. Finally, cdc is committed to ending epidemics, including an increase of 371 million to support the president s initiative to end the hiv epidemic. Cdc is deploying proven approaching to alter the injection of rates in the United States as we are doing with the opioid and Drug Overdose epidemic. Overdose deaths have declined by 4. 1 between 2017 and 2018. The budget includes 476 million for Overdose Prevention and an additional 48 million to address Infectious Disease related to drug use disorder. Cdc and our Public Health partners are the nations first line of defense against these disease threats. We are committed to working with you, to protect the health and wellbeing of all americans and i look forward to answering all your questions including, chairwoman, the question you asked. I will answer that also. Thank you. Thank you, dr. Redfield. Cdc has been work fog respond to covid19, including utilizing Quarantine Authority that hasnt been used in decades. The last couple of weeks weve moved from a strategy of quarantine to a strategy of mitigation. People are following cdcs guidance, calling their Health Care Provider to get evaluated. Health care providers are facing reality that they cant get their patients tested. Other countries are testing thousands. South korea testing 10,000 people a day. We are behind the curve. My understanding is that testing kits continue to be distributed, commercial firms are involved as well. Im going to try to keep within five minutes for all of us. You know, why is the u. S. Behind other countries when it comes to testing availability, why was there such a delay in cdcs ability to replace the test kits sent to the Public Health labs . And i have a question after that, dr. Redfield. Thank you very much, chairwoman. We, obviously, got first notification of this new disease actually new years eve, december 31st. And occurring in china. The chinese very rapidly published the genetic sequence at the end of the first week of january. We actually worked at cdc based on that and created a diagnostic test that really, i think, tested the first person in january 17th. Fairly quickly we had a diagnostic test up and running at the cdc, which is our job to get that Technology Available to the Public Health laboratories in the country and we let them know and they began sending in samples. I think we had our first diagnosis in january, i think it was, 21st, in the state of washington. Obviously, at that time, there was it took time to fly the samples to cdc and run them. Sometimes it was a threeday turnaround, fourday turnaround, sometimes even a fiveday turnaround. Dr. Redfield, why are we behind other countries and why was there such a delay in the ability to replace the test kits sent to Public Health labs . Yeah. I think we very rapidly developed the test. Then we had to expand that test to go to the Public Health labs. When that was scaled up by the contractor, the Public Health labs then need to validate it to make sure the test works. When they tried to verify that it works, some of the labs found that one of the reagents wasnt working correctly. Its part of our Quality Control procedure. We had to tell them to hold off on using those tests for Public Health, could still sa send the samples to cdc. We worked to correct it with the fda. It was in a very short time and then that was replaced. The availability of testing is that cdcs focus was to provide testing for the Public Health system. Theres a whole other part we need testing for, clinical medicine. With lab corp and quest both operational as of yesterday, any Doctors Office can go through lab corp be be and quest. Its insistence on maintaining a narrow clinical definition for testing lead to an increased transmission in our communities . Did the delay undermine cdcs traditional Public Health of track and trace . Im not willing to concede the second. I am willing to say we had to go through a regulatory process to get our tests out. And our test was approved for very specific clinical settings. So when the test was approved by the fda, it was approved for use in highrisk individuals that were coming in, at that time, to china. Later it was expanded to individuals with pneumonia. Later now any physician who feels theres a need or Public Health person can order that test. It was a series of going through that regulatory process to get that test available. But i think the conclusion is that we are behind the curve in testing, when south korea can test 10,000 people in a day. Very, very quickly, if you can otherwise ill come back. 2. 2 billion for cdc. We bought your assurance that the funds will be allocated quickly and were also going to need you to outline cdcs plan for its share of the emergency supplemental and deal with what your Top Priorities are. What should the American Public see in the next coming weeks . I can assure you were going to get that money out very quickly, much of it to the state and local Health Departments but i would like miss berger to comment more. Okay. Well, i dont want to weve got a lot of folks here. Thank you very much for the opportunity. And thank you for moving so quickly with the funding. Our top priority is to get funding out to the local and state jurisdictions. Using the language we received, top priority is to get 90 of the preparedness grant amount out to the 62 grantees as quickly as we can. We plan to do that in the next two weeks. Do you have enough resources . Do you have enough resources . I think the most important thing that you all realize is to make sure that cdc is overprepared for a response, not underprepared. That means resources. Thank you very much. Ranking member . Thank you very much, madam chair. I appreciate those questions on the testing. Theyre very much mine as well. And since weve covered part of that, let me ask you something very different that ought to be a more pleasant question in some ways. Were not going to cut cdc by 700 million. What this committee will wrestle with is whats the appropriate increase honest lly going forwa and what are the things we need to prepare you as best we possibly can to deal with things that were dealing with now. The committee has seen this coming for a long time. Congress has been ahead, i think, in this area of the last two administrations. So given that, what are the things were going to have to ask this question at some point. What are the things you really need if you had as much money as you would like, as opposed to the budget that youre assigned . Thank you very much, congressman cole. Im hoping that the legacy for the time i get to lead cdc is really one thing. I helped build the capabilities of the Public Health system of this country. That is, data. Not data when i get presented something that i know what happened two years ago, but i want predictive analysis to be the name of the game, not just for cdc, but for the entire Public Health structure of this country. I need laboratories, what you were just talking about, to be so prepared that the complexities weve gone through these last six weeks are not going to be an issue, because weve invested heavily in Laboratory Capacity in the Public Health labs of this thing. I want to build a Public Health wrk force that right now those of you who know for example, like seattle that i was just out visiting, probably one of the best Public Health if not the best Public Health in the nation. Theyre struggling right now. Thats not what we need. We need to be prepared. I need the Rapid Response fund to be rebust so that it can really roll out and finally i need a Global Health Security Foundation across this across the globe that can protect the nation. I need core capabilities. It will help diabetes, cancer, Infectious Disease. Thats what i need. Building a budget takes time, as everybody up here knows, that you work with us to put dollar figures to those kinds of so we can, you know chair will have difficult decisions, our counterparts in the senate will. Ill make a bet that the budget for this agency is going up, not down. The critical thing for us is to work with people who know what theyre doing, honest ly, so we can get you those dollars and the appropriate amounts so we can go forward. The second area again, not to beat on you for a budget that i know you dont agree with, but i was disappointed to see the good health and wellness, one of the only programs that funds Public Health proposed for elimination. Let me assure you that isnt going to happen. And i know your own commitment in this area. So i suspect i know where that proposal came from. I would like you to expand on what you think we ought to do, because every set of statistics we have, you know, puts native Americans Last in just about every Health Category and risk. And this is everything from, you know, trying to make the Indian Health service more robust but also this is a unique population in some ways that has special challenges. What do you think we ought to do to try and end that disparity again, an area we have lots of minority population, my good friend, miss lee, points this out appropriately so with africanamericans, too, but we need to try to erase these disparities. Thank you, congressman cole. I think you know my personal views on this. You know, were continuing to make progress. We think that the good health and wellness Indian Country program is extremely important, supporting 27 tribes, indian organizations throughout our country. Obviously, key areas of critical importance in chronic disease, opiate injury, environmental Health Issues. Theres been a movement. As you know, american block health grant and Public Health Data Initiative, both of these can help to support. I think were trying to move away from disease specific interventions as opposed to allowing the Tribal Community to look and see what are the important Health Issues they need to address . It is obviously an important area we would like to see continue to be effective. Hopefully, there will be more flexibility and maybe a gain in efficiency, allowing the local groups to decide exactly how to invest the money in chronic disease, rather than saying they have to do this to this and this to this. That was our attempt, sir. Thank you very much. Thank you, madam chair. Dr. Redfield, as i mentioned, as you know, in my home county of westchester, new york, 98 cases have been confirmed in one week. New york is trying to combat the virus by increasing Testing Capacity, has asked for approval to used qualified hospitals, labs, additional state facilities to process tests. How many test kits does the cdc have the capacity to deliver on a daily basis . And how is cdc and fda working to increase Testing Capacity in state . How long will it take for these facilities to be approved . And how long do they believe they can take before a Rapid Response test is available for Health Providers . I got the impression that cdc was a stumbling block and new york was raring to go in producing these kits, and they didnt get approval. I wont tell you the other things ive heard. Thank you for that. Ive probably heard them all times ten. First, let me tell you ive worked very carefully closely with howard zucker, your Health Commissioner in albany. February 29th he requested that he could couse our era to bring up the lab. Fda approved it the same day, february 29th. We were on the phone last night because hes one of the first state labs to try to go to a much more automated high putthrough system. Im hopeful. We cant just do it. They have to verify. Im hopeful that the verification run that should have been completed last night and theyll be the first Public Health lab to be able to use the very high system. February 29th the administration gave regulatory relief to any preapproved lab that wants to develop the test to develop the test and use it. Theres no delay from the perspective. All they have to do is be preapproved to do clivengal testing and then they have to verify themselves that the test works. They have 15 days afterwards to file. So they can actually go forward on february 29th, if they choose to go forward, and develop that test. Third is weve worked there are three new york labs that have requested testing from cdc and we have provided it and we will continue to provide what they request. They make a request to irr, how many kis they want shipped out, theyre shipped out to them. Fourth and most importantly, the decision of the diagnostic industry. They didnt come together as independent companies. They came together all together and said how do we help get diagnostics throughout this country . And i know the two big ones, major lab corp and quest are operational as of yesterday in Doctors Offices throughout this countr country. Oh, i have a minute and a half. Ill speak quickly. They tell me to speak shorter. Its hard for me but ive tried. I know. A patient was treated several days in the hospital before he received the correct diagnosis. We now know that Health Care Professionals working in that hospital as well as two other area physicians have tested positive. Were already facing a nursing shortage. Im very concerned about our Health Workforce and whether the Health Care System will collapse under its own weight of nurses, doctors and other Health Professionals if not protected. What guidance is cdc providing to Health Care Providers, in particular Emergency Departments to minimize the number of personnel exposed to covid19 . We have guidance. Correct me, i think our updated guidance is going out today on Infection Control procedures. One of the greatest vulnerabilities to this nation right now is Nursing Homes. You know that the cms recently upped the resources. They have all their inspectors now told not to worry about all the other stuff they inspect for. All they want to do is Infection Control, Infection Control, Infection Control. This is a critical issue in the state of washington. 600 Health Care Professionals have been exposed in the state of california. We dont have that much redundancy to have that many. It is critical. I will say one thing i want to say that i think is important, this epidemic started in china. That was kind of helpful for us. We knew that was the risk. 99 of the cases that occurred last night occurred outside of china. This isnt china. Right now, the epicenter the new china is europe. And theres a lot of people coming back and forth from europe that are now starting to see these communities, and were moving quickly to try to understand how to address europe. Thats why youre seeing more in new york. Thats why youre seeing more and, again, well try to really reinforce that early consideration of coronavirus in treating individuals as if they have coronavirus is what the Hospital System has to do, and i think the diagnostics now have penetrated to the agree that clinicians will get a timely diagnosis. Let me say quickly in conclusion, i would hope based upon these particular incidence that all those emergency rooms, it seems so basic, are tested before they see a patient. I was shocked some of the stories weve heard are really shocking. Thank you. Thank you, madam chair. Congresswoman hererabutler . Thank you very much for coming out to Washington State. I joined you and the delegation with Vice President pence. I appreciate your readiness to be available to our Public Health workers all the time, all the time. Im sure youre enjoying the time delay that we experience. And were very grateful for that, and shout out to our Public Health workers. Washington states Public Health system, i think, is the best in the country. As you said, we are struggling. I wanted to bring up a couple of question questions to clarify. I know cdc has partnered with a private to make testing kits available. My colleagues were who later tested positive were able to get tested almost immediately and get their result while folks in my district and folks across Washington State cant get their test results back. People are now getting tested. I was on phone with one of my local Public Health agencies yesterday but what im being told swere trying to get people into the university of washington, right . But people who go locally and go to the state lab, theres still a delay. Weve been waiting for five tests every day the headline is still waiting for test results. Can you speak to that . Its why i dont, in the time i get, i accomplished i want in building core capability. These Public Health labs need redundancy. They dont have it. This is when i go back about the core capability about data, lab, people, Rapid Response and Global Health, weve not invested we underinvested in the theres not enough people . Not enough equipment, not enough people, not enough internal capacity. Were being told that they also so even the udab can process about a thousand a day. Does udab then still have to be validated by the state . What theyve done is on the 29th when the regulatory relief was done and they preapproved a lab and they do their own test. We told them how to do it. All they have to do is run to make sure their controls work. Dont have to scene to it us or fda completely decoupled. In 15 days they have to file with fda. I want to say one thing. Why are they different . Public health labs, we built technology in those labs to monitor flu. That uses a certain equipment which we call thermocycler. Those machines can do thousands and thousands and so they are converting to those high puts but what Public Health system never had the equipment. I apologize. We dont have a lot of time left. So there is a lab in my district. Im grateful that quest and labcorps are coming online. Thats important. I have a lab in my district that worked with cdc on hiv and found it point to get in contact with cdc on covid19 testing and due the fact they werent able to get samples back from cdc they had to get their samples from israel. You in the beginning days had the challenges, basically develop their own tests, like they went through it all themselves. I know that the administration has been working with the big guys to get them going for capacity. I would be grateful if they could also be responsive to some of the smaller guys because in the rural areas we just need more people and if these labs are willing to do it. Go ahead. If i can give you specifics ill be happy to look into it. The one last question i had im sorry im breezing through this has to do with nursing home guidance. I know the administration has a new focus on enforced protocols, right. Have been people following protocols we would be in a better place today. What im hearing on the ground level things go up on a website, but my local Public Health says i dont have the capacity to go into every single home and make sure im para phrasing. How can we help make sure that the Nursing Homes in our communities right now today are getting the information and are at least communicating about what they are going to need or what they will need and how can you help with that . Weve put together specific guidance, and we will continue to try to make sure. I know cms will be aggressively making sure each of the Nursing Homes are up because this is our vulnerability. When you see tragically the 27 people that weve lost. I think 23 of them had been in your state. And many of them had been in that nursing home. So this is really a priority to get that up and running, Infection Control up and running, provide the Technical Assistance. This is our number one vulnerability right now. Thank you. Congresswoman. Welcome. Thank you for being here. During the time that ive been on this subcommittee we have justifiably doubled the nih budget once and are on a trajectory to do so again. However, during this same time period the cdc budget has remained relatively flat despite the fact that Credible Research has shown that every dollar invested in Public Health results in 67 to 88 dollars in benefits to our society. Cdc funding is critical for maintaining infrastructure at state and local Health Departments. Over the last decade our failure to robustly fund the cdc has resulted in our local and state Health Departments losing 25 of their staff since 2008. If theres been a failure in our Coronavirus Response i dont believe it reflects on the competency and effectiveness of cdc but rather on our chronic underinvestment in the Public Health system. That is why i strongly support the 22 times 22 initiative to increase the cdc budget, 22 by the year 2022. I would like to take this opportunity to give you another chance to share your professional judgment about our Public Health funding. What do you consider to be the greatest funding needs for the cdc right now and is our current level of investment enough to ensure the best federal, state and local response not only to the coronavirus, but also while responding to a Public Health emergency such as covid19. Do you have the capacity to maintain responses to the ongoing Substance Abuse epidemic, Maternal Mortality health crisis, hepatitis outbreaks and addressing chronic disease such Salvatore Assenza ma and diabetes . Thank you very much, congresswoman. Gives me a chance to sort of reinforce once again what my goal is as cdc director and thats to rebuild the Public Health infrastructure not just at cdc but of the whole nation. As you know about 70 of the funding thats appropriated to cdc is used to go out to state, local, tribal Health Departments. We provide the funding really for the back bone of Public Health across this nation. Like cdc, the state and local and territorial Health Departments are underfunded. I want to rebuild the core capabilities so that we have daytoday modernization wouldnt it be nice if when he a data system that every Health Department in this country could see in realtime so we can predict whats going on and where to go, where to put assets. We dont have that. Wouldnt it being a great if we had redundancy in our labs. These labs need to be equipped. Not at cdc and new york and california but the whole country. All right. We need to basically get more people into Public Health and get programs there. We need that Rapid Response fund at an area we can robustly respond and not try to make priority choices how well use the money that we do have. Finally, we need to build a robust Global Health Security Network throughout the world. I got a plan to do eight to 12 Regional Centers that have full capacity so we can detect, respond and prevent infections at their source rather than deal with them at home. That to me is the most important. Because if we have that, all the Health Departments are going to go up. All the Health Departments and all of your own jurisdictions, i guarantee you, if you go talk to them, they are underfunded. Just to follow up to what you just said. By the end of 2020 its estimated the percentage of Health Agency employees eligible for retirement will reach 25 . What level of investment do we need to train and hire the next generation of Public Health professionals . That is one of the critical core capabilities and i would like to get back to you with more specifics in that exact arena as we were challenged to couple with a very specific budgetary requirements to deal with this. It is critical. We have one program that i mentioned just briefly that my predecessor started. It took young people out of college and gave them two years called the Public Health Associates Program and put them into Health Departments all across the country thatted them. Now you get young energetic people at the beginning of their career. They are not sure what they want to do. They see what a gift it is to do Public Health. Doesnt come out that way when you read a career magazine. They get out there and practice Public Health. A number of them then say i want to go on to medical school and a number of them are working at cdc today. Expanding those programs to get young people to see the value of a career in Public Health, i think, is critically important and then, obviously, to be able to continue to retain individuals that we have. But i think Tom Friedmans Public Health Association Program is an important thing for our nation. Congressman harris. Thanks very much, madam chair. And thanks for taking time to appear here because youre like a one arm paper hanger right now running around doing things. Let me follow up just on that Global Health security issue. We could have all the Global Health security we want but when china denies the presence of the disease for what a month, a month and a half, what effect does that have . I mean how you know, the bottom line is that we know the fatality rate in china is higher than it will ever be here in the United States. What protections do we have against a bad actor like that . You know, congressman harris, i just think if we have these regional presence of strong teams, its going to give us more eyes on the ground of whats actually going on. Nothing will be perfect. You know, this particular outbreak started in a certain area of china. I know ive had direct contact on new years eve or the day after with my counterpart, head of chinese cdc. I dont think he was in the light that he had a problem in early december. So, i cant really comment of how the local Health Department in wuhan and how that was shared. I know as soon as he knew, i knew. Well, ill just stop you there. They arrested the physicians who literally arrested physicians who tried to talk about this new disease and how bad it was. So, you know, again, we just need to be protective here. If we think well ever get into that closed system and somehow affect it, no communist chinese will continue that system and we just have to live with it. Now whats interesting, though, is one of the things that i hope do you is your advocates for the kind of innovation that were going to need to deal with these new viruses boet on the vaccine front and antiviral front. This idea that we produce an mr and a based vaccine and got it delivered within six weeks from conception is phenomenal but its an American Company that has not had a profit for ten years developing this platform and if this vaccine works we will owe it to American Innovation and yet, you know, bills like h rr. R. 3 will destr innovation. So how important it is for this and ain and antivirals. Its antibiotic resistance. We have a program right now that really looks at surveillance and containment. Were never going to win that. Its a containment strategy. The only way well win it is new innovation. So innovation is fundamental for us to stay ahead of Antimicrobial Resistance for us to rapidly respond in six weeks. So innovation has to drive and if we lose innovation were going to lose our ability to maintain the advances we have in clinical medicine for Antimicrobial Resistance. The cbo agreed there were a dozen of diseases that we would not be able to develop treatments for if we punish innovators in this country. Let me talk about one last and bring it around back to the testing issue because one thing you said and im curious about this is quest and labcorps now are geared up to do this. Could they have geared up sooner . Because you implied we have to have a parallel track. We need this one system thats for Public Health bodies and then this other system for the privatesector which it sounds like is, was ready to go and probably because there is a profit motive theyre ready to go much quicker. Is that a model to look at in the future doing private Public Partnership with these companies who have ability to rapidly gear up and make it available to the Public Health sector. My point is what cdcs responsibility was on the Public Health side. That said as a clinician, like yourself, you know, i guess i anticipated the privatesector would have engaged and helped develop for the clinical side. Cdc has tried to help because the test that we did develop, idt asked the fda if they could now actually commercialize it and we said its fine by us, they can do reoa, but i think those decisions on the commercialized section i mean we do have groups that can fill groups, barnard if they see a gap they can try to promote that. But i think, you know, i can tell you having lived through last eight weeks i would have loved the privatesector to be fully engaged. Thank you, madam chair. Congresswoman lee. Thank you very much. Good morning. Thank all of you for being here. Dr. Redfield for being here and for really your tremendous leadership and all of you. These are very challenging time but you all have stepped up in so many ways. Let me ask you, first of all, with regard to hand sanitizers. And im not sure, and im trying to unpack how we move forward on this, but i know and we all know that one of the Prevention Strategies is to wash hands 20 seconds and if, in fact, we dont get to wash our hands we use hand sanitizers, right . Thats part of the directive. Now, unfortunately, we cant find hand sanitizers. This small one i have, fortunately, i have another one at home so i just fill it every day. Now, ive been in three cities in the last ten days. Nowhere can i find hand sanitizers. So, what in the world is going on and how do we make sure that hand sanitizers are available . I mean in house people need them. There may or may not be water around. People who just dont have a lot of people, vulnerable populations, if they were around they probably couldnt even buy hand sanitizers. And, in fact, our Health Care Workerser and medical professionals on the front line. What in the world is going on and how do we wrap our heads around this to make sure the direction we receive from our federal government can be ad heard to . Adhered to. The Interagency Working Group is looking at a variety of Different Things to figure out where the shortages and what can to be done. Whether its respiratory mavericks or medicine or hand sanitizers and i can get back to you exactly. But i do from a Public Health point of view at least remind people 20 skocheconds of vigoro hand washing with soap will work. Where the is the supply issue here. Could you please because a lot of people dont have access to warm water and soap. I understand that. And need. We need to know that. Ill get the information for the Interagency Group and make sure it gets back to you. The second question i have on the grand princess first thank you for your assistance on this very challenging Public Health emergency and operation thats taking place in my district. I know cdc and hhs, i think hhs has been in the lead with our governor tease office. Could you clarify what role cdc has in this entire operation and what do you think in terms of time frarjs how lome, and how ll learn and what have you learn in the last 24 hours since people embarked. The leader is robert catellet in charge of the response. We provide Technical Assistance and support under his direction to the response. We, obviously, are also going to provide Technical Assistance and support as these individuals move to housing, either at travis or lackland or in georgia. But the operation is really under control. Probably most importantly, we make sure Infection Control issues are done right and we are the agency that gives the federal quarantine orders. Are you the agency that monitors the whole Public Health criteria and protocols as it relates to the health and safety of the dock workers, Health Care Workers, the crew, the passengers, the community . Where the ship is being docked is in an area in my district where historically weve had to deal with environmental racism and injustice, so naturally we want to make sure this is not another one of those instances where we will, you know, unfortunately we provide Technical Assistance to the assistant secretary for responsive preparedness and our Technical Assistance is highly respected within the department, but they are ultimately in charge. But were there to provide who signs off on the health and safety, Public Health and safety . Ultimately goes back up to the assistant secretarys office. Assistant secretary does. Okay. Ill ask my next question go around madam chair. Thank you very much. Congressman. Thank you very much madam chair. Thank you for being here. I have a lot of questions. I did a Facebook Live found hall on sunday and several thousand views in the first hour. Were not cutting your budget. Are we past containment . Is this strictly mitigation . In different areas. Were in a containment in certain areas. I would in general were in a containment blended mitigation, in some areas were in high mitigation. When you say Nursing Homes does that include assisted leaving and or Senior Housing living areas yes. Thank you. Yes is a great answer. I want to ask at the friday press conference the president interrupted you and said anyone who wants to get tested can get tested. Is that true right now . Go to your Doctors Office. You dont have to give me a long answer. Can anyone get tested anywhere in the country. Through a physician. You can. Is that yes through a physician. Yes. Great. I wrote you a letter last week. You quit keeping track of how many people were tested on the cdc website. You dont know what you dont know which is why we want to keep track of those tests. We had secretary azar as of this morning saying he doesnt know how many people were tested in this country. This was an article on cnn. Why are we not keeping track of that and why are we only updating the cdc website now three days a week. World Health Organization does it daily and this is information people really want to know. Were doing it every day now and actually got a new reporting system that includes cdc Public Health labs. Well get direct dumps from labcorps and quest so people can see all the tests done and where they are done. The answer from yesterday about three days a week is already old news. Yes. Others have said we should be proactively testing. Dr. Fauci agreed. Anybody in a hospital with pneumonia symptoms as well as health care personnel. Are we proactively testing folks like that . Were recommending to physicians that anyone that has a variety of clinical scenarios to be tested. How aggressively . Were aggressive now. Proactively proactively and individuals with pneumonia or respiratory illness. It does vary by community. Where we have Significant Community spread. Recommendation is testing Health Professionals. Not necessarily all Health Care Professionals. If they had exposure, yes. How about Police Officers . Again were seeing as weve seen in washington, its one of the things on my trip that surprised me how many firefighters were no longer available because they are in 14 day quarantine. So, again, it goes with exposure. We have increased awareness of how to approach a patient so you dont get exposed. How about a question on the tests going back, other countries use the world Health Organization test. Why did we not use that test and who made that decision . Again as i tried to say our test was created as fast as anybodys test in the world. I get that. W. H. O. Doesnt actually make a test. They have the german, one of the german universities made a test. So, again, that test would have to come here and go through regulatory reviews. Our test is much quicker. I would refer that question to the fda. I have them in committee tomorrow. Ill ask them that. Thank you very much. Another question. There was an article over the weekend, ill pull it up. I dont mean to be rudd. Saying cdc recommended seniors not travel and then wasnt per the White House Task force recommendations, Vice President pence said it was never a recommendation for the task force and the story was fiction. Did the cdc recommend Older Americans not travel . Yes. Cdc now recommends did they recommend at this point . Not at this point. At that point did you recommend to the task force i dont know exactly when that was. Over the weekend when there was a report that did not say it and they are saying cdc recommended it. At what point did cdc recommend senior not travel . Probably in the last 72 hours that we recommended. I can get back with you the exact date. I dont want to do a freedom of information request. You wont have to. I want to know when it was recommended by cdc. Theres a real distrust out there. This is one where right now im trying to convince my inlaws not to travel to las vegas tonight. These are questions were getting asked. When somebody says it was a request, i need to know when it was requested. Well get the information back to you, sir. Thank you very much. Is that my time . Im sorry. It went that quick. Thank you very much. Congresswoman frankel. Thank you for your work. I agree we shouldnt cut your budget. First, i want to say and im sure you would agree with this, you said this virus is expansive in italy and south korea now in this country. Its absolutely wrong and inappropriate to call this the chinese coronavirus. I assume you would agree with that. Yes. China was the first phase. Korea and iran the second phase with italy now all of europe. Just if you looked at even just last night, i think if you have a second, just over the last 24 hours theres almost 1500 new cases in italy. Okay. Thank you. You answered the question. Thank you. Theres been some other real misleading statements that are wrong ill read some. If you agree with these statements let me know. Our tests have been perfect. That this is like coronavirus like the regular flu. That its a hoax. That anyone who wants to be tested can be tested. The number of cases will soon be down to zero. Magically disappear. You can still go to work. Its okay to shake hands. This is a bit misleading. Since im not hearing anyone wants to correct that i assume you agree authors misleading statements. I havent heard any that i would say is not other than i do believe that the availability of testing in the last two days is getting us where we need to be. I just want to ask you are you familiar with the public charge rule . Yes, i am. Im concerned that it might lead people not to go to get the care they need. Could you respond to that . I would encourage you. Ive talked to some of your colleagues when we were on the trip in the state of washington. They brought this and were looking at it to see its Public Health implications. Thank you very much. Would you say were at the beginning, middle or end of this Coronavirus Fight in the United States . I would say i cant predict. Okay. Can you say what percentage of americans you think youre predicting will get the coronavirus . I think it depends how effective our Public Health response is right now. I do want to state one thing. We all have a role to play. Its really serious when we say to practice, washing of your hand, cough in your elbow, try not to touch your face. I know they will count how many times i did on this. Its very hard. But you have to try not to. If youre sick please stay home. Okay. Did any Health Agency recommend to the white house that people over 60 should not fly on planes . I dont know the exact days. We have recommended that the elderly and vulnerable including children with chemotherapy and others should really reconsider at this point travel. What is the age of elderly . I didnt define it but ill tell you that in the discussions we had the individuals brought it up say it was a year older than they were. What is that age right now were looking at the data, if you look at the data, you know the average age in italy of death is like 82, 83, 84 years of age. Its really the data that we have gotten from china, italy, korea and our own nation. Looks like 65 and above is where most of the people are dying. One of the concerns i know we would have especially in these Nursing Homes, everybody is getting sick including the care providers. What is the level of your concern about us having enough care providers to take care of people as this disease spread . This is the importance of what we talked about before, being overprepared. If youre overprepared the ability to protect the Health Care Professionals not just the Health Care Professionals, i think the congresswoman knows in washington one of the places ive been they dont have firefighters. Their firefighters are all in quarantined. Selfisolation. We have to be overprepared to respond to these outbreaks. Not try to catch up. Time matters Infectious Disease. We have more time in environmental disasters like hurricanes and flooding than we do when it comes to an Infectious Disease. Infectious disease if youre a week late as some of you have criticized about the testing or whatever, it matters. Im running out of time. Well have another round coming. One more question on this round. So i have some friends, people, who are selfquarantined themselves. We read about it in the paper and so forth. You get exposed, you selfquarantine for 14 days. Is that how long you have the disease for, 14 days . Right now the average incubation period from infection to symptoms is 5. 2 days. How long does disease last when you get it . It varies if you do get it. If you get exposed, you will develop symptoms within those 14 days and be able to then be either diagnosed. If you stay asymptomatic we have no evidence you shed virus longer than that. You selfquarantine for 14 days come to work and you get exposed again then you might have to selfquarantine yourself again which means we may be in that process of selfquarantining. You sound like what my wife said this morning. We fully intend i do believe if were all in this together, from individual citizens all the way up, we have a great Public Health department. We want to stay with our early diagnosis, aggressive use of mitigation strategies. Were in a fight to contain and basically stop this outbreak at least for now. Many of us are hoping, not knowing, hoping, that this will follow the pattern of flu. And other respiratory viruses. That means transmissibility in our environment will change. Its interesting when i look at cases around the world and i censor out all the contacts of exports and you look in the Southern Hemisphere theres very few case in the Southern Hemisphere right now. Its a great possibility that might change just like the flu changes. I think we need to stay the course, be aggressive. This is, again, why i think being overprepared is where the posture we want to be in. Why the supplemental you did in a fast way in a bipartisan way is so important to us because it gave us resources now scale up. I think youre getting dr. Redfield thank you for your willingness to hop on the phone with us. I appreciate your willingness to take a little time. Ill start with some of the questions i was going to ask you yesterday. Obviously, the white house was calling, i got bumped. Its all right. Is this a pandemic . I think the word i think really is not important. Usually the w. H. O. Is the jurisdiction that makes that call. This is clearly a massive global outbreak. Okay. So i know chairwoman started out focusing on where shes from, new york city. Im from a different part of the country, a very rural district that i represent in the northwestern corner of illinois. In fact 11 of the 14 counties in my direct are almost entirely rural. So as you can imagine my office is taking the necessary steps to prepare for cases and were doing what we can to make sure were going within people with what we know. So we have been in communication with all of our hospital, our Public Health centers, our county Health Departments, et cetera. One of the concerns that have been shared with us is how the virus could increase provider shortages especially in rural areas. And so let me give you and example to back up a little bit. One of the counties in one of my districts is called henderson county. We have a physicianpatient ratio of nearly 7,0001. If you want to compare that to cook county thats about 1,2001. If rural doctors need to isolate themselves theres limited openings for people. Im wonder if you could offer and anybody at your table there maybe give folks, other folks an opportunity to answer this as well. But what steps can Rural Communities take to continue treatment if their providers get sick and cannot see patients. If you have any advice specific to more rural parts of our country . This is an issue. And this, again swhy weve heightened the area of Infection Control because as we see now in washington, we see now in california we got 600 Health Care Provider out of work in both of those environments and thats causing strain. The source for most communities if this is going to happen is probably going be in a nursing home and then they go into the hospital and then the hospital you dont have diagnosis, someone gets sick from the nursing home because someone came in and visited that just came back from italy, visited their sick mother in the nursing home, then got sick and went to the hospital and then boom. We have to be aggressive and really work hard because, you know, this is what happened in wuhan. Thats why the mortality was so high. They had 130 infection beds when it started. They had 20,000 within four weeks. What they didnt have, they didnt have doctors and nurses to staff those 20,000 beds. Their Health System fell apart. Thats why the mortality was so high. Are our rural areas at more risk. You may have the benefit of being more isolated from larger population. You pray the virus doesnt get into a community. Anybody else at the table would have anything else to add to what dr. Redfield just shared . Thank you for the question. Rural shaehealth is an ongoing e for a longtime. The coronavirus and covid19 issue is just shining a light on a number of deficits we had in our Health Care System and Public Health system for a while. Weve been involved and had some resources in terms of how Rural Communities not in this situation specifically can have resources that they normally wouldnt have that might be helpful and we can follow up and send you that information and talk to your staff whats available and other things we supported generally that may come to bear for covid19 as well. We would appreciate that. Anybody else have anything else to offer in something eales weve heard is theressp ira the tors, latex gloves, they expressed a need tore more equipment. This really is the important role, im sure youll have a hearing at managing our stockpile. The Interagency Group has done critical analysis of as i mentioned before all the Different Things we need. You know, masks, protective gear. Williamsport went out to 3m the other day to visit them with masks and try to series, they are making about 35 Million Masks a day but unfortunately only 4 million of those are for medical use and 31 million are for industrial use. Youll hear more about that because i think others will be coming up with a plan to see how maybe some of that do be modulated. Its an aspire issue. Congresswoman comb. Thank you, dr. Redfield, thank you for the information youre sharing. I associate myself with all my colleagues who say were not cutting your budget in any way, shape or form. I do have some questions. Do you have any idea how many people have been tested . [ inaudible ] to collect the data and were going to put it out every day as i mentioned can you tell me how many . Right now i have as of yesterday 4846 from Public Health labs. That doesnt know include Clinical Labs or private labs. Were trying to get it all together so you have a single digit point and that surveillance should be out soon. Do the individuals who get their tests at the private labs still have to have the diagnosis confirmed by the cdc . If their lab is not independently approved by the fda, we do still do a confirmation of those the state labs. So the Clinical Labs have been reporting their test as is. I have a new jersey specific question. Unfortunately, we only have i think ten is the number today, presumptive cases but there are six people with presumptive positive cases that have yet to be tested by the cdc. So new jersey did its preliminary whatever it did it does and i understand this is a rapidly evolving situation but can you confirm with us why theres been a delay in the confirmation from the cdc on these six cases . Our staff have checked and cdc staff confirmed theres not currently any delay due to volume on previous media calls, cdcs doctor meserne takes about day to ship tests to cdc and then we get confirmation within 48 hours. She also said the cdc does have the secondary test for Quality Control measures. Why is it taking more than one week for verification. Why do we have this delay as it relates to the six presumptive cases in new jersey . I have to look into that. If they confirmed in new jersey and i have theres 11 confirmed cases in new jersey as of now, they are considered a case. All right . Then we follow up. Do they know that . Yes. Okay. Because i got the impression they are still waiting for confirmation which suggests to me they dont necessarily well clarify for sure and well get back to you so you know exactly what the reality is. Okay. Thank you. I have a question about what happens if you are confirmed to have this virus, and you are isolated, in a hospital, whatever. Youre in a hospital. What is the treatment . Its very important for everyone to hear this very clearly. A majority of people who get infected with this virus, particularly those under the age of 60, are quite relatively healthy and they would be, go to home isolation. We would ask them to restrict their moments, stayathome for 14 days. And to what . Basically do everything they can to not infect anybody else that lives around them. Nothing they can do . Nothing they need to do other than what we used to say when i was a doctor, you know, rest, drink a lot of fluids. Drink orange juice. And please, please, you know, honor the home isolation. But i will tell you for people that are very sick and which have a number that are very sick, there is an experimental drug thats available right now in compassionate use. This country has used it. A number of people in the state of washington have been treated and theres clinical protocols going on comparing that with placebos here and overseas in asia. Well know by april whether that drug works or not. Thats important because thats a drug that can save lives if it works. Should we expect the cdc to not confirm state health lab results . I think were moving in that direction. Why is that . Isnt that primarily what you aldo in this situation . Whats going to happen is a number of these laboratories are going to come out with their own Regulatory Approval to do these tests. Will we be sure all states will have the same sort of standards. Apples to apples, not apples to oranges and pears. We put out our standards for Public Health labs. Obviously as you know each state has their own. We do put out our standards. All state labs are working under our emergency operation, our emergency use authority. We are in the process of guesting each state, each lab to get their own with the fda and thats ongoing. Thank you. I yield back. Thank you. Congresswoman clark. Thank you madam chair and thank you all for being here today. As you know, we have been warned about moving from containment to mitigation. And i think the lack of testing that was done has hastened our move out of containment phase into mitigation. Would you say thats true across the country . I would say, congresswoman, that i think one of the biggest drivers of what were going through right now is the movement of this outbreak risk from travel from china to travel from europe. And individuals are coming back from europe and they are seeding communities. Well have to determine and we will know quickly how much is that driving it or how much was there Community Transmission before that wasnt recognized because of less testing . Well figure out that answer as we go back and look at lets say blood samples, we can go back a month ago and do surveillance and see what was there. But ill say my own personal opinion right now, the new cases that were seeing in the United States are probably disproportionately driven from people that have returned from europe and then gotten into a community and then weve seen secondary cases. Thats my own personal opinion. I wont die on my sword on it. Im open to the data to show us that is not true there is more transmission we missed. We want to make sure we remain datadriven. I appreciate that. As we look at whats happening i think well continue to see totals doubling and more of a move to broad scale, you know, actions that we need to take to, to mitigate this because our testing is behind where the virus and infection rates really are. Are you how are you working with sort of the front lines on this which is going to be our local Public Health officials, managed by the state and hopefully supported by the federal government . How are you working with them to, to give opinions on large scale gatherings . Should they be cancelled . Is there a role for the cdc in that sort of work . Thank you very much for that. We initially deployed teams into california and to seattle to work in the last several weeks just on this issue. Ill tell you today, Vice President s office will be releasing a Mitigation Strategy for all states and territories in this country. Guidance that weve worked on for the last couple of weeks. Can you give me any preview . What sirkts its a framework for each of the states to look at a number of different areas and we put into low risk, moderate risk and highrisk and different examples of what they need to do. Ill be reaching out directly to massachusetts in light of the recent cases that theyve had. They now basically are the top five. Last night when he a long call with the top leaders of the top four and we asked them to take this template and edit it carefully. We want them to fill it out specifically with the questions you just asked. What will they do about the marine ea mariners game. What about schools. All of that is in play so we give them a framework and have a couple of groups that have been dealing with sustained Community Transmission in the last four weeks see how they will do this. Because i do think this is critical. Were here to get Technical Advice to all of the groups. I will be reaching out to massachusetts in light of the last couple of days and see if they want to engage directly with cdc. We sent people to new york, to seattle and to california and florida to help them and i think massachusetts is the next one that the Health Department wants assistance. Are your making recommendations that people dont have gatherings over 100 people or have you set sort of that criteria were currently working in partnership with the current state Health Departments to come up with what we believe is an effective Mitigation Strategy. Is that part of what the Vice President will be releasing. Hell release the frame woshlg. Well tell them how to do this. Then well be follow up with the specific jurisdictions like i did last night and the day before, actually for the last couple of weeks to work in partnership to see how they operationalized that framework. They will all be different but were very involved. Rather than cdc give a blanket recommendation since this is community by community were working with the local Health Departments head on to come up with an, obviously expressing our Technical Assistance and recommendation. Im almost out of time and i dont want you to interpret this as a flip question but is there anything in those recommendations that say sort of structural barriers at our borders would be of any use in mitigating the outbreak of this virus . Not that ive seen. Thank you. Thank you. Doctor, i have a couple of quick questions for you and i want to get a another question in. This is about Public Health data. And i think what we heard here this morning is that the coronavirus outbreak for it confirms the need for modernizing our Public Health system. I understand you worked on the Public Health Data Initiative. Let me ask you a couple of questions. If the Data Initiative had been implemented over the last five years and cdc had a modernized Public Health data system how would the current Public Health response be different . So in the spirit of conjecture, it would have been different in two ways. Possibly. One is that we would hatch detected it much, much sooner and been able to contain it further and more effectively. The other is even before detecting, depending on relying on different sours of data which we do not now and want to do more of and analyzing that information we could start seeing there might have been a problem even before getting scared about the number of cases that were being detected. Its both detection and very quick prediction. Are there examples of things you cant do right now but what cant you do right now . What we cant do right now is two fold. One is and they are related. One is the delay in finding out what actually is happening. A lot of it has to do with unfortunate barriers that the current systems have with getting that information from Health Care Providers, getting it from states that we can use then to engaging that response earlier. In that regard what we did was to provide in the supplemental to improve surveillance and reporting. Are cdcs Public Health systems up to the task of handling all the data coming from state and local jurisdictions in such an emergency and i make the reference to the 4856 number that you gave us dr. Redfield. Are we not 100 . Not what we know is possible. The initiative 75. The initiative would get to us 100. Not only get to 100 but allow us to maintain that over time. The difficulty were running into is that methods are changing significantly faster than they ever have been. Tools are showing up faster than they ever have been. If we cant keep up with that then well fall back even more. If we talk five years from now and dont make those changes it might be 50 instead of 75. Its fundamentally critical every state and territory has that capacity too. Folks we heard from the them and we talked about Electronic Medical records. They were talking about data entry and et cetera which holds up the process. Making your point we need to invest in this effort. First time in 20 years, 2020 appropriation included funding for cdc firearm injury and mortality prevention research. Enthusiast enthusiasm for this. Cdc really appreciates the appropriation and we have moved very quickly on this funding. February 21st we issued our first funding announcement for our ro 1 grants. We had an informational call for potential applicants yesterday. Record number for interested applicants. Letter of intent are due next week and we hope toi issue thes grants by september to look at areas like mass violence. How are some prevented. Why are others not. Selfdefense use of firearms. When is it used against a person or helps in a crime. School programs. Are they effective in preventing firearms violence. Safe storage. What are the best circumstances for it. Is there any applicants looking at homicides versus suicide . So we dont know yet. Our hope is we get a wide variety of applicants. We have really decimated this information to a Diverse Group of the stakeholder. Its important. We appreciate the suicide funding as well to look at primary prevention. And Community Interventions for that as well. Let me yield my colleague. Madam chair, you anticipated one of my questions that i had for the doctor on the importance of Health Care Information which weve all mentioned one way or another. Could you work our committee we obviously have a very substantial supplemental that we hope will be important in this area. What you requested might get to you 100 of what you need. What you also need is a look forward as you mentioned yourself and i you know cant estimate every new piece of technology that will come along or what might be useful. When you think through these things you really have to have a multiyear plan even though we only budget one year at a time. Really helps if you can tell us particularly on technology because we tend to invest once and the speed of change is much faster than we usually anticipate and so you end up with equipment thats out of date pretty quickly if we dont have at least some way of thinking proactively about what you think you might need going forward. Thank you for that invitation. Were work on a long term plan. Were building as we go along the way. Part of that plan is doing what weve not done before and thats work the privatesector where those advances are showing up and introducing them into Public Health way before than what were doing now so we dont fall behind. This directs to you. I dont ask you to make a judgment here. We have the system we have. I am struck honestly that was one of the things i learned when i was chairman about how heavily states and localities are dependent on cdc. Again i want a robust partnership. I dont want people to think that theres not at that role here for states to actually step up and do a little bit more and the locale needs to do more. In my own state lack of investment is here so im not throwing stones at anybody else. When youre providing 60 of the Health Care Budget or Public Health budget for state and local thats something we ought to be worried about as oklahomans and not being waiting around for equipment and advice. We need to do more across the board, dont we . Yes. I agree with you. I want to add because, you know, were all impacted by the degree of preparedness of any state. So if we have one state underprepared were all underprepared. If anything i would have loved and state of new york is great, they have a great lab. They stepped up. They got their lab tests going up. Not just cdc, its at the state level, cdc and state developed their own. I would like all the jurisdictions to be able to bring up their own tests. We could have a race who gets the test quick. It goes back to that Core Investments in Public Health. A point well made. Let me ask you this and, again, i want to be careful for two reasons. Ask you two related questions. The first one does relate to china. I recognize the delicacy of your position. We got work with china. This wasnt the best result but better than what weve seen in the past. But hopefully theres some candid discussion going on with them. Not letting our folks in as rapidly as they should have. I think we could have been helpful to them and certainly would have been helpful to us. And this kind of close system does invite puts one in five people on the planet live there and they just cant im glad its coming down where they are at but going up every where else. More Rapid Response from them would have made a big difference to every other place in the world. Theres a special responsibility. They are a superpower. They have world class science and they have, you know, very capable people. So i would just what are you doing to invite them to sort of integrate themselves more fully into the world Health Organization . You know, congressman, weve had more than 30 Year Cooperative relationship and the reason it is called cdc china, it was built by cdc america. I actually have a small group of individuals in cdc china and youll see in my Global Health Footprint Plan expanding that is part of it at least in china. We did offer directly to provide amplified assistance to the outbreak in early january. Our cdc colleague my counterpart actual actually requested that. It had to go up through higher channels and that was not done until the w. H. O. Did the report where we did have one cdc individual and one nih individual from the United States on it. But we do believe we could have been helpful early on and helped us in our own policy decision. And ill just make this plea and im out of time here, this isnt directed at you or your counterparts because i suspect they wanted to do it. This is a discussion that immediates to happen between our political leaders and their political leaders. It is an area that with we should be able to cooperate with one another and help the overall relationship. So i just hope it is on the radar screen of our state department and our president as well, they need to have this kind of conversation privately. Were not trying to embarrass our friends or anything else, but tear a big part of the solution or the big part of the problems. They could choose to be one or the other. I know you have urged your counterparts to do that and i suspect they want to do that. Theyre professionals and dedicate their lives to defending people just like you do. This is one where the the political leaders need to get involved with for the good of all. That is my sermon, madam chair. Take it to heart. Congresswoman. Thank you very much. The vaping epidemic as we know is a Public Health crisis that must be met with every level of government. Thats why the cdc office on smoking and health is so crucial and why congress provided an increase of 20 million in the fy20 bills so all levels of government could have the resources could combat vaping before we lose the generation of children to the harms of nicotine addition. Last years vapingrelated respiratory illness resulted in 64 deaths, nearly 3,000 hospitalizations and many if not all of the cases were avi we attributed to vitamin e and why cant the cdc say with center what caused the illnesses and do you consider vaping as a risk to Public Health and my question, are you concerned athat compromised lung health could exacerbate risks for those who contact coronavirus . First, the last question is yes. The first thing i like you learned about this from my grandson who told me i was a cdc director and i needed to stop it because he has a brother with cystic fibrosis. I would like ileana tell you more and clarify anything she doesnt clarify. Sure. Thank you for the question anything that could go into a lung through vaping or anything else is a concern. Vitamin e as tate is a concern and that may go away but other things are going to take its place. One thing that is very important is to make sure that although the response has been the activation for the response has ended and the activities and the the surveillance activities looking at symptoms people are presenting in emergency room departments and what is it that they are using in the substances that may be related to that. For like we were talking about before, to catch it before it gets to point where we were with vitamin e acetate. And in addition to that were continuing to work on making sure that we understand how it is at adolescence and how they think about the substances which is different than what the adults think like and make sure that we reach out to them and make them understand what the choices are that they are making and help them to make more healthy choices so that not only continuing the progress that we made with adolescents on combustible tobacco but relate to vaping as well. And you know it is not working. And ive been to campuses with my own kids and i met with the president and said what are you doing, and can dr. Redfield, i learned about it from a grandchild who told me before she was in college, must have been five years ago, and she was upset because she was saying 65 of fifth and sixth graders, these are crazy statistics. Do you think perhaps now we know it could be connected with coronavirus, maybe that will shake them up. It is a very important priority for us and dr. Arias and the team is a Bigger Picture of adolescent nicotine addiction. When the decision was to take flavored products off, menthol was not taken off at that point in time, and were tracking very carefully to see if now underage are shifting and were going to really be seeing the data. We have a commitment. If we have evidence that adolescence are shifting to menthol well butt up that for reaction from the fda but my biggest concern was mine were in middle school and telling me 50 of the class was using ecigarettes on a regular basis. Well, let me, since i have 46 seconds left, you know it, i know it, our grand kid cans know it and so far theyve been reporting rather than talk about the impact themselves. Theyre reporting what is happening to their friends. Are we making any progress . Is anything were doing working . I hear the statistics are the same whether it is in junior high or now in college. Theyre all vaping. Everywhere in the country, man or women, it is all the same. So what are we doing . Anything. So it is increasing. And as you know when things are increasing it is hard to start turning them around an it is going to be a while before that starts to happen. However what we are doing is focusing on things that happen effective in terms of communicating and how adolescents understand the communications and in order to understand dont just look at the pretty colors on the package, which they respond to, think about what is in side of the package, even if the packaging doesnt change. And what other sister agencies are doing in terms of regulation that will make it a little bit easier to sort of control the environment so that they basically are protected from that side as well. But a lot has to do with finding out why theyre using it and how they are using it and how it is that we could get them to stop. We showed progress. But i would like to pursue this madam chair, because were talking about it, everyone is concerned, youre concerned and im concerned but we have failed and we havent done anything. Were trying to do something but were not successful. Ban it. Congresswoman. Right. Dr. Harry, the fy20 final appropriation included 10 million for the first ever dedicated funding for Suicide Prevention at the cdc. And as you know, there are unique populations that are at higher risk for suicide. Such as latino adolescents and veterans and nurses. Im cochair of the maternity caucus with long what my colleague Jaime Herrera butler and in recent statistics indicates suicide may be a contributor to the high incidents of Maternal Mortality in this country. Can you speak to the connection between postpartum depression and suicide ideology and tell us what efforts your agency to doing to track and address this problem. I could start and turn it only to my panel to add to it. With regard to suicide, the 10 million appropriation were going to Fund Applicants to look at data within their communities to identify who are the most vulnerable and what communications have the highest risk rates and then work with them to focus effective intervention on those areas. So it might be rural populations, it might be veterans, to your point it might be young mothers. And to then really look at the evidencebased Community Level strategies to drive that. With regards to Maternal Mortality in suicide, i believe it is about 6 of Maternal Deaths that are due to suicide. We do know that the ages of 10 to 44, i believe it is the fifth leading cause of death due to suicide in that group so we do see that is an increased age for suicide deaths. But were focused on primary prevention of suicide deaths, things like making sure that there is good programs in schools around social Emotional Learning and improving connectedness and if those are at risk for suicide make sure they are linked to care. Our vital signs found that more than 50 people who died by suicide did not have a Mental Health diagnosis. Are you coordinating with other agencies on this problem such as sensa and the veterans administration. Very much so. And working closely with the v. A. Sarn the veterans organizations to look at things why are some veterans not accessing v. A. To look at what can he could do more in the community and work closely with sampsaw and talked about the medical packaging done at cdc to help cities implement those strategies. Dr. Arias, over the last two decades weve seen significant gains in the Life Expectancy for those living in spina bifida. This cre aces new challenges because when young adults age out of pediatric care there is no system in place to follow and for them. The cdc the program has been flat funded at 6 million for the last six years and it currently down two Staff Members. Do you have concerns that progress and investigation into critical lifesaving issues such as the cause of sudden death in mid life and prevention of sepsis related morbidity are possible within the current staffing structure . Were working within the confines of the resources that we have to address these issues. It has been significantly difficult. I think that we need support in order to branch out and address the problem in its full complexity. So right now it has been very limited in the kinds of things that can be done. It is not just true of spina bifida, it is true such as alzheimers and multiple sclerosis and other things that have been difficult for us to make much of an impact as we think we can because the resources hasnt been there and we have to work what we have and that means measuring it and getting information to the extent that we can about prevention but in most cases sort of managing. And then a lot of information which is were getting more requests now for dealing with the care giving community in each of those situations. Well then what funding level would you need to ensure that the National Spina Bifida Program Covers the life span of those living with a disability and what are your plans to track people as they age out of the pediatric system . So we have been work on a plan sort of looking for areas that we need to go and we could get information to you about what that plan would look like and what would be necessary in order to support the implementation. The resources. Thank you. Congresswoman frankel. Thank you again for being here. You would agree this is not a time to cut any of our Global Health budget . As i said, i think one of the most important things we need to do is build a robust longterm foundation of Global Health. I think cdc is the tip of spear and i think this is a time to get that foundation built. So the answer is yes. We should not cut or no we shouldnt cut or the answer is, yes, we shouldnt cut the Global Health budget. Are there enough i dont know if i could ask it this, but are there enough masks for First Responders and Health Care Workers and if not where do we get them. Again, this is something that asper is in charge of looking through and in making those calculations. So we could get back to you but i refer to that asper. So i have a couple of practice c a couple practical questions. My mom is older than me. Thats obvious, okay. [ laughter ] shes healthy, knock on wood. She was supposed to go to the doctor for a checkup and shes afraid and said im not going to go for a checkup there could be a room of sick people. Of course it is a room of sick people. What do you say to that . I think your mother has a lot of wisdom. Okay. I love that. Okay. Unless she has a requirement to do things right now, were trying to get the elderly and vulnerable to just step back and try to avoid being in crowded places, avoid travel. This is with where we are right now. Got another practical question. So were told to wash our hands and all of that. Dont touch our face. People are coming in contact even ourselves with our clothing, with our furniture, and all of that is is it spread that way . Congresswoman, that is a very important question. This virus clearly can live in the Environmental Services for some period of time. With the ship in japan, very aggressive studies are being done to see how much virus they find on railings and different places. Finding the virus doesnt mean it is infectious, but we can detect this virus for a prolonged period of time and in services and the role we call fo mite transmission and that is why it is important as you put your hand on the handrail as you walk down, you need to wash your hands after that and you touch the handrail and then touch your clothing but you can wash your hands but you cant wash your clothing. It is probably more touching the rail and putting the hand to your face. Okay. All right. So is the information coming from the world Health Organization reliable . I would continue to say the world Health Organization is a very wellrespected Public Health organization. So as of right now, can anyone go to the doctor and get tested for coronavirus or we still have a delay and having enough tests for that . As of yesterday well i dont remember what today is. Is today monday . Tuesday. Tuesday. Okay. As of monday, quest labs and lab corp labs have made this test available. They have in Doctors Office. When you go to the doctor and get your blood drawn, it is done by lab corp or quest and now that same thing could happen if your doctor wants to order a coronavirus test. And i want to just go back to this is another common sense question, though. It seems to me that some of the reasons i mean, not shaking hands, washing hands, selfquarantine is not just about not getting the coronavirus, well it is about that, but the fact is we dont want everyone to get it at the same time because we cant take the stress on the Health Care System or the stress on the economy, is that right . Yes. And we dont want them to get it at the the same time they are getting flu. Unfortunately this virus is very similar in a sense it is a respiratory virus so if you look at Hospital Capacity right now much of it is full, up to 96 , 98 . Are there test shortages in any other part of the world . I dont know exactly. But i can tell you obviously in areas like sub Sahara Africa, theyve been spared by now and the reason for that is unclear and if it is seasonal well have challenges and you asked me medical interventions before and the one medical intervention you need if you go to the hospital is oxygen. And there are many hnl systems that dont have the capacity to deliver Health Oxygen to their people. Is that in this country. In other countries. Thank you. Yield back. Congresswoman lee. Thank you very much. I apologize. I had to step to the add committee. So if this is redundant, ill ask what the answer was in terms of pandemic versus epidemic, has anyone asked that question and where are we in terms of describing this emergency. I said it is really the the word is not that important. This is a major global outbreak. But the w. H. O. Is usually the organization that formally declareses something a pandemic. But clearly this is a wide scale global outbreak. Let me ask you about sickle cell, the sickle cell trait. It is been estimated by cdc that over 4 million americans have the sickle cell trait and the incident of sickle cell trait in screening was over 1 for births and spuhispanic births and is te protocol for learning families or Health Care Providers to the presence of sickle cell trait and informed them about the potential outcomes that might be associated with with the trait or counseling about the impact that trait status might have on families future reproductive decision making. I ask this because once a child is tested at birth, by the time theyre 18 or 19, who knows if they know or not whether they have the trait. And i have personally examples of that with regard to the interaction between the a1 c test. If you dont know you have the trait, the doctors are not required to test if you are from the specific tarkt population. So how in the world do we deal with this. Because it is really a problem. So we could send your information about the Sickle Cell Program at cdc. A lot of that work is done in conjunction or in partnership with providers and with the Health Care Community to make sure that they get that information to families and point out resources that are available to them. And you could see that as we operationalize this data modernization for the whole nation, we could have data that could be in the system that the Public Health system nation could have access to. But why when an adult gets a blood test, if this adult is of a specific population, why isnt part of that panel a test for sickle cell trait . I mean, if i have the trait at birth, at 20 if im getting married or 25, there is an issue there. And i dont even f and i dont i dont even know i have it. Sure. I could get back to you and find the systemic things that stand in the way of that happening. A lot of it would have i would imagine a lot has to do with the fact that it is known at birth and at assumption being that is known to the individual and there is no point, but youre right if it is known at birth how do i know at 18 or 20 or 30 that i have the sickle cell trait. If it is part of the birth record that you have it. Please, there is nobody in this country, i guarantee you, who is an africanamerican who knows that they have the sickle cell trait based on birth record. Well definitely get back to you. It is something we need to address. Thank you very much. Now, going back to the Reach Program and the issue of Health Disparities which my friend congressman raised in terms of the budget, the Reach Program is a Critical Program in eliminating racial and ethnic disparities and its been eliminated and ive heard how youre going to make some moves with the cdc but this budget eliminating and being eliminated in the president s budget, i dont think you could compensate for addressing racial and Health Disparities. You indicates some kind of move into the aspects of the program around to address this in terms of not disease specific but community specific or whatever. But this is unacceptable when you look at people of color, you look at the native American Community and every community in this country, the exhibits Health Disparities to eliminate this program is to me unethical, in terms of health and medical standards, and its a shame. And so are you all weighing in on this . Is cdc saying this is not a Good Health Care decision to make . Public policy decision . I think you all know that were constrained right now in this environment. That is why i put focus encore capability. It will help all programs. All programs including the Health Disparities program by building this capacity. I do believe that block grant flexibility will give local communities to be able to invest the money they want and but were not turning our eyes off to the Health Disparities of the nation and well continue to try to navigate how we can continue to address those. Again, im going to come back ive done it multiple times, i think the core capability beyond cdc and to all of the Public Health structures that we have at state and local, tribal and territorial that gives enormous ability to function on multiple areas including Health Disparities. And unless directed by the federal government with some major protocols in place, with some Major Research in place, with some Major Investments by our government in terms of the Reach Program, were going to be set back. Thank you, dr. Redfield. Thanks. Thank you. I have an additional question and i know the Ranking Member does and then well hear from the Ranking Member to close and then i will close up. This is about Global Health security, dr. Redfield. And you just mentioned africa and i just got then email again from my dear friend who was the former Health Director Health Commissioner in south africa, the shadow commissioner just said they now have the first cases in south africa. So these are my questions, because the viruses dont have borders. And africa can easily be overrun. What is cdc and Global Partners doing to assess the risk for immune suppressed clients withand other Infectious Diseases . What resources are available to support diagnosis and Clinical Care and can this be scaled up with other partners . Is cdc able to send Health Specialists to support the africa cdc and its regional collaborating center. We provided 600 million if the past, in the supplemental, we include 300 million for Global Health. If you could just answer those three questions. Thank you very much, chairwoman. Clearly hit on one of the real concerns in sub Sahara Africa, in general, how immune compromised will react to the virus. One would predict it would be more likely to cause more severe illness. And in africa that obviously causes the other problem because more severe illness needs greater likelihood of dependency on oxygen. And many of the nations dont have that capacity to the degree they may need it. We have from the beginning, as you know, because of the pep far program, cdc has Country Offices all through sub Sahara Africa and have them providing assistance and the cdc africa is a cdc colleague gone on loan to hes now hired by the African Union and one of the best and well helped him building Testing Capacity and there is testing in west africa and in the african cdc in south africa. But africa is a great vulnerability. It is one of my biggest concerns on a global scale because if this virus gets into africa like it is into italy, there is going to be a lot of casualties. Mmhmm. Let me yield to my Ranking Member. Thank you, madam chair. Obviously weve talked a great deal about coronavirus and health care and security and ill get to that in my close and i want to shift to another area and this is addresses to you dr. Mallory, when im home i hear more about Drug Overdose deaths, more families and more people affected, obviously i suspect the death toll this year will be worse than anything we see in coronavirus that is just year in and year out. Finally last year we saw it come down a little bit. First time in 28 years. Congratulations for some of the great work at cdc to help us in that area. So going forward, what can we do and where do you need additional help . Ive seen different it is not always opioids. There are different substances that seem to be more common, even so, tell us what we should be doing as a congress to try and provide the resources to help our fellow americans in this area. Absolutely. And thank you for that question. What i would say is the resources that we have received from congress have really helped us build that infrastructure. We are now able to collect syndrome Surveillance Data and with our current grant we added in a category to look at meth and other psycho stimulants because we didnt want to be three years later when our grant is over saying what is going on with the trends. So were able to really pick up that in more realtime. We also realize that linkage to care is important and weve built that into current programs. And what could we do to help provide for Health Providers. In the last 15 years i worked in the county e. R. And watched this evolve and i came to cdc because i knew it wasnt about the individual patient but what we could do at the population level. I still work in a clinic once a month to see the integration cdc things that were doing like with Electronic Health records. Were now seeing that surge of methamphetamine and other substances. What i think is important is not to lose sight of how we got here. We need to look at the whole range. We are starting to see a decrease in high risk prescribing but many that go on to other drugs got started with prescription opioids. Many patients in clinic are wrestling with cocaine use and heroin and we could treat them and so having that linkage is crucially important and then looking at vulnerable populations like tribes, were working closer to give direct funding to tribes and groups at Cherokee Nation in utah have integrated problems to identify the highrisk patients and link them to care to prevent them from having overdoses. Dr. Redfield. I want to add one point. I think it is important to aggressively engage in a innovation here. This is a chronic recurrent medical disease. It should engender the same aggressive research that were getting new cures for cancer or heart disease. This is going to be a medical disorder that will have affective therapies. We have them now that are a little bit for opioids. But we really need to have effective therapies to recognize this is the disease that it is. This is not a behavioral choice. This is a medical condition that needs that innovation, that medical research, private sector has to get engaged to develop the same passion for cancer cures that they do have for addiction cures. As we look at the misuse in the first place and primary prevention such as the funding for Adverse Childhood Experiences and childhood trauma could lead to suicide and over dose deaths so looking at that linkage in the whole spectrum is key. Thank you very much. You want me to close . Okay. Well first of all, thank you. Less exchange is a splendid example of why we admire you so much because of your commitment to our fellow americans and all of humanity in the search for cures and defending people and therapy. It is an extraordinary noble profession and youre engaged in. And i hope we made it clear, not to you, but to the powers that be that we intend to continue to make these investments on a bipartisan basis. And i will just say to my friends, and they are my friends at omb, and i mean this with no disrespect, when somebody in Congress Tells you on a bipartisan basis were going to spend money in these areas, you would either help us figure it out, by letting your people to work with us to where does the money make the most difference or not. And well do it any way. So it is just much better. And again ive had that discussion when i was chairman. Im sure the chairs had that discussion as well. This is something that congress decided to do and it is not decided to do it in a substantial way over multiple agencies, nih, cdc, strategic stockpile, mechanisms to get into the fight as quickly as you possibly can for all of our benefit. We all agree very much with my chairman, this isnt a republican or democrat thing at all. And weve just made that collective decision. It is not triggered by this particular event. As a matter of fact this event is vindication of the bipartisan judgment over the last several years this is an area with needed to make investment and we want to work with our best people that with we think are in these agencies if a very collaborate way. So that we dont make mistakes. So thats not your requirement its to do what you all do and that is to defend the president ial budget but i would submit for the record that administrations would be a lot better off had they listened to up several years ago in this area and we would all collectively be better off and i hope we all learn a lesson from that. There are some things to have a sharp pencil about and a very keen eye and look im a conservative republican. There are other areas that with where you need a substantial Public Investment to protect the American People. I think this is this area probably more than any other single one, although there is certainly a range of activities that were involved in. But here youre literally talking about the health and well being of people in a very individual way. In a very immediate way. In a way that could come out of nowhere when you least expect it as Something Like this has happened. So i think it is sort of the collective of wisdom of congress over many years, again with congress that had doubled this nih budget b and ill tell you saz a membe as a member, you lot. Ive had the opportunity to go down and visit cdc and i learned a lot. Just sitting down and talking to the people and getting an idea of the range of capabilities. And i think we all reflect that over time. So i want to thank the chairman for the hearing, first one shes had since 2016 and very timely, madam chair. But more importantly, i just want to thank my chair for the bipartisan commitment here. Because this is not something that is likely to go away. And i think that is something, again, i hope the executive branch realizes over time regardless of who is there. This is a kind of enduring commitment. And so there is no sense sending us a budget that cuts things that were not going to cut and doesnt work with us in areas where we want to make investments and but recognize that you have enormous expertise at your institution that we ought to be listening to as we fashion what those investments are going to go be. So we look forward to working with you. And continuing this. I wish you very good luck. All of us very good luck in dealing with with coronavirus. And i now suspect things get worse before they get better in this area. But at some point they will get better an at some point well turn the corner but i hope the Lessons Learned here are enduring. I have no doubt they will be for this subcommittee because they have been. But i hope they are for the American People as well. We take a lot of things for granted around here. These are investments that matter. These are investments that if not made for years ahead of time cant be parachuted in at last minute and cant make a difference without a sustained plan without investing in what each and every one of do you and madam chair youve had that commitment for your entire career. I appreciate that. Were very lucky to be led by you at this particular time. Yield back. I thank the gentleman but unfortunate why we have been able to produce i think quite remarkable labor hhs bills over the last several years. There is a compatibility here that i think at the outset someone would say well it is not going to work. But because of the competence and professionalism and deep compassion and caring and the values of the Ranking Member and our ability to Work Together, yes, there are differences, but those differences dont cloud the goals and the challenges that we see. And you know it is been in the past history of this country that members on both sides of the aisle that crafted the responses to the serious challenges that weve had, they were not naive but understand that the challenges were that great that wherever you come from, that our obligation and our responsibility is to see that we address this issue and that is the kind of cooperative relationship that i find on this committee with my Ranking Member and i think it is true with the subcommittee as well. So i thank you for being here. Very much to all of you. There are a couple of things. I did look up pep far which is critically important and that is been cut by half. We will address that issue as well. On the vaping issue, dr. Arias, the fact of the matter is that ecigarettes never had an fda approval which is why i made my comment on ban until we know. I want to go on science. Thats stop it until we figure out whether or not and who where we go forward. Dr. Redfield, because you talked about the masks and i say this to the Ranking Member, what i heard yesterday was that, yes, 3m, it is 35 million and it is 4 million in terms of the hospitals or Public Health workers. 31 million is for the commercial sector. But it is only 4 million because that is all the insurance that 3m has. And without some notion of indemnification, we need the strength of the administration to say get more insurance and lets move forward with what we need for the Public Health. And thats something that im asking to do. It is wrong to stop because at 4 million because we cant get there. And there is no answer to this. But i dont know for the life of me who was monitoring the selfmonitors, you fknow, and what they are doingment and that is a hard task to if you want to Say Something about that go ahead and then ill wrap. Ill only say one word because we did this with the Ebola Outbreak a number of years ago. And it is just heartening to see the cooperation of the American Public when they understand what were asking them to do. I think about 97 of them did what they were asked to do. Not everybody. But it is heartening to know the American Public when they understand that they will, in fact, abide to these clear instructions. And, again, thank you very, very much. You heard the concerns of there are serious concerns, we keep asking the questions, we want to make sure that the statement is accurate, that anyone who needs a test gets that test immediately and we allay fears. The crisis is here. We know that. We are all dependent on the strength of our Public Health infrastructure. If we are not strong, you said it, if were not strong in all 50 states, we are not strong. Let us help you with the core capabilities and i wrote those down. Rapid response, predictive analysis and data modernization, Global Health security, and say Public Health workforce that is second to none. We want to do that. And, please, let us know, because you know you have listening ears here, to what you need and we want to get you where this country needs to go during this crisis. Thank you all very much for being here this morning. We bring this hearing to a close. Thank you very much, chairwoman. Thank you. [ hearing concluded ] thanks for what you do. [ hearing concluded ] if you missed any of this the event it will be available shortly at cspan. Org, just time 2021 cdc budget request in the video search box at the top of the home page. A quick reminder, follow the federalsons to the coronavirus at cspan. Org coronavirus. And we have news about the outbreak. During this hearing you may have heard subcommittee share rosa dell talk about warning posters from Immigration Courts. Immigration court staff thagswide were ordered by the Trump Administration to take down all coronavirus posters from courtrooms and waiting areas. The executive office for immigration refew which falls under the department of justice told all judges and Staff Members in an email that all coronavirus posters that explain in english and spanish how to prevent catching and spreading the virus had to be removed immediately. However on tuesday morning, just four hos after the miami herald published the story, a department of justice said the signs should not be removed and officials declined to discuss where the email was sent in the first place and who told the chief administration judge to issue the directive. Read more about that at miami herald. Com. The president coming to capitol hill to speak to Senate Republicans during the party caucus meeting and expected to discuss the Coronavirus Response and including potential economic assistance for those affected and a possible payroll tax cut. If he appears before the camera with comments well bring that to you. Well have more on the coronavirus and interagency subcommittee is hosting. Watch live coverage at 2 00 p. M. Here on cspan and also online at cspan. Org or listen live with the free cspan radio app. Following the federal response to the coronavirus at cspan. Org coronavirus. You could find white house briefings, hearings with key Public Health officials, and interviews with Public Health specialists. Review the latest events any time at cspan. Org coronavirus. It comes out to be a campaign in which we have one candidate who is standing up for the working class and the middle class. Were going to win that election. For those who have been knocked down, counted out, left behind, this is your campaign. The president ial primaries and caucuses continue tonight for six states. Including idaho, michigan, mississippi, missouri, north dakota and washington. Watch our campaign 2020 coverage of the candidate speeches and results tonight live on cspan, cspan. Org or listen from wherever you are with the free cspan radio app. Cspan, youre unfiltered view of government. Created by cable in 1979 and brought to you today by your television provider. And we have more from campaign 2020 now with democratic president ial candidate joe biden. He hosts a Campaign Event in detroit joined by a Michigan Governor Gretchen Whitmer and cory booker and kamala harris, both former 2020 president ial candidates who endorsed mr. Bidens campaign after ending their own bids. From yesterday, this is just under an hour. All