Transcripts For CSPAN3 White House Coronavirus Task Force Members Testify On Coronavirus Response... 20240713

The committee will please come to order. First, straightive matters based on the sergean u attending physician after we consulted the department of health and Human Services and the centers for Disease Control and prevention, individuals in the hearing room are six feet apart. As a result theres no room for the public to attend in person. Relayingni observations to colleagues. The hearing may be watched online. Unedited recording will be available on www. Senate. Gov. Witnesses are participating individual i dont conference in a onetime exception. Some senators, including the chairman, are participating by video conference. Senators, weve been advised, may remove their masks, talk into the microphone in the hearing room six feet apart. Grateful to the rules committee, sergeant of the arms, capital police, Committee Staff all for their hard work to keep us safe. We are hearing last thursday, all roads back to work about back to school run through testing. And what our country has done so far on testing is impressive, but not nearly enough. Over the weekend, senator schumer, the democratic leader, was nice enough to put out a tweet, quoting half of what i said. He left out the other half, the impressive part. Let me say again what i meant by that. When i said impressive, i meant according to Johns Hopkins university study, the United States has tested over 9 million americans for covid19. Thats twice as many as any other country. We dont know what china has done. And its more per capita than most countries, including south korea, which manyni members of r committee are cite d, according to dr. Deborah birx, the United States was double testing in the month of may, 10 million tests conducted. Here is what i mean by impressive here in tennessee where i am today. First, anyone who is sick, First Responder or health care worker, can get tested. Our governor, bill lee, is also testing every prisoner, every resident staff member in a nursing home, has offered weekend drivethrough testing, has done specific outreach for testing to lowincome communities. Any tennesseean can get a test. The governors slogan is when in doubt, get a test. Federal government is helping him make sure that he has enough supplies, in case he has trouble getting them through the labs and the other commercial sources. As a result, our state has tested about 4 of the population. The governor hopes to increase that to 7 . Phase one of going back to work, which i said last week is not nearly enough to provide confidence to 31,000 students and faculty members that we hope will show up at the university of tennessee campus in august when school start. Last week i talk ed to chancellr plowman about that. What would persuade those 31,000 students as well as the 50 million k through 12 students in the country and the other university students, what will persuade them to go back to campus in august . Thats where the new shark tank comes in, dr. Collins calls it red x. We had our hearing about that on thursday. Remarkable scientific exercise. Take a few early stage concepts, swimming around what we call that competitive shark tank, see if dr. Collins and his associates can find a few new technologies to create millions of new tests that will scale up rapidly and make it more likely students will go back to school in august. First diagnostic testuation saliva, that a person provides at homestead of nose swab or blood. First niniantigen tests, like t onescoq used for flu or strep throat, which involves the swabbing of the nose and you can get the result in a few moments. Another test not approved is to put in your mouth a lollipop sponge, take a photo of that. It lights up, youre positive. A university might send that saliva lollipop to a nearby laboratory, which could be a gene sequencing laboratory, which can deal with thousands of those samples overnight. And that same process could occur at a middle school. It could occur at a factory. Of course, anyone testing negative one day can test positive the next. Widespreadco screening at schoo campuses or placesnrco of work encourage to persuade the rest of us to go back to school and back to work. In addition to more testing i expect dr. Fauci to talk to us about additional treatments that will be available to reduce the risk of death and the administrations plan to do something that our country has never done before, which is to before it actually has been proven to work in order to speed up the result in case it does work. Those vaccines and treatments are the ultimate. Before we have them, the more tests we conduct, the better we can identify those sick and exposed and quarantine the sick and exposed instead of trying to quarantine the whole country. In my opinion, this requires millions of new tests, many from new technologies. Some of these will fail. We only need a few successes to get where we want to go. Thats why i said on thursday that what our country has done is impressive but not nearly enough. Squeeze all the tests we can out of current technologies, next try to find new technologiesni help us try to contain the disease and persuade us to go back to work. One other thing. This is a bipartisan hearing to examine how well were preparing to go safely back to work and to school and to determine what else we need to do in the united vsenate. Such an exercise sometimes encourages finger pointing. Before we spend too much time finger pointing, i would like to suggest that almost all of us, the United States and almost every country so far as i can tell, underestimated this virus. Underestimated how contagious it would be, underestimated how it can travel silently in people without symptoms to infect other people. How it can be especially deadly for certain segments of our population, the elderly, those with preexisting conditions, minority population. Let me go back to the march 3rd hearing we had in our committee on coronavirus. Six weeks after the first case was discovered in the United States, a day when only two deaths were recorded in this country, i read at that hearing this paragraph from the New York Times two days earlier on march 1st. They reported this. Much about the coronavirus remains unclear, the times reported and its far from certain, march 3rd march 1, that the outbreak will reach severe proportions in the United States or affect many regions at once. With its topnotch scientists, modern hospitals and sprawlingn Public Healthxd infrastructure most experts agree, United States is among the countries best prepared to prevent or manage such an epidemic. That was the New York Times on march 1. A lot of effort has gone in to trying to make our country well prepared over the last 20 years, four president s, several congresses in response to 9 11, bird flu, katrina, ebola, h1n1, passed nine major laws to try to help get this country ready for what were going through today. These laws stood up the Strategic National stockpile, created an assistant secretary for preparedness. It created incentives for the developments of vaccines and medicines that were using today to strengthen the centers for Disease Control,co created arr of senator blunt and senator murray, weve increased funding to the National Institutes of health. All ofco this was part of a shad goal. Democrats, republicans, several president s and congresses, to try to get ready for what we were going through today. Whether it was known, like anthrax, or counknown, like covid19, but despiteco that effort, even the experts underestimated covid19. This hearing is about how we improve our response toco this virus as well as the next. During the oversight hearing i also intend to focus on, as i just said, the next pandemic, which we know is coming. What can we learn from this one to be ready for the next one . Can we learn from the fasttracking of vaccines and treatments that were about to hear about that will make it even faster the next time . How can we keep hospitals and states from selling off protective equipment when their budget gets tight . How can we make sure congress does our share of the funding responsibility . How do we provide enough hospital beds without canceling elective surgery, hurting other patients and bankrupting hospitals . Whose job should it be to coordinate supply lines so technical equipment and supplies get to where theyre supposed to go when theyre supposed to go . Whats the best way to manage the stockpile . My preacher once said im not worried about what you do on sunday. Its the rest of the week that concerns me. Im afraid during the rest of the week between pandemics, we relax our focus on preparedness. We become preoccupied with other important things. Our collective memory is short. Just three months ago, this country was preoccupied with impeaching a president. Now that seems like ancient roman history. Now while this crisis has our full attention, i believe we should put into law this year whatever improvements need to be made to be well prepared for the next pandemic. If there is to be finger pointing, i hope theyre pointed in that direction. Four distinguished witnesses who are at the heart of the response of the coronavirus. Were grateful for their service to our country. We ask them each to summarize their remarks in five minutes, then well have fiveminute round of questions from each senator. I agreed to end our hearing about 12 30 after we have a full round of questions. Every senator will have a chance to have four or five minutes. Senator murray will have an opportunity to ask the last question or close the hearing and then i will close the hearing. Other hearings to follow this hearing, like last thursdays hearing and senators may submit their questions in writing within the next ten days. Staying at home indefinitely is not a solution to this pandemic. There is not enough money available to help all those hurt by a closed economy. All roads back to work, back to school lead through testing, tracking, isolation, treatment and vaccines. This requires widespread testing. Millions more tests, created those exposed can be quarantined and contain the virus in this way can give the country confidence to go back to work and school. In the near term, those 31,000 ut students and faculty members show up in august, we need widespread testing. Millions more tests, created mostly by new technologies, to identify those who are sick, who have been exposed so they can be quarantined by contain iing the disease in this way, to give approximate the rest of america enough confidence to go back to work and back to school. Senator murry . Thank you very much, mr. Chairman. My thoughts are with you and your team right now, as you try to navigate the same challenge so many in our country are worried about. We all wish your staff member a speedy recovery. I would like to thank not only our witnesses for joining us today, but our Committee Staff in working to set up a safe format for members and witnesess and the public to participate in this hearing remotely. Families across the country are counting on us for the truth about the covid19 pandemic, especially since it is clear they will not get it from President Trump. Truth is essential. So people have the facts, so they can make decisions for themselves and their families and their communities. Lives are at stake. The president isnt telling the truth. We must. And our witnesses must. And were counting on you today. Families need us to take this opportunity to dig into facts about where things did go wrong, so we can finally get them on track, because the Trump Administrations response to this Public Health emergency so far has been a disaster all on its own. Delays, missteps have put us way behind where we need to be on diagnostic tests and allowed inaccurate Antibody Tests to flood the market. Corruption and political interference have impeded efforts and promoted dangerous, unproven treatments and we recently learned that after experts at the centers for Disease Control and prevention spent weeks developing a detailed guide to help our communities understand how to safely reopen, when the time comes, the Trump Administration tossed it in the trash bin for being too prescriptive. But this is far from the first time this administration has silenced experts who were doing their job and putting Public Health first. The fact of the matter is, President Trump has been more focused on fighting against the truth than fighting this virus. And americans have sadly paid the price. Since this Committee Heard from these witnesses on march 3rd, weve seen 900 deaths in my home state of washington, and the numbers continue to climb. Still, President Trump is trying to ignore the facts and ignore the experts who have been very clear we are nowhere close to where we need to be to reopen safely. My hope today is that we can cut through this and have a serious discussion about what is needed to safely open. How close we are as a country to meet those needs and how we actually get there. We need dramatically more testing. It is unacceptable we still dont have a National Strategic plan to make sure testing is free, fast and everywhere. That is why i fought to make sure our last covid19 package included an additional 25 billion testing fund and requirement that the Administration Submit a plan by may 24th. And when i say a plan, i dont mean a pr plan. I mean a plan with specific timelines and numeric goals tore supply and funding needs, one that actually addresses the issues were seeing on capacity, distribution, disparities and building out our Public Health system. And makes clear to states and tribes and employers and the American People what they can expect and what the administration will do to keep americans safe. Testing alone wont be enough to reopen our country. We still need far more personal protective equipment than has been available for our Health Care Workers on the front line. And we will need far more for our workers as we reopen. So we desperately need this administration to step up and get that equipment to states who are doing everything in their power to purchase supplies but simply cannot get nearly enough, because the reality is, unlike states, the federal government has the tools to actually fix the problem if only the administration would use them. And we also need that equipment to actually work and for the fda to act promptly if it does not, not weeks later, when people may have already been exposed. And just as importantly, we cant expect people to go back to work or to restaurants or to confidently send their kids to school if there isnt clear, detailed guidance about how to do that safely. Schools, from Early Childhood through college, need to know how to keep their students, their staff and their educators safe. When should they wear masks . How do you run a School Cafeteria or a school bus . And if they cant reopen classrooms, schools and families need to know were working to ensure every student gets an education. Tools like Online Learning can only get us so far if we dont address the Digital Divide so that every student can access them. And even then, there will be learning loss that could deepen educational disparities among lowincome students, students with disabilities, english language learners and other vulnerable populations if we dont make sure they get equal access to resources and support. And, of course, schools arent the only workplaces weve got to be thinking about. We need to make sure that industries across the country know how to safely reopen and that people know their workplace is safe. Secretary scalia needs to stop dragging his feet and do his job and set forward a rule that makes clear worker safety is not optional. Mr. Chairman, i hope those th committee can hear about those issues from secretary scalia and secretary devos and others in the days ahead. Other congregate care facilities where weve seen the deadly outbreaks. And as the rash of outbreaks at meat packing plants shows, its not just an issue for the health care industry. Its an issue for everyone. Just as we need to plan before we can start to reopen, we also need to plan well before we have a safe and effective vaccine to guarantee that we can quickly produce and distribute it on a global scale and make it free and available for everyone. So, ill be asking about our progress on those issues today. Today, safely reopening our country may be a ways off. And the administrations planning may be way behind. But theres still a lot that Congress Needs to do. There isnt time to spare. Some, including the white house, say weve already provided enough economic relief. My question to them is, what good is a brenlg that only gets you to the middle of the river . We dont need to wait around to see if people need more help. We know they do. We need to work quickly on another aggressive relief package and we need to make sure our priorities in that bill are protecting our workers, our students and our families and addressing this Public Health crisis, not bailing out corporations or protecting big business from accountability. People across the country are doing their part. They are washing their hands and Wearing Masks and social distancing and staying home. They need their government to do its part, too. They need leadership. They need a plan. They need honesty. And they need it now. Before we reopen. So they can rest assured that we are doing things safely and competently with their health and wellbeing as a top priority. Thank you, mr. Chairman. Its an important hearing. Some people may be watching it for the first time. If they are, i hope they notice that we have 23 members of this committee, i believe, one more republican than democrat. We have some very strong views, but were able to Work Together and express those views and respect each other and our witnesses and a big part of that goes to senator murray and her staff. So, thank you for that. Each witness will have up to five minutes to give his testimony. Thank you for making an exception and agreeing to testify by video because of these unusual circumstances, and thank you for what youre doing for our country. Our first witness is dr. Anthony fauci. He is director of the National Institutes of allergy and Infectious Diseases at the National Institutes of health. He has held that position since 1984, which meant he has advised six president s, and worked on hiv aids, influenza, malaria, ebola and other Infectious Diseases. He was involved in treating ebola patients at nih and worked on patients with ebola. Next, dr. Robert redfield, director for centers of Disease Control and prevention, which has its headquarters in atlanta. More than 30 years, he has been involved with clinical search related to chronic immunoviral infections and Infectious Diseases, especially hiv. U. S. Militarys hiv research program. He spent 20 years with the u. S. Army medical corps. Third, admiral brett giroir. Admiral gichlt roir is assistant secretary of health at the department of health and Human Services, putting him in charge of Public Health policy recommendations. He has taken on the responsibility for coordinating testing and focused on the increasing number of tests that we can do with existing technology. This federal Service Includes a variety of activities with our Defense Department in advanced research, threat reduction. He was part of the Blue Ribbon Panel that informed the u. S. Veterans health system. Finally, dr. Steve n hahn. Before joining fda, he was the chief medical executive at the university of texas md anderson cancer center. He was chair of the department of radiation oncology at the university of pennsylvania, was a senior investigator at the National Institutes of health, commander of u. S. Public Health Service commission for 2025. Well ask each of our witnesses to summarize their remarks in five minutes. Following that each senator will have five minutes for questions and aens in order of seniority. Dr. Fauci, lets begin with you. Welcome. Thank you very much, chairman, Ranking Member murray and members of the committee. Thank you for giving me the opportunity to discuss with you today the role the National Institutes of health and research addressing covid19. The Strategic Plan that we have is fourfold. One, to improve our fundamental knowledge of the virus and the disease it causes. Next, to develop new point of care diagnostics. Next, to characterize and test therapeutics and finally develop safe and effective vaccines. First, with regards to diagnostics, as you probably heard from dr. Francis collins last thursday, the nih has developed a program. Up to half a billion dollars to support the development of covid19 diagnostics. It is a national call, Innovative Technologies that will be evaluated in a shark tank like Selection Process to get to either success or failure rapidly. Moving on to therapeutics, ill talk a bit about the remdesivir success antiviral in a moment. There are a number of Broad Spectrum antivirals in various stages of testing. In addition, well be looking at convalescent plasma, plasma from individuals who have recovered from covid19 to be used in passive transfer either in prevention or treatment. In addition, hyperimmune globulin, well be looking at repurposed drugs as well as immunebased therapies and host modifiers and, finally, antibodies. Let me take a moment to describe the remdesivir placebo control. More than 1,000 individuals and sites throughout the world. It was in hospitalized patients with lung disease. The end point was primarily time to recovery. The result was statistically significant, but really modest. We must remember, it was only a modest result. Showing that the drug made a 31 faster time recovery. We hope to build on this modest success with combinations of drugs and inventive drugs. Moving on to vaccines, at least eight candidate vaccines in clivengal development. The nih has been collaborating with a number of pharmaceutical companies at various stages of development. I will describe one very briefly, which is not the only one, but one that we have been involved in heavily developing with moderna. You might recall in this committee that in january of this year, i said that it would take about one year to 18 months, if we were successful, in developing a vaccine. The nih trial moved very quickly. On january 10th, the sequence was known. On january 11th, the Vaccine Research center met to develop a plan. On the 14th of january, we officially started the Vaccine Development. 62 days later, we are now in phase one Clinical Trial with the two doses already fully enrolled. There will be animal safety, phase one will directly go into phase two, three in late spring, early summer. And if we are successful, we hope to know that in the late fall and early winter. There are some important issues, however, in covid19 Vaccine Development. We have many candidates that hope to have multiple winners. In other words, multiple shots on goal. This will be important, because this will be good approximate for global availability if we have more than one successful candidate. We also, as the chairman mentioned, will be producing vaccine atrisk, which means well be investigating considerable resources in developing doses, even before we know any given candidate or candidates work. I must warn that theres also the possibility of negative consequences, where certain vaccines can actually enhance the negative effect of the infection. The big unknown is efficacy. Will it be presence or absence, and how durable will it be . Finally i want to mention the nih has launched a Public Private partnership, accelerating covid19 therapeutic interventions and vaccines. The purpose of that is to prioritize and accelerate clinical evaluation of therapeutic candidates with nearterm potential. Hopefully, our research efforts, together with the other Public Health efforts, will get us quickly to an end to this terrible ordeal that we are all going through. Thank you very much. Happy to answer questions later. Thank you, dr. Fauci. Dr. Redfield, welcome. Good morning, chairman alexander and Ranking Member murrmur ray and members of the committee. We are not defenseless. We have powerful tools to fight this enemy. We have tried and true Public Health interventions such as early identification, Contact Tracing, combined with important mitigation strategy, including social distancing, frequent hand washing, face covering. These Public Health tools have and will continue to slow the spread of covid19. I appreciate the opportunity this morning to provide a brief overview of some of cdcs ongoing work in response to covid19. Cdc has been working 24 7 to combat the pandemic. Emergency Operation Center is supporting state, tribal, local, territorial efforts in building core capabilities, data and predictive analytics. E epidemiologyists. Our Laboratory Experts are performing serological testing to better define asymptomatic population. As local leadership makes decisions to reopen, theyll require varying degrees of federal support. Each location will be different and will face unique circumstances. Cdc has conducted a statebystate assessment of Public Health testing, capacity and key Contact Tracing capacity as well as surge plans. Cdc is providing Technical Assistance and funding to the states provided through supplemental c. A. R. E. S. Act and health care enhancement. Were working directly with state and local Public Health leaders to define their needs of testing, testing device, supplies and manpower, surveillance, data collection, reporting, Contact Tracing, Infection Control and outbreak investigation. I want to spend a moment to focus on several key elements. First, testing. Rapid, extensive and widely available, timely testing is essential for reopening america. Cdcs role in testing continues to support diagnosis and Contact Tracing, surveillance and outbreak. When we work with the Public Health partners to define their particular testing strategy, their jurisdiction, admiral giroir will address the response. Contact tracing, state, local and tribal Contact Tracing capacity is critical. Its a critical part to stop the chains of transmission and prevent the occurrence of sustained community transmission. Cdcs role is to provide technical training, assistance and support to the states as they hire and build a workforce necessary to be fully prepared to effectively respond to the Public Health challenges posed by the ongoing covid pandemic. This will be an expansive effort. Surveillance, our nations Surveillance Program is build on a combination of assistance, including existing Surveillance Systems combined with commercial and research lab platforms and our case reporting system. Cdc is adapting these and revising it to have a Surveillance System in response to covid19. Importantly, in light of the significant occurrence of asymptomatic infection, the surveillance for asymptomatic infection becomes an important Public Health tool for early case identification. Cdc is working with each Public Health jurisdiction to develop a perspective Surveillance Program to include active surveillance among those who are most vulnerable, such as individuals in longterm care facilities, intercity clinics and homeless shelters. We need to rebuild our nations Public Health infrastructure. Data and Data Analytics, Public Health resilience and our nations Public Health workforce. Now is the time to put it in place. For generations to come. Not only for the Public Health system that our nation needs but for the Public Health system our nation deserves. Before i close i want to recognize the tireless commitment of the dedicated cdc staff who deployed to every corner of this nation to fight covid19. More than 4,000 employees have deployed here and globally. Science and at a tima continue with Technical Expertise in Public Service to be the backbone of cdcs contributions to the u. S. Response. I extend my serious gratitude to the Health Care Workers on the front lines as well as their family and the essential Emergency Personnel as well as the American People to say thank you for adhering to the stayathome guidelines in protecting the most vulnerable. Its important to emphasize were not out of the woods yet. We are more prepared. We need to stay vigilant with social distancing and remains imperative. We are a resilient nation and i am confident we will emerge from this pandemic longer together. Thank you. Thank you, dr. Redfield. Admiral giroir, welcome. Here to provide you with an update on the navys process. On march 12th, secretary azar requested i lead the covid19 testing effort within hhs, including oversight and coordination of the fda and cdc with regard to testing. Since then, the nation has performed more than 9 million covid19 tests, a number far greater than any other country and double the per capita tests performed to date in south korea. We implemented a phased approach to meet testing needs during mitigation and now during phase one reopening of america. Beginning march 20th, we pioneered 41 communitybased drivethrough testing sites in locations prioritized by the cdc. These sites have been profound success, testing over 167,000 highrisk individuals and demonstrating our prototype that is being duplicated multifold in nearly every state. Next, the administration leverage trusted retailers, including cvs, rite aid, walgreens, and health mart now providing testing at 240 locations in 33 states. 69 of which are in communities with moderate to high social vulnerability. To meet the need for collection supplies, like swabs and media tube, we first secured the supply chain through a military bridge. We worked with manufacturers to increase domestic production. We collaborated with the private sector and the fda to validate multiple swab and media types that vastly expanded supplies while minimizing the need for ppe. Finally, we used a title iii of the defense production act to further invest in domestic manufacturing to prepare us for reopening. To support the need for surveillance testing during reopening on april 27th, we issued a new testing framework that also prioritized testing for persons without symptoms, who are prioritized by Health Departments or clinicians for any reason, including screening of asymptomatic individuals according to state and local plans. Next, our federal Multidisciplinary Team conducted multiple calls with leadership from each state to set statespecific testing objective. Collectively, states and territories established an overall goal to pechl 12. 9 million tests over the next four weeks. The federal government is able to and will support the achievement of this goal. Specifically, the federal government is shipping to states 12. 9 million swabs and over 9. 7 million tubes of media in may alone. Last month, we also detailed the location and capacity of every lab machine, in every state that could potentially run covid19 and our team has worked with test suppliers to match reagents to these machines. Looking forward between now and the end of 2020, the federal government will procure over 135 million swabs and 132 million tubes of media and distribute these to states as requested to supplement the now robust commercial supply. We anticipate marked increases in current tests as well as the dramatic expansion of new point of care tasks like the first in class quidel antigen test. 300,000 tests per day within just a few weeks. So, by september, taking every aspect of development, manufacturing and supply chain into consideration we suspect our nation will be capable of conducting 40 to 50 million tests per month if needed at that time and if new are authorized, any Novel Solutions uncovered by nihs new diagnostic initiative, that number will be much higher. Finally, i want to acknowledge and express my heartfelt gratitude to the officers of the u. S. Public Health Service commission corps, the Uniformed Service i am honored to lead. 3,471 men and women have deployed in support of this pandemic. On the cruise ship in japan, to our military bases repatriating americans, to our communitybased testing sites and international airports, to fema and our task forces, to nursing facilities, including king county, washington, and to field hospitals and hardhit communities across our nation. I thank each and every one of these officers and their families, and on their behalf, i thank the members of this committee for supporting our Training Needs and the establishment of a Ready Reserve to supplement our ranks in future national emergencies. Thank you for the opportunity to provide these remarks. Thank you, admiral giroir. Now dr. Steven hahn, our fourth and final witness. Chairman alexander, Ranking Member murray, members of the committee, thank you for inviting me to participate in this hearing today. I first want to start by thanking the American People for their incredible efforts at mitigation and extend my condolences to those who have lost loved ones. From day one of this pandemic, the 18,000 fda employees who are just incredible scientists, doctors and nurses have taken an active role in the all of government response to this pandemic. Fda has worked to facilitate Counter Measures to diagnose, treat and prevent covid19. Weve worked closely with laboratories, manufacturers, academia, product developers, federal partners and companies, companies that dont even make medical products but want to pitch in. For example, making hand sanitizer, personal protective equipment and ventilators. Every decision we have made has been driven by data with the goal of protecting the health of the American People. In a Public Health emergency, however, our response has balanced the urgent need to make medical products available with the provision of a level of oversight that helps ensure the safety, effectiveness of those medical products. I would like to take a few minutes to tell you what fda is doing to help the country at this point, and which judge americans return to work and school. Fdas worked with more than 500 developers who have or said they will be submitting emergency use authorization request for covid19 tests. This includes some newer technologies that heretofor have not been used in response to a diagnostic test or pandemic. 92 individual emergency use authorization test kit manufacturers and laboratories and weve been informed but more than 250 laboratories theyve begun testing under the regulatory flexibilities we outlined in march. We are conducting rolling reviews of ua submissions so we can quickly authorize tests, which the data support. In a Public Health emergency, the accuracy of diagnostic tests is important, not only for the individual patient but for the patient at large, for the public at large. Fda is helping to ensure the availability of tests that are providing accurate answers. We are also monitoring the marketplace for fraudulent testifies and are taking pro appropriate action to protect the Public Health. And were taking more clarity to see which have been authorized by the fda and which have not. Unlike diagnostic tests, which detect the presence of the virus, serolog approximate iacl tests measure the response of the body to infections like covid19, overcome the infection and developed an immune response. To find a balance between the assurance that an Antibody Test is accurate and timely access to such tests. Of course, the way we will eventually beat this virus is with a vaccine and fda is working closely with our fed partners, including the nih, vaccine developers, manufacturers and experts across the globe. We intend to use our regulatory flexibility to help ensure the most Efficient Development of a safe and effective vaccine to prevent covid19. Until a preventive vaccine is approved, however, we need medical products to bridge the gap. Fda has been working for several months to facilitate that as much as possible and created an Emergency Program for this acceleration called coronavirus treatment, reassigning staff to work with urgency to review our quest for scientists and doctors to develop therapies and using every available authority and regulatory flexibility appropriate to facilitate the development of safe sbesktive products to treat covid19. A variety of therapeutic areas are being evaluated as mentioned by dr. Fauci and others, antiviral drugs as well as c convalescent plasma. Issued an eua for hospitalized patients with covid19. Two other promising treatments that i mentioned are the antibodyrich products, hyper mun globulin and im happy to go into more detail if you have questions about this. Stake holders to facilitate, which if shown to be safe and effective could act as a bridge therapy to the development of vaccine. We recognize the developing vaccines and therapies need to go hand in hand, with ensuring there will be sufficient supplies for our companies, for our country. So were also working with manufacturers to make sure this supply chain is robust. Mr. Chairman, Ranking Member, members of the committee, please know in fda you have a dedicated team to some of the nations finest scientists, health care professionals. We are guided by science and data and we wont let up until we facilitate the products our nation needs to get back to work. I appreciate your questions. Thank you, dr. Hahn. Thanks to all four of you for your expertise, your dedication to our country and your hard work. Alternating between democrats and republicans. I would ask you to stay within five minutes for your questions and answers. I will start. I got a question for dr. Fauci and then the admiral. Doctor, lets look down the road three months. There will be about 5,000 campuses across the country trying to welcome 20 million college students. 100,000 Public Schools welcoming 50 million students. What would you say to the chancellor of the university of tennessee, knoxville, or principal of a Public School about how to persuade parents and students to return to school in august . Lets start with treatments and vaccines first, dr. Fauci and if you can save half of my five minutes for testing, i would appreciate it. Thank you very much. I would be very realistic with the chancellor and tell him when were thinking in terms its a her in this case. I would tell her that in this case the idea of having treatments available or a vaccine to facilitate the reentry of students into the fall term would be something that would be a bit of a bridge too far. As i mentioned, the drug that has shown some degree of efficacy was modest and was in hospitalized patients. Not yet or maybe ever to be used either yet as prophylactic as a treatment. So if the issue is the young individuals who will be going back to school would like to have some comfort in that theres a treatment, probably thing that would be closest to utilization then would likely be passive transfer of conva lelest serum. Were not treating if a student gets ill but how to make a student feel safe going back to school. If when he a vaccine, that would be the end. But even at the top speed were going we dont see a vaccine playing in the ability of individuals to get back to school this term. What they really want is to know if they are safe. And thats the question that i have to do with what we discussed earlier about testing. So, im about halfway through the remarks. I would like to pass the baton to tad mhe admiral who will add the question of testing. Admiral usaid while were doing about 10 million test this month, we might be a size 40 or 50 million by the end of september and a month, which is a significant increase. If im chancellor of the university of tennessee, could i develop a strategy where i say to all my student we have, for example, antigen tests which is quick and easy, we want everybody on campus to come by and take it once. Let everybody know that on that day we isolated anybody thats positive and then we can continue to monitor. Is that strategy possible in august and september . So, thank you, mr. Chairman. May i reserve 20 second for dr. Redfield. The strategy deployed is whats the Community Spread. If theres no Community Spread your strategy will be different. If theres High Community strategy that would also be different. Yes, technically well have the ability and your chancellor will have the ability. We expect 20 to 30 mill loin point of care tests. Its possible to test all the students or much more likely that there would be a surveillance strategy done where you may test some of the stu students at different times. That would to be done in conjunction with the cdc and local Health Department. There are strategies that are still needing to be validating but a pooling sample. We know in experimental labs 10 or 20 samples can be pooled. Essentially one test could test 20 students. Finally there are some experimental approaches that look interesting, if not promising that, for example, wastewater from an entire dorm or entire segment of a campus could be tested to determine whether theres coronavirus in that sewage, the wastewater. So there are other strategies being developed and i would like to at least give 20 seconds to dr. Redfield who really will be working on the strategy on how to deploy this. Dr. Redfield . Just quick comments. First, i think its important to evaluate critically the role in changes of social distancing on College Campuses and schools not forget the importance of what weve learned. Clearly also developing Aggressive Program for wellness education, making sure people understand when they are symptomatic, they need to seek evaluation. I think you are going to have to look at the role of testing. I think there will be an Important Role of testing in these circumstances and i think it will be individualized based on where these Different Schools are, how much infection is. Im going to wrap it up there so i can set a good example for the other senators. Senator murray. Thank you very much, mr. Chairman. Thank you to all of our witnesses. Dr. Fauci, you have warned of needless suffering and death if we push to reopen too soon but the president has actually been sending the opposite message. I want to ask you today, what is the most Important Message you would have for communities and states that are reopening, even as our Public Health experts make it clear its too soon. Tell us what the consequences are. Thank you very much for that question, senator murray. As i said many times publicly, what we have worked out is a guideline framework of how you safely open america again. And there are several checkpoints in that with a gateway, first, of showing, depending on the dynamics of an outbreak in a particular region, state, city or area, that would really determine the speed and the pace which one does reenter or reopen. So my word has been and ive been very consistent in this, that i get concerned if you have a situation with the dynamics of an outbreak in an area are such that youre not seeing that gradual over 14 day decrease that would allow you to go phase one and then if you pass the checkpoints of phase go to phase two and phase three. But ive expressed then and again is my concern that if some areas, cities, states or what have you jump over those various checkpoints, and prematurely open up without having the capability of being able to respond effectively and efficiently, my concern is that we will start to see little spikes that might turn into outbreaks. So, therefore, i am being very clear in my message to try to the best extent. Possible to go by the guidelines that have been very well thought out and very well declinatdecli. If a state or region goent by those guidelines and reopen, the consequences could be pretty dire, correct . The consequences could be really serious. Particularly and this is something that i think we also should Pay Attention to, that states even if they are doing it at an appropriate pace, which many of them are and will, namely pace thats commensurate with the dynamics of the outbreak that they have in place already the capability that when there will be cases there is no doubt even under the best of circumstances, when you pull back on mitigation, you will see some cases appear. Its the ability and capability of responding to those cases with good identification, isolation and Contact Tracing will determine whether you can continue to go forward as you try to reopen america. So it is not only doing it at the appropriate time, with the appropriate constraints but having in place the capability of responding when the inevitable return of infections occur. Thank you for that and its very clear in order to do that we need knowledge which is about testing and for months this administrations approach to testing has really been plagued by unrealized goals and disregard for systemic problems within that supply chain and last week an average of 250,000 tests per day were performed in the United States. Thats a small fraction of what we need and yesterday President Trump had the gall the u. S. Prevailed on testing at a press conference that was filled with misinformation and distortion. Public Health Experts do not think the u. S. Has prevailed. Im glad you think states will receive enough tests to meet their goals for may and june but this administration has had a record of giving us broken promises that more testing supplies are coming and they dont. We know, by the way, testing is going to, needs will persist long past june. So i wanted to ask you today, will the administrations forthcoming Strategic Plan that is now required under the covid package that was just passed inside this law, will that Strategic Plan on testing include specific numeric targets tore Testing Capacity, supply capacity and shortages . Thank you for that question. And statement, senator murray. Yes, we are as ive stated we continue to have a work in progress as we build the Testing Capacity. We have established the targets with the states of over 12 million tests over the next four weeks. We think those targets will be good in may and june but as dr. Fauci said we really have to be evidencebased. We expect those targets to go up as we progressively open it as communities go through phase one and then into phase two and certainly those numbers will need go up significantly again in the fall when we potentially have influenza circulating with covid. So, yes, there will be targets. Targets will need to change based on the evidence that we see but were highly committed to securing the supply chain. We worked daily with every manufacturer and im just pleased were in may and june able to get ahead of the states so that we can supply them with what they need so they have those assurances. So my question to sue when you put out that specific plan that youre required to do, well see numbers that youre going to tell us that you will reach, targeted for testing and supply chain capacity and production. Instead of just saying we hope to have a million this week, youll give us the specific target, correct . We know specifically ill say yes, maam we know the specific. We know the specific amount of tests we have over the summer. Not have, how many we need. Yes, maam. We developed the a need for a statement by working with the states individually with epidemiologists, with the cdc so that overall in may well be testing about 3. 9 of the overall u. S. Population. Fine. But what im telling you time, senator murray. How many will we need not just for may but in the coming months so that question be prepared to have them. Yes, maam. Not to be repetitive, but we need to be evidence and datadriven because what we may see in may or june will drive differences in the amount of test goals we have. We really need to be very humble about this. We need to look at the data. We know testing needs will go up over may and june as we progressively open and well do our best to predict that. You have to understand what the data and evidence shows at that time. Okay. I appreciate that. Mr. Chairman, again, what our Strategic Plan requires what is the goal, not how many we have but how many we need and thats what well be looking for. Thank you. Thank you, senator murray. Senator enzy. Thank you, mr. Chairman. I liked the specific list we need to learn from this pandemic for the next one. Not only should we be working on this, but we need to look at the future too and i think we learn ad lot. Were fighting a virus at the same time that scientists are learning about it. So we need be nimble, we need to be sure were prepared for a second wave of outbreak that cocoa inside with the start of the flu season potentially stressing our Health Care System even more than it also has been. Admiral, i thank you for your comments. I think they have been comforting about what has been done and what can to be done. I agree with senator murray that we need to have some specific goals as an accountant thats always one of the things im always looking for. Dr. Hahn, our understanding of the clinical picture of covid19 continues to evolve. What first looked like a respiratory illness now seems much more comprehensive, potentially affecting the heart, the brain, kidneys and other organs. How does evolving picture impact the ability to evaluate appropriate clinical or surrogate end points for review of vaccines and treatment . Thank you very much, senator, for that question. The evolving clinical picture and obviously the way this is manifesting around the country clinically does, in fact, form the end points that well work with developers of therapies so that we can get the absolutely most efficient but the most Accurate Information and appropriate end points to make the necessary authorizations and approvals. We have set up this program called the Coronavirus Treatment Acceleration Program where our top scientists and clinicians have been at the table consulting with our colleagues at nih and cdc to actually aincrease those questions. What are the appropriate end points. We do know that in some circumstances patients who had severe covid disease have developed clotting episodes so we have agents that might be beneficial and obviously the clinical end points for those trials is different than an antiviral like remdesivir which were looking at times to recovery. I want to adapt it to the clinical circumstance as well as to the type of therapy thats put before us. Thank you. Other question to dr. Hahn. We have made a lot of progress in Vaccine Development already, but its been identified manufacturing of a stringent is significant gap in pandemic preparedness. What has hhs done in advance of potential National Vaccination campaign to ensure we have sufficient capacity to administer a vaccine . Senator, thank you for that question. This is a really important point. As you mentioned its not just about the vaccine or hopefully vaccines that are developed, its all about its also about the supplies that are needed as well as an Operational Plan for administering the vaccine. So this is an all of government approach. There is a program thats been set up called operation warp speed that includes dr. Collins, dr. Fauci, his colleagues at nih, department of defense, as well as other members of hhs and fda. Dr. Peter marks from our center for biological research has been hoping to coordinate that and working closely with dr. Fauci and his team and we created a chart to look forward what are the necessary supply chain issues, syringes, et cetera, depending on the different vaccines and how many they have to be administered and route to administering. So when a vaccine is ready to go well have the supplies to administer it and optionalize the initial vaccine. I suspect im at my time. Ill submit my questions in writing. Thank you, senator enzy. Senator sanders. Thank you very much, chairman. Let me thank all of the panelists for the hard work they are doing and for being with us today. It is sad to say that we have a president of the United States, the leader of our country who from day one down played the dangers facing this country from the pandemic. Who told us that the crisis would be over in a few months, that we did not have to worry. Who fired those members of the government who wanted to act aggressively among other things at a time when we need International Cooperation cut funding for the world health organization. Let me also say that i think we understand that facts are terribly important, not everybody that we dont fully understand all of the ramification of the covid19 epidemic. Let me ask dr. Fauci, if i might trkts official statistic, dr. Fauci is that 80,000 americans have died from the pandemic. There are some epidemiologists who suggest the number may be 50 higher than that. What do you think . Im not sure, senator sanders, if its 50 higher but most of us feel that the number of deaths are likely higher than that number because given the situation particularly in new york city, when they were really strapped with a very serious challenge to their Health Care System, that there may have been people who died at home who did have covid, who were not counted as covid because they never really got to the hospital. So in direct turanswer to your question, i think you are correct. The number is highly. I dont know exactly what percent higher but almost certainly higher. Dr. Fauci, let me ask you this. In the terrible pandemic of 1918, the virus exploded in the fall. It came back with a vengeance. Are we fearful that if we dont get our act together, as bad as the situation is now, it could become worse in the fall or winter . Senator, thank you for that question. Its a frequentlied asked question. I think that a possibility does exist. However, the reason i say that is that when you talk about the virus just disappearing and as i said many times thats just not going to happen because its a highly transmissible virus. Even if we get better control over the months, it is likely that there will be virus somewhere in this, on this planet that will eventually get back to us. So my approach towards the possibility of a rebound, a second wave in the fall is that a, its entirely conceivable peen it would happen. But b, i would hope that between now and then, given the capability of doing the testing that you heard from admiral and the ability of us to stock up on special protective equipment and the workforce that the cdc under dr. Redfield will be putting forth to be able to identify, isolate and contact trace, i hope that if we do have the threat of a second wave, we will be able to deal with it very effectively to prevent it from becoming an outbreak not only worse than now but much, much less. Let me ask, we heard a lot of this question about vaccines, obviously. Everybody in congress and in this country wants a vaccine. We want it as quickly as possible, as effective as possible. Let me ask the honorable fda commissioner, sir, if god willing a vaccine is developed and were able to produce it as quickly as we all hope we can, i would imagine that that vaccine would be distributed to all people free of charge, make sure at least that everybody in america who needs that vaccine would get it regardless of their income. Is that a fair assumption . Senator, i certainly hope so. Fda is very committed to making sure that all populations in the United States, including those most vulnerable are included in the Clinical Trials and will not sir, thats not what im asking. What im asking is if and when the vaccine comes it wont do somebody any good if they dont get it and if they have to pay a sum of money for it in order to profit the Drug Companies that will not be helpful. Your guaranteeing the American People today that that vaccine will be available to all people regardless of their income . Sir, the payment of vaccines is not a responsibility of fda but im glad to take this back to the task force. I share your concern this needs to be made available over tory american. Does anybody else want to comment on that . Do you think we should make that vaccine when hopefully it is created available to all regardless of income or do you think poor people, working people should be last in line for the vaccine . Im sorry, senator were you asking me . Yes. I was. No, my office is one of the offices committed to serving the underserved and we need to be absolutely certain that if a vaccine or an effective therapeutic preventative is available it reaches all segments of society regardless of their ability to pay or any other social determinants of health that there might be. Good. So what youre telling the American People today that regardless of income every american will be able to gain access to that vaccine when it comes. They should gain access to it. I dont control, you know you represent the administration that makes that decision. I will certainly advocate that everyone is able to receive the vaccine regardless of income or any other circumstance. Let me just senator sanders im sorry. Those are important questions. I dont want to cut senators off and its hard to see the time clock if we can stay as close as possible to five minutes then all senators can get their questions in. Thank you, senator sanders. Senator burr. Thank you, mr. Chairman and thank our witnesses what youve done for the people in this country and their safety and people around the globe. Let me ask you, dr. Fauci, because youve been at the task force and at the majority of the press conferences. Has anybody in this administration asked you or any member to take the foot off the gas in finding a cure or any type of Counter Measure . No, senator. Not at all. As a matter of fact, we at nih, have been fright the very beginning put our foot right on that accelerator in every aspect including the development of vaccines and therapeutics. As i described in my Opening Statement we actually started that in january literally days after the virus was known and its sequence was published. No, i have never been told by anyone to pull back on the development of any Counter Measure or any basic Research Project that weve been involved in. Thank you, dr. Fauci. This question is directed to dr. Redfield. Dr. Redfield we have authorized in this committee and appropriated out of congress over the last few times money for virus. In past four years from fy 16 to fy 20, 23 million a year wasnt the c. A. R. E. S. Act its over a billion. Weve seen the privatesector go out and use payment available to track the progress and spread of coronavirus around the world. Why is cdc not working with privatesector Technology Companies to use their tools for bio surveillance . Senator, thank you for the question. This is a critical issue, as you know, and also comes into one of the core capabilities i talked about data and analytics and modernization which were appreciative of the additional Funding Congress has given. I can tell you that this is under critical review now. We do have contracts with some of the private sector groups now to try to make the type of availability of data weve seen with florida available in all of our jurisdictions across the country and in the process of making that happen. Doctor, in april of last year, or june of last year we reauthorized the pandemic and all hazards legislation which authorized at that time 30 new employees at cdc specifically in surveillance. Now i asked the doctor in march how many of those 30 had been filled. She said zero. As of midapril zero of those 30 have been filled. How many of those 30 employees that this committee authorized cdc to bring on to provide surveillance have been filled today . Senator, again, thank you for the question. I know our staff has been in discussion since the doctors testimony and i know were in the process of continuing to try to figure out how to move that forward, sir. I can get back to you on it as i discussed what progress has been made since we had that discussion both with the hearing with you and you brought that to light. I brought it to light the first of march and now were in midmay. So im hopeful that we wont just talk about surveillance, well actually execute it and well focus the unbelievable amounts of money that weve provide for you that they will show some benefit to the American People. Dr. Fauci, let me come back to you. This is one of the fastest developing timelines weve ever seen for vaccine, and the American People and hopefully people around the world will be the beneficiary of what you fine the eventual licensure of that product. One of the biggest unknowns with this particular virus that can affect the Development Process and dr. Hahn if you have anything to add to that after there please do. Theres a couple of things that are inherent in all Vaccine Development. First of all, theres no guarantee that the vaccine will be effective. As you well know because we discussed this many times in the past, you can have everything you think is in place and you dont indues the kind of immunity response that turns out the be durably protective. Given the way the body responds to viruses of this type, im cautiously optimistic that we will with one of the candidates get an efficacy signal. The other thing thats an unknown thats of a concern but we can get around that by doing tests properly do you get an enhancement effect. Namely theres a number of vaccine, two in particular that indueses a suboptimal response and when a person gets exposed they actually have an enhanced disease which is worrying. We want to make sure that doesnt happen. Those are the two major unknowns. Putting those two things together i feel cautiously optimistic well have a candidate that will give some degree of efficacy, hopefully a percentage enough that will induce the kind of herd immunity that will give protection to the population at home. Dr. Hahn, anything to add to that . Yes, sir. Thank you for the question. The obstacles, i think, are being met by the approaches being taken out of hhs and led by peter marks and is that a common Preclinical Development pathway so we can appropriately assess one vaccine against the other and than master protocol that allows for a common control group and assessment of very common end points. That will let us be efficient as possible for the development of vaccine. We will evaluate approximately ten candidates preclinically and in phase one and two studies and take four to five in phase three studies in this hhs effort. Those are the obstacles that can be broken down speed the development but also to allow us to ensure safety and effectiveness. Mr. Chairman the senator in South Carolina started to publicize the recovered members those individuals who had coronavirus but had recovered. Its my hope that nationally we will start reporting recovered numbers. I think thats important for the American People to hear. I yield back. Thank you, senator burr. Senator casey. Mr. Chairman, thank you for the hearing as well as Ranking Member murray. Mr. Chairman, i wanted to start today with a a question regarding Nursing Homes, in particular across a state like ours. Weve had a high number of cases in pennsylvania. At last count over 57,000 case. The number of deaths have gone above 3700. Of course a lot of those deaths are in Nursing Homes. Were told that nationally more than a third, as high as 35 of all deaths have been in Nursing Homes, either death of a resident of a nursing home or worker. I want to start today with a question for dr. Redfield. Doctor, when we consider this challenge in our longterm care facilities, when we look at the number of deaths in Nursing Homes, i think a lot of families want basic transparency and thats one of the reasons why senator wyden and i sent you a letter dated april 2nd, who was directed to you as well as the administrator of the centers on Medicare Medicaid services. In that letter we asked for basic information about what the administration was doing to track the outbreaks in Nursing Homes, to provide information, basic information to families and residents, the families of residents in Nursing Homes. Certainly to the workers and to the community and Public Health professionals. Now it took you about a month to respond to that. But in your response you didnt give us any information about the timeline. These families need this information. Now were told by the cms mr. Straight administrator, this information may not be available until the end of may. I need to hear from you today why has there been a delay, a three month delay in basic information that families and people within a community. Need about the outbreaks in Nursing Homes, the number of cases, what is happening in Nursing Homes. Tell us when were going to see that information. Well, thank you very much, senator. You highlighted one of the great tragedies that weve all experienced together. Clearly, the longterm care facilities have been particularly hardhit by this pandemic. Several things i know again, several things have been done and i can get back to you in terms of where they are in term of activation. Clearly all Nursing Homes now are required to report cases in either their individuals that are patients there or staff to the cdc. Secondly, i have put a policy in place that all Nursing Homes are required to notify members of that Nursing Homes of the existence of covid in that nursing home, include Family Members. Verify in terms of when that if thats operational today. Ill get back to you with that. One of the most important weve decided as we talk about key in reopening as tony mentioned, symptomatic cases we need to do Contact Tracing. The other thing we need to do is do surveillance because this virus does appear to have a propensity for asymptomatic infection which means our traditional ways of verifying cases will be blunted. Were developing a national Surveillance System and first and foremost importantly in that is to do comprehensive surveillance in all the Nursing Homes in the United States, cdc will be doing that in partnership with the state and local territorial Health Departments. I think they will have the responsibility to do it within the innercity clinics and indian Health Service clinics. This is critical. We get in front of this through comprehensive surveillance of everybody in these Nursing Homes. Weve also done, you know, aggressive outreach in all of them and enhancing Infection Control procedures, et cetera, cdc has been out to help these Nursing Homes with that wasnt guidance along with standards. Ill get back to you. Im pretty confident its operational but i need to double check just to make sure because i know its been announced they are all reporting to cdc now any infection in workers or patients and that they are required now to notify other members of the nursing home as well as Family Members. Mr. Chairman, i just have one question for dr. Fauci. Doctor, i wanted to ask you in your testimony earlier in response to a question by senator murray you outlined a basic concern you have with regard to states reopening. Can you restate that for us yes. Thank you. My concern is that as states or cities or regions in their attempt understandably to get back to some form of normality disregard to a greater or lesser degree the checkpoints we put in our guidelines about when its safe to proceed in pulling back on mitigation. Because i feel if that occurs, there is a real risk that youll trigger an outbreak that you may not be able to control which, in fact, will set you back not only leading to some suffering and death that could be avoid but could even set you back on the road to get economic recovery. It would almost turn the clock back rather than going forward. Is that my major concern, senator. Thank you, doctor. Senator paul. Dr. Fauci, scientists have shown monkeys that are infected with covid19 cannot be reinfected. Several studies have shown that plasma from recently infected coronavirus patients neutralizes the virus in lab experiments. In addition fusion of c convalecent. Studies show recovery of covid19 patient from the asymptomatic to the very sick are showing significant antibody response. Studies shows sars and mers also coronavirus induce immunity for at least two three years and yet the media continues to report that we have no evidence that patients who survive coronavirus have immunity. I think actually the truth is the opposite. We have none of that survivors of coronavirus dont have immunity and a great deal of evidence to suggest that they do. The question of immunity is linked to Health Policies and workers who gained immunity can be a strong part of our economic recovery. The Silver Lining to so many infections in the Meat Processing industry is that a large portion of these workers now have immunity. Those workers should be get it again instead of being alarmed by media reports that theres none of of immunity. Stated publicly you bet it all survivors of coronavirus have some form of immunity. Can you help set the record straight that the scientific record as its being accumulated that its supportive that infection prone virus likely leads to some form of immunity, dr. Fauci. Thank you for the question. Yes, youre correct, give went what we know about the recovery from viruses such as coronaviruses in general or even any Infectious Disease with very few exceptions when you have antibody present its very likely indicates the degree of protection. I think its in the semantics of how this is express when you say has it been formally proven by long term Natural History studies which is the only way you can prove one is it protected which i said and will repeat is likely that it is but also what is the degree or type of antibody that gives you that critical level of protection and what is the did yourability. You can make a reasonable assumption it would be protective, but Natural History studies over a period of months to years will then tell you divisive kn definitively if thats the case. Thats important. The vast majority of these people have immunity instead of saying theres no evidence. W. H. O. Fed into this by saying none of of immunity. In reality theres every evidence stacking up, in fact a lot of the different studies have shown that its very unlikely to get it again in the short term. With regard to going back to school, one thing that was left out of that discussion is mortality. I mean should we at least be discussing what the mortality of children is. This is for dr. Fauci as well. The mortality between 0 and 18 in new york data approaches zero. Not absolutely zero. Between 18 and 45 mortality in new york was 10 out of 100,000. So really we do need to be thinking about that. We need to observe with an open mind what went on in sweden where the kid kept going school. The mortality per capita in sweden is actually less than france, less than italy, less than explain, belgium, netherlands bthe same in switzerland. Nobody is arguing what happened in sweden is an unacceptable settle. People are intrigued by it and we should be. I dont think any of us certain when we do these models, more people wrong with models than right. Were opening a lot of economies around the u. S. And i hope that bhoerm predicting doom and gloom and saying oh, we cant do this will admit they were wrong if there isnt a surge because i think thats whats going to happen. In rural states we never really reached any sort of pandemic levels in kentucky and other states. We have less deaths in kentucky than we have in an average flu season. Not say this isnt deadly but really outside of new england weve had a relatively benign course for this virus nationwide. And i think the one size fits all to have a National Strategy and nobody will go to school is ridiculous. We really taught be doing it School District by School District and the power needs dispersed because people make wrong prediction and really the history of this when we look back will be wrong prediction after wrong prediction after wrong prediction starting with ferguson in england. I think we ought to have a little bit of humility in our belief we know whats best for the economy and as much as i respect you dr. Fauci i dont think youre the end all, i dont think youre the one person that can make the decision. We can list zwroirn advice but people on the other side there wont be a surge and we can safely open this economy. If we keep kids out of the school for another year, what will happen is the poor will not learn for a full year and i think we have to look at the swedish model and look at our kids getting back to school. I think its a huge mistake if we dont open schools in the fall. Mr. Chairman, can i respond to that . Yes. You might make it clear whether or not we shouldnt go back to school in the fall. First of all, senator paul, thank you for your comments. I never made myself to be out the end all. Im a scientist, a physician, and a Public Health official. I give advice according to the best scientific evidence. A number of people come in to that and give advice to things more related to what you spoke about. The need to get the country back open again. I dont give advice about anything other than Public Health. I wanted to respond to that. The second the thing is that you used the word we should be humble about what we dont know. I think that falls under the fact that we dont know everything about this virus and we really better be very careful particularly when it comes to children because the more and more we learn, were seeing things what this virus can do that we didnt see from the studies in china or in europe. For example, right now children presenting with covid19 who have a very strange inflammatory syndrome, very similar to kawasaki syndrome. I think we ought to be be careful if were not cavalier in thinking children are completely immune to the effects. So, again, youre right in the numbers that children in general do much, much better than adults and the elderly and particularly those with underlying conditions. But im very careful and hoefrlhoefrl hopefully humble i dont know everything about this disease and thats why im reserved in making broad predictions. Thank you. Thank you senator paul. Thank you mr. Chairman and Ranking Member and witnesses. I want to cover a lot of territory in my five minutes so i certainly would be appreciative of concise answer. I want to start with dr. Redfield. Dr. Redfield, do you think the testing protocols at the white house present as model for other essential workplaces . Im sorry, senator, you broke up in the beginning of your question. If you could just say it again, im sorry. Dr. Redfield, do you think that the testing protocols currently in place in the white house present a model for other essential workplaces . Well, thank you for the question. I think one of the important things you bring up is the essential worker guidance that cdc put out and i think it was originally modeled, obviously, on Health Care Workers where there were Significant Health care shortages and individuals detector workplaces. Im asking if you think the white house protocol testing are a model for other essential workplaces . I would just say that i think each workplace has to define their own approach as to,000 operationalize we already had some considerable comment on fact that osha has not stood up and enforceable mandatory emergency temporary standards for workers in all sorts of work settings. That aside would you say that the ppe rules and protocols in effect right now in the white house are a model for other essential workplaces . We would my own view and go back to the guidelines that cdc has put out about essential workplaces for people if they are an essential workforce that they go in public, they maintain six feet distancing and wear face coverings. Okay. Admiral, you have testified about how far youve come with regard to testing assessments. I want to ask you if you believe that we already have a National Testing strategy today that spans from the nationwide testing Needs Assessment to the nationwide testing supply assessment and a strategy to fill that gap to procure domestically what we need in terms of bridging that gap with testing platforms, swabs, specimen collection, media and agents and ppe needed to conduct those tests . So, thank you for that. We do have a strategy that spans us at least to the fall and beyond. As i mentioned, were working individually with every state and i think senator paul is correct that kentucky, wyoming or new jersey, rhode island are different and there are vastly different testing needs. The east coast will have multiples of testing versus other states and were working those individually. So i know you testified earlier that not only are you working with the states but youre work with every lab in every state. Correct. To increase capacity. What about working with those who would be those who would need testing to say reopen their school, their university, their business, each of them have identified what they think are their testing needs based on, you know, guidance not mandatory enforceable rule but are you in contact at that level . Is your dashboard have visibility at that lowest level or are you mostly in contact with the states and with the labs . So, over the last few months weve done a lot of individual work at Nursing Homes, at meatpacking plants, really down to the very granular level. Where we are right now, however swere really work with the state leadership wthe Public Health lab, the state epidemiologists, the state Health Officials because they really need to understand what their sum is going to be in their state and in the funding were asking very specifically and the cdc funding for specific plans for schools, Nursing Homes underserved, et cetera. So i have two more points that im going make, i dont have time for questions. One is about transparency of that Needs Assessment. Can the public see it . Can the state see it . Can the Health Members see it . Is it publicly available . And secondly the delivery of the supply is a critical issue and it seems to me that the logistics for getting this out, whether its ppe, testing, or medical equipment is still extremely fragmented leading to price gouging and many other inefficiencies. We need to stand up the full power of the defense production act. Would you like me to comment on that, maam i would be happy for you to comment with the indulgence of the chairman. Weve gone over time. Try to give a succinct answer to the senator. Yes, maam and yes, sir. Particularly for things like swab and media, theres still a vi would say nonmature industry within the country and thats why weve made the designate to procure that all through centrally to september and distribute that to the states. Theres too many vasculriables control. In more mature aspects of the industry, like some of the large test producers, we feel that by helping direct them to make sure that the states get what they needed to right distribution that were not procuring them directly by us but, again, were going be very evidence and datadriven as we move on. Thank you, sir. Thank you very much senator baldwin. Senator collins. Thank you, mr. Chairman. Let me begin by first thanking each of our Witnesses Today for their expertise, their dedication, and their hard work. Dr. Redfield, i want to start with you. I am hearing from dentists all over the state of maine that the fact that they cannot practice in our state despite following very strict Infection Control protocols is causing growing health problems. Dentists tell me that teeth with cavities that could have been filled are now going to need root canals. Teeth that could have been treated with root canals are now going to require extractions. People with oral cancers cannot get the treatment, the cleanings that they need before beginning their treatment. Dental health is clearly so important. And maine state officials as well as our dentists are seeking assistance in reaching the right decisions. 47 other states either have reopened dental practices or have a date set for them to reopen. So my question to you is this, if dentists are following the American Dental Association guidelines, if they are instituting strict protective measures for their patients, their staffs, their hygienists, themselves, and if they are closely examining and seeing a decline in the number of covid19 infections in their county, are these reasonable factors for states to consider in reopening the practice of dentistry . Yes, senator. Thank you for the question. You know, weve been interacting and talking with dentists and working with the state and local Public Health officials to update our guidelines on reopening a variety of medical surfaces, as you know. And i think you raise a very important point and i would, would not disagree with what you said about looking at the American Dental Associations as well as the reality of the outbreak in the area. But we are in the process of updating those guidelines and they will include direct guidelines for dental practices. Thank you very much, doctor. Doctor girard and dr. Hahn, recently theres been a significant demand for remdesivir i may be mispronouncing it which transition to receiving an emergency use authorization. Last week maines two largest Hospital Systems contacted me with questions about how this therapeutic will be allocated going forward. Hhs finally released a statement on saturday about allocations going to states, interestingly not directly to hospitals. But once again the decisionmaking behind these allocations is very unclear. Hhs and the assistant secretary for preparedness and response say that each state is to expect to receive an allocation but no timetable has been provided. Beyond those who are being treated with this drug that made Medical Center through a Clinical Trial im concerned that hospitalized patients in maine will have little or no ability to be treated with this promising therapeutic for the f foreseeable future. As this and more therapeutics and ultimately a vaccine come on to the marketplace how can these allocation and distribution issues be resolved so that patient care is not delayed and so that it doesnt depend on which state you live in, whether or not youre going to get access to these treatments and ultimately a vaccine . Senator, collins, this go ahead, go ahead commissioner. Senator collins, i think we completely agree with you that this has to be an evidencebased approach getting the medical therapeutics, vaccines, remdesivir, whichever it happens to be to the bhoerm in neepeopl need. We learned a lot of lessons from the remdesivir situation. Thats being led by hhs and what youve seen in the most recent announcement is that what the test did was provide guidance to hhs regarding where the most significant outbreak occurred and where those hospitalized patients were. This represented about a quarter of the supply of drug that we have and more will be allocated according to methodology to get the drug to where hospitalized patients are. Valuable lessons can be learned a and will be learned and we must incorporate those into our Operational Plans moving forward. Thank you, doctor. Admiral, do you have anything to add . Im over time. Sorry. Thank you. If you have anything to add, if you can so for the record. No, maam. I agree with the commissioner. Its absolutely critical that its evidencebased on the people who can benefit from it and also fair and justice throughout our country. Thank you. Thank you, senator collins. Senator murphy. Should during your period of quarantine that correct. Were essential workers as part of the essential infrastructure and we are when needed which is often, you are doubting and respect the places at the white house. I was at white house yesterday and i will likely even perhaps be there today and in my often at the nih. So it is not really strictly speaking the quarantine as we know it but performing our do t duties as critical workers and i would be happy to have others respond to that. I would agree with dr. Fauci and yes, i am drawing a salary and i have continued to work during any quarantine. And as an essential worker, will participate in meetings facetoface when that attendance is considered critical. My point here is you all should draw a salary while you are taking precautionary steps because of the contacts that you have made. My point is that quarantine is relatively easy for people like you and me. We could still work and get paid, we could telework but there are millions of other americans who work jobs that cant be performed from home or are paid by the hour. And it is just remarkable to me that this administration has not yet developed a mechanism for states to implement and pay for a quarantine system that will work for all americans, your plan to reopen america requires states develop that plan. And yet my state has no clue how to implement and pay for that system without help from the federal government. Which leads me to my second question. Dr. Fauci, dr. Redfield, youve made news today by warning us appropriately by the dangers of states opening too early. But as senator murray mentioned, this is infurry ating to many of us because it comes hours after the president declared we have prevailed over coronavirus and im going to tell you is going to make it purchase harder on state leaders to keep social distancing restrictions in place. It comes days after the president called on citizens to liberate their states from social distancing orders and i think youre all noble Public Servants but i worry that youre trying to have it both ways. You say the states shouldnt open too early. But then you dont give us the resources to succeed. You work for a president who is frankly undermining our efforts to comply with the guidance that youve given us and then the guidance that you have provided is criminally vague and i want to ask my last question on this topic. Obviously the plan to reopen america was meant to be followed by more detailed nuanced guidance. What is a downward trajectory mean and what happens if it is downward in some settings an upward in others and then you reopen and there is a spike in one location or another setting and of course you knew this because you developed this guidance, this Additional Guidance that is site specific, that frankly is helpful, some of this is on the cdc website and some of it is not. And we need it. My state needs it. We dont have the experts that you have. So we rely on you. So reporting suggests, dr. Redfield, this guidance that was developed by you and other experts was shelved by the administration. That it was withheld from states and the public because of a decision made by the white house. So my specific question is why didnt this plan get released and if it is just being reviewed, when is it going to be released . Because states are reopening right now and we need this Additional Guidance to make those decisions. Senator, i appreciate your question. Clearly we have generated a series of guidances as you know and as this outbreak response has evolved from cdc to all of government response as we work through the guidances, a number of them go for inner Agency Review and input to make sure that the guidances are more broadly applicable for different parts of our society. The guidances that youve talked about have gone through this inner Agency Review, and there are comments that have come back to cdc and i anticipate theyll go back up to the task force for final review. But were reopening in connecticut if five, ten days, this guidance isnt useful to in two weeks. So is this this week, next week, when will we get this expertise from the federal government . The other thing i will say is the cdc stands by the Technical Assistance to your state and any state upon any request that i do anticipate this broader guidance to be posted on the cdc website soon. Soon . I could tell you your state could reach out to cdc and well give guidance to directly to anyone in your state on any circumstance that your state requires guidance from. That is terribly helpful. Thank you. Senator cassidy. Thank you very much for your service and ill have a set of questions so if your questions could be brief, i appreciate your answers to be brief. Doctor hahn, if your testimony you mentioned that the testing for the populations and the vaccine trials now includes over americans, i guess my question is what about children . Does it include children . Does it also include the obese, the diabetic, the immunocompromised, those at risk of having a less nonsponsor a mitigated response to vaccination, can you comment on that, please. Yes. Thank you senator cassidy. When the phase two, phase three trials are in place, they will include our most vulnerable population including the individuals that you describe. Were working very closely if i could interrupt. Phase two would check tor safety and you dont have to do a separate phase two in the patient who was younger . If you follow what im saying, or you assume the safety ty data from the adults apply to the children. So we would want to assess safety as well in children. So the current phase two trials, do they include children . Theyre in phase one studies right now, sir. I thought dr. Fauci said we have a phase two going on. Well i think it is about to start from the majority of the vaccine. Perhaps dr. Fauci could answer that. I know, senator, cassidy, i did not say phase two. I said were in the second dose of the phase one and we will proceed when we finish with phase one to go into phase two. So i think im hearing that children will be included in phase two trials . No, that is that is under discussion between fda and nih at this time, sir. Because we do realize that it is important. Sounds good. To understand what this is in children. Dr. Redfield, to back up on what senator murphy said, the publish guidelines for School Opening youre about to modify but i notice there is nothing about testing so we speak about testing, starting testing and how we use testing but the guidelines for school has nothing about how to integrate testing. Will these be in the guidelines that are being released . Senator, thanks for the question. Clearly there is going to need to be and as already stated an integration of a testing strategy that is going to be different for Different School settings as well as different jurisdictions whether it is a School Setting and that is going to have to be integrated into each of those. There is a general overarching guidelines and then as i said i do think the testing strategy which is important is including the surveillance strategy needs to be a individualized now let me comment on that, dr. Redfield, in all due respect, i think children, whether youre rural, frontier, suburban or urban, is the one setting in which there is a remarkable commonality . And ill echo what senator murphy said, the resources that the federal government has greatly exceeds all but the most sophisticated populous wealthy state and even then it skeepds it by some extent so i do think it would be good to have in a prime School Setting this is best practices, or these are three options and choose between one of these three. To say each School District or private or Parochial School work it out seems a wasted effort and i say that because Children Play a role in protection of disease, the spread of disease, et cetera. So your thoughts on that because it really seems that is the one setting where you could have, you know, not cookiecutter but certainly a pattern which could be followed. Senator, i must have been misunderstood. When i was talking about differences, i was thinking of the difference between an elementary school, a high school and a college and in terms of how we a trade school, there may be differences on how you integrate a testing strategy but i do think having a test in strategy with different options for people to evaluate based on different principles will be important in terms of guidance. Dr. Fauci you persuasively argue that the risk of reopening prematurely is great. But i think the frustration, if i think of children in particular, the risk benefit ratio of the child being at home potentially away from enhanced nutrition without the parent able to work because the School Provides day care, without the monitoring that sometimes occurs for incidences such as child abuse but more importantly for all children the opportunity cost of a brain which is forming not having access to the information that will help that brain form optimally. Now, has there been any sort of risk benefit ratio for the child. Yes, they are at risk for kawasaki but they are at particular risk for missing out on a year of education, particularly those from less than rich backgrounds, i guess im very concerned about that tension. What are your thoughts on that . You make a very good point, senator cassidy. It is very difficult of the unintented consequences trying to do something that is broadcastly important for the Public Health and the risk of having a return or resurgence of an outbreak and the consequences of having children out of school. We fully appreciate that. I dont have an easy to that. I just dont. You just have to see on a step by step basis as we get into the period of time with the fall about reopening the schools exactly where we will be in the outbreak. I may point out something i think alluded throughout some of the questions that we have a very large country and the dynamics of the outbreak are different in different regions of the country so i would imagine that situations regarding school will be very different in one region versus another. So it is not going to be universally or homogeneous and i dont have a good explanation for solution to the problem of what happens when you close schools and it triggers a cascade of events and could have some circumstances. Mr. Chairman ill close by asking the permission of the chair to submit for the record a article that just came out of the journal of pediatric nursing, children are at risk for covid19. It will but included. Thank you, senator. Senator warren. Thank you, mr. Thank you mr. Chairman and thank you to our witnesses for being here today. I hope everybody is staying safe and healthy. In the past 16 weeks over 1. 3 million americans have been infected with coronavirus. We now know that about 80,000 people have died and 33 Million People are out of work. Dr. Fauci, you have advised six president s, you have battled deadly viruses for your entire career, so i just like to hear your honest opinion. Do we have the coronavirus contained . Senator, thank you for the question. Right now, it depends on what you mean by containment. If you think that we have it completely under control, we dont. If you look at the dynamics of the outbreak, and we are seeing a diminution of hospitalizations and infects in some places such as new york city which has plateauedond starts to come down but in other parts of the country we are seeing spikes. So when you look at the dynamics of new cases, even though some are coming down, the curve looks flat with some slight coming down. So i think were going in the right direction. But the right direction does not mean we have by any means total control of this outbreak. So my direction as i understand it, we have about 25,000 new infections a day. And over 2,000 deaths a day. I think those are the right numbers. And some are estimating we could be at 200,000 new cases a day by june. Is that right, dr. Fauci . I dont foresee that as 200,000 new cases by june. I am hoping and looking at the dynamics of things starting to flatten off and come down that we will be much, much better than that senator. Just so i could understand, we are right now at 2,000 new infections a day and 25,000 new infections a day and 2,000 deaths a day. Right. And that is where we are right now. Yeah. So let me just ask, we know that it is possible to get this virus under better control. Other countries have done it like south korea. But we are now three months into this pandemic and basically weve continued to set records for the number of people who are diagnosed an the number of people who die. Dr. Fauci, you recently said that a second wave of coronavirus in the fall was, quote, inevitable. But that if america, quote, puts in place all of the Counter Measures that you need to address this, we should do reasonably well. And the Counter Measures that you identified with are things like continued social distancing, significantly more testing, widespread Contact Tracing. You also said that if mesh doesnt do what it takes and this is your quote, we could be in for a bad fall and a bad winter. So right now were about 16 weeks away from labor day. That about the same length of time since the virus was first detected here in the u. S. Dont we have enough robust Counter Measures in place that we dont have to worry about a bad fall and winter . Right now the projection, as youve heard from admiral giroir with regard to the testing and other elements that will be needed to respond, the projection is that by the time we get to the end of the summer and early fall, that we will have that in place. That is the projection. We dont have it in place now but were projecting well have it in place. And let me ask the other side of this. If we dont do better on testing, on Contact Tracing and on social distancing, will deaths from coronavirus necessarily increase . Of course. If you do not do an adequate response, we will have the consequence of more infections and more deaths and that is the reason why you quoted me, senator, quite correctly, everything you said and i will stand by that. If we do not respond in an adequate way, when the fall comes, given that it is without a doubt that there will be infections that will be in the community, then we run the risk of having a resurgence. I would hope by that point in time in the fall that we have more than enough to respond adequately. But if we dont, there will be problems. I appreciate your hope and i wish we could tell the American People that the federal government has this pandemic under control. But we cant. In fact, you have said that the virus is not under control in the, we havent yet taken measures necessary to prevent a second wave of death, and we all know that the people who are going to be most affected are going to be seniors, essential workers, the people out on the front lines, the president needs to stop pretending that if he just ignores bad news it will go away. It wont. The time for magical thinking is over here. President trump must acknowledge that the federal response has been insufficient and that more people are dying as a result. We are running out of time to save lives and we need to act now. So thank you, dr. Fauci, for all you are doing. Appreciate it. But the urgency of the moment could not be clearer. Thank you. Thank you, senator warren. Senator roberts. Thank you very much, mr. Chairman. And thanks to all of the witnesses. You all are like the fab four, i guess it was a fab five back in the day but shining the light of truth in the darkness of individual flashlights for sure. Thank you mr. Chairman for emphasizing that we need to be bipartisan to this approach otherwise we wont get anywhere and that is in the eyes of the beholder. We have a great relationship, governor kelly, who happens to be a democrat and obviously im a republican and her Emergency Management plan is spot on. Dr. Lee norm is doing a great job this morning i talked to lee in kansas and im reading here, kansas receives new [ inaudible ]. You see this mural behind me is coming into dodge not getting out of dodge and dodge city is my home town. In regard to the hot spot of kansas because of two packing plants. We have five 26 of the cattle market. At any rate, kansas is going through a tough time and we shouldnt worry about the safety of the food supply chain, i think nationwide it is under a great deal of stress. We see that in dairy and poultry and euthanizing pigs and the livestock. And the department of agriculture has stepped up, so has the president , declaring that the packing plants are a national asset, with progress, dodge city, when we first started out had five tests. Five. That is between four and six. Five. It is not 50 million as we hoped to receive, that has been said by one of the witnesses. The reason im really harping on all of the problems were having in agriculture, on top of the fact that the relationship with china is such that even at first breakthrough with regards to trade to china seems to be on hold now. And that is another and this is going on five or six years where our prices have been below the cost of production. In result our consumers are figuring out that food doesnt come from Grocery Stores and im very worried that the harm to good value chain is very real, not to mention the financial situation that our farmers, ranchers and our growers are facing. Having said all of that, i want to ask admiral, you spoken about the importance of having diversity in the kinds of tests that are available. Of the five packing plants we have in kansas, if we could get a rapid test and we could get it as we hopefully ask for it because of the hot spots that are developing not only in kansas but also doing great harm to the food value chain, that would be absolutely wonderful. Would you speak to that, sir. Yes, thank you, senator. Both dr. Redfield and i have been very actively involved in getting strategies or the industry particularly in kansas. We are supplying very heavily the Public Health lab with Rapid Diagnostics and surging them to areas like that. The one tradeoff, however, is that the rapid point of care dying no diagnostics are very slow. So each machine could only do four per hour and that is very, very slow. So it is a mix of testing that you need at these kind of situations, on sort of the high throughput available at a lab, a quest lab right there in kansas, as well as a mix of the Rapid Testing and that is what were supplying in order to provide a comprehensive holistic solution and i believe cdc is on the ground as well in kansas supporting that. I appreciate that. If youre only doing four an hour, that is not a rapid test. Maybe it is a rapid slow test. Im not quite sure how you define that. But i, for one, think that as we reopen, and by the way governor kelly started the opening process the first of this month and there is may 18 and then we go to june and the hope is we can open up. But we do have contingency plans if that doesnt work as aptly described by dr. Fauci, i think well be all right. But this is going to be a tough go. I have to tell you that in terms of agriculture, were not in good shape. I appreciate everybody and the job that you are doing. Well stand beside you when you are taking the boos and behind you when you are taking the bows. Thank you, senator roberts. Senator kane. Thank you mr. Chairperson to the Committee Leadership for calling this important hearing. Last time dr. Fauci and hahn reported was march 3. I have a slide that i want to show what has happened in america since then. The chart, which is here, compares the experience of the United States and south korea on three days. An january 21 both experienced the first case of covid19, at that time the unemployment rates in both countries were essentially identical. On march 3rd when witnesses were here south korea had experienced 28 covid19 deaths and the u. S. Had experienced nine. Again the economies in both nations is measured but the unemployment rates, were nearly identical but now the story changes. As yesterday, more than 81,000 americans have died, and the u. S. Economy has experienced job losses not seen since the great depression. Meanwhile the economy of south korea has not changed dramatically as all and the death toll is now at 256. South korea is smaller than the United States. One sixth of our population but even if you bulk up the death toll, the per capita death toll in the u. S. Is 45 times the rate in south korea and health care is causing a near depression while south korea has protected its economy by managing correctly. I could have done this chart with other nations. The u. S. Has the seventh highest per capita death rate in the world. Our death rate is off the charts higher than india, australia, new zealand and japan and mexico and three times the death rate in german, twice as high as canadas rate and the question is why. If we want to open up our economy and schools we have to learn from the nations that have managed it well. Here are some things that dont explain the difference. Our hospitals are as good as or better as south korea and our Health Care Providers are as good as those in south korea and our Research Capacity is as good or better than south korea and we have more resources than south korea. Our gdp is 12 times south korea and our per capitia is 50 higher. So to dr. Fauci, the death rate in the United States, especially when compared with other nations, is unacceptable, isnt it . Excuse me, sorry, sir, yes of course. A death rate at that high is something that in my matter of forth in my mind is unacceptable. And dr. Fauci, the experience of other nations shows that the u. S. Death rate is not only unacceptable, but it is unnecessary, isnt that correct . I dont i dont know if we would say that, senator. But would you say that the u. S. Has to do better . Of course. You always have to do better. I mean as a and the experience of south korea shows that how a nation manages the health care crisis, has a huge impact and also on the economic conditions, isnt that the case . That is the case, sir. I understand where youre going with this but i have to tell you there is a big difference between south korea and the United States. And in terms of the outbreak. And let me get to that. I want to get to factors that do explain the difference since we know it is not resources or health providers. First is testing. South korea began aggressive testing much earlier than the u. S. Now in the fifth month of the pandemic weve surpassed south korea in the testing but in the critical month of march south korea was testing population at a rate of 40 times the testing in the u. S. Admiral giroir has set out the standard for us. When we get to september, the United States needs to do 40 to 50 million tests a month to be safe. That equates to about 1. 3 million to 1. 7 million tests aday. Yesterday we did 395,000 tests. Weve got a long way to go. A second factor is Contract Trace Contact Tracing. South korea embraced a rigorous Contact Tracing right from the beginning. The United States still has not engaged in any national Contact Tracing, isnt that right . Would that be dr. Fauci or dr. Redfield . So i think that question would best be directed to the cdc and not the nih. When the outbreak started, sir, we have an aggressive Contact Tracing program but unfortunately as the cases rose it went beyond the capacity and we went to mitigation. So we lost the containment edge clearly and that was key to the economy as well because south korea did testing, Contact Tracing, protect, serve, isolate the sick and they didnt have to do the shutdowns that helped the economy. And social distancing is the next and finally Health Care Systems. Would you agree it helps keep people safers from serious conditions if they have access to health care. Yes, of course. Of course thats the case. In south korea, 97 of the state have Health Care Insurance and massive job losses in the last month threaten to take Health Insurance away from millions more and President Trump is doing all he can to dismantle the Affordable Care act which would take Health Insurance away from tens of millions more. Lets learn the lessons from those who are doing this right. Thank you, mr. Chair, i yield back. Could i make a clarification, please, mr. Chairman. This is brett giroir. I want to clarify thatdy project well have the ability to perform the 40 to 50 million tests per months in that time frame and ip said if needed at that time. Im not making a proclamation. We have to really understand what where the epidemic is, what the Community Spread is before we could estimate the number of tests that are needed. I was simply stating the fact that our combination of testing capabilities will be at that level even barring new input from the nih. Thank you very much. Senator cain. Thank you and gentlemen thank you for being here this morning virtually but also for all you have been doing for these many, many months. Is doing okay right now from a numbers perspective and quite honestly we want to keep it that way because we know we have exceptionally vulnerable populations, we know we have a geography that is challenging and we have facilities that are very limited, last hearing we had an opportunity to hear from dr. Collins and he shared where they are with the red x and also spoke to red x up, which was very interesting about what we could be doing in rural areas by using on hot spots. And as i reminded him, we dont want to be a hot spot in alaska so every effort that we make to keep the virus out of alaska is our lives that are saved. I educated him on the community of cordova that is just getting ready to open its salmon fishery in two days. And was able to share that they had had one worker tested positive as he was coming in from the lower 48 to come to work. The good news on that is that all of the protocols that we have put in place seem to be working. The quarantine, the isolation, not only for that individual but for others that he had come in contact with were secure. So i want to recognize the assistance that we have received from the administration. Dr. Isman is in the state at this moment. The chief medical officer for the department of Homeland Security going out to Rural Communities to really better understand our vulnerabilities, go to some of our fishing communities to, again, understand how we could successfully prosecute a fishery when you have to bring workers in from the outside. We thank you for the assistance with regards to additional Testing Capacity. Ive been in contact with our chief medical officer of the state this morning and mayor of cordova to better understand, again, do we have the tests that we need, what do we need on the ground. And one of the things that i would like to have clarified and this is probably to you, dr. Giroir, because youve been helpful on shining the light on what we need to do in the rural areas but so much of the focus has been on hot spots and responding to the hot spots but how do you keep those rural, remote, small communities from becoming the hot spots in the first place. Are we doing enough . And right now the strategy has been we just lock it off. The travel restrictions that are in place are apparently working. But theyre also theyre also devastating our economy, whether it is tourism, whether it is our resource industries, or whether it is the potential for our fisheries. So admiral, if you might speak to that aspect of it and then i have a very important question as it relates to Contact Tracing that i would like to direct to either admiral giroir or dr. Redfield. So thank you, senator. And as you know, you have an outstanding state Health Officer in dr. Anzic and ive had the privilege of working with her and you have a have good protocol in trying to keep alaska safe by isolation over a period of time when you come in. As you know, we also work with the state to meet your very challenging testing requirements because you cant really send labs out a thousand miles away. So we put a real customized mix of point of care and the machines, i think we sent nine or ten to alaska and 50,000 tests which is for times than youve done to date collectively in order to provide that support. So, again, i do think there is a comprehensive strategy that you do have. But, again, the mitigation is to the degree that you can given the circumstances, the face masks, the hand washing, the hygiene, we understand fully the challenges in the fishing environment and the remote but all of these have to come together, the testing, the tracing, the mitigation, the hygiene factors to try to keep your community safe. And we really understand culturally that many of your communities were almost annihilated in the 1918 influenza pandemic. So in that memory is still very sharp and very hurtful to many citizens so we bant to do our best to assure them were giving all of the protection we can. So let mess turn to dr. Red field because this is relating to Contact Tracing and i think this is a key part of how we move forward into getting people back to work, getting people back to school. Right now we have about 100 people that are involved in Contact Tracing in alaska. That is clearly not sufficient. There has been talk about a National Strategy but i think we recognize that we have teams in place whether it is america or peace corp, our Public Health corp, what more do we need to be doing to make sure that once youve been tested positive, you know then what happens after that. Who else needs to be brought in to into this and im not convinced that were focusing enough on that aspect of how we move to reopening if we havent done Contact Tracing. Thank you very much, senator. I want to just reemphasize what you said. I think Contact Tracing capabilities is critical. Its going to be the difference from succeeding in containing this outbreak, from wide Scale Community transmission or not. Were positioned as you know to deploy and redeploy the number of cdc, over 500 cdc individuals. We have another about 650 that were trying to put in through our foundation but most importantly were trying to work with the Health Department. The resources that weve been able to give because of the Congress Also as you mentioned with these other agencies with lab corp, i mean with amiri corp with the Census Bureau to Work Together and have the state develop theyre capacity. Some states have reapp lick ated work or the National Guard while they begin to do this and i agree with you and i said it will be a significant effort to build the Contact Tracing capacity that we need in this nation. It will be state by state. But it is going to need to be augmented probably in your state from what you just said from tief to ten fold and were there to work with the states to help them accomplish that. That needs to get into place before september. We need to move on to the next question. Thank you, senator. I dont want to put any senator off but we have eight more senators who have five minute rounds and it is 12 30 so i would like to request that the senato senators and the witnesses succinct questions and try to stay within 5 minutes. Appreciate it. Senator hassan. Well, thank you, mr. Chairman and thank you and the Ranking Member for having this hearing and thank you to our Witnesses Today and pass our thanks along to the hard working women and men in your agencies who i know have been working virtually around the clock to try to improve our response and keep americans safe. And mr. Chair, i hope you and all of the witnesses are healthy and safe today as is everybody on your team. I want to just start by echoing the comments by colleagues have made about needing leadership from the cdc and our Public Health experts on how we are going to use facts and evidence as guidance so that our schools and our day cares and our businesses have the information they need to create safe and sustainable plans to reopen. And of course that needs that our Testing Capacity not only has to be enough, but it has to be flexible enough to meet our needs. The key distinction between south korea and the United States is not how many tests per capita over a certain amount of time weve done, but the fact that at the onset of this pandemic south korea was much more able to do a lot more tests per capita than we were and then follow that with all of the other measures youve talked about. So that we continue to need to identify the need and then build our capacity towards the need, not the other way around. I wanted to start with a question to you, dr. Fauci, first of all thank you for your work and your expertise. I wanted to talk about Nursing Homes for a minute. In new hampshire, and across the country, a huge number of the deaths from covid19 that we are seeing have been in Nursing Homes. We all know people who have lost a friend or a Family Member in Nursing Homes and the grief compounded by the fact that people couldnt be at a loved ones bedside if they died. Yesterday dr. Birx said all nursing home residents should be tested in the next few weeks as well as nursing home staff. Dr. Fauci, as a shortterm goal that makes sense to me, but after that what will the ongoing federal recommendations look like. How frequently do we need to test patients and staff on a continuing basis and what other measures will be necessary to keep our loved ones in these facilities safe . Thank you for the question, senator hassan. The general plan as you mentioned that was recommended by dr. Birx is a sound plan as you said in the immediate. The question is in the long range well have to have Infection Control capabilities in Nursing Homes that are really pristine and really unassailable. We have to do the kind of surveillance and have to have the capability of when you identify someone you get out of that particular environment so they dont spread the infection throughout. So general testing for all, i think, is a good start. But when you look at where youre going to go into the future, there has to be a considerable degree of surveillance capability. Thank you, doctor. The white house is now requiring all staff to wear masks and anyone in regular contact with the president to be tested daily. Do you think Nursing Homes should implement those same measures to help make sure that our seniors could get the same level of protection . I think there should be a a system in place for the optimal protection of people in Nursing Homes and that would be not necessarily testing every person every day. That is one approach that might not be practical when you think of all of the Nursing Homes in the country. But strict regulations and guidelines about who is allowed to go into the Nursing Homes and the staff, i believe, needs to be monitored very carefully, with intermittent testing to make sure we dont have introduction into the Nursing Homes of infected individuals. Im not sure you could test every day. That, i dont think, would be feasible. But something that is much more aggressive than has been done in the past i believe should be done. Well, thank you. I have one last question for dr. Fauci and dr. Redfield and i would say that if we are able to get masks to everybody in the white house, i hope we could get masks to every Nursing Homes employee that needs it. The u. S. Needs to prepare now to make sure we have capacity to manufacture and administer vaccines and something you have both touched on and for the covid19 vaccine and other illnesses such as the flu. The failure to ramp up testing and early protective equipment early on made things worse here, and those mistakes cant be repeated when it comes to vaccine production and distribution. We are already seeing reports that some children are not receiving routine immunizations as it becomes more difficult to access inperson care. Dr. Fauci, what step do we take now to make sure we have sufficient manufacturing for a covid19 vaccine without putting at risk our capacity, manufacture and distribute other important products such as the flu or measles vaccine and my follow up question to dr. Redfield is what efforts are underway at cdc to make sure all vaccines are accessible during the covid19 emergency. Ill answer that as quickly as possible. I alluded in my introductory remarks when i was talking about vaccines for covid19. And what we said, that as we do the testing on those vaccines, were going to make production at which means well start putting hundreds of millions of dollars of federal government money into the development and production of vaccine doses before we even know it works. So that when we do, and i hope we will and i have cautious optimism that we will, ultimately get an effective and safe vaccine, that we will have doses available to everyone who needs it in the United States and even contribute to what is the needs globally because were partnering with a number of other countries. The other part of your question about making sure that when we get into a situation like the socalled shutdown that we might be in now, that we make sure that children get the vaccinations that they need. Because that would be an unintended consequence of shutting down as we are now. It is a good point. We want to make sure we dont fall behind on that also. Thank you. Thank you. And ill take my answer from dr. Redfield offline. Thank you very much. Thank you senator. Senator scott. Thank you to the panel and thank you all for being here virtually and we find ourselves in the situation that we wish we were not. Im very thankful for folks like dr. Birx and dr. Fauci and many others for your dedication 24 7 without any question and we have safer because of your hard work. I want to direct my questions toward dr. Fauci yesterday. We have plans to by the end of the month, we will have tested 100 , 100 of nursing home residents and the staff it takes to take care of them. And after increasing our Contact Tracing workforce 20 fold in a matter of weeks, our state Health Department announced were going to increase by an additional 1400 contact tracers. We have built and we continue to build the tools necessary to better detect and isolate cases to map their exposure and through substantial spikes moving forward, most importantly, our Health Care System thanks in part to flexibility from this administration has the beds and equipment necessary to address the most serious cases when they arise. With these tools in hand we have begun to reopen. To be clear we continue to seal up testing and to make measures to protect the most vulnerable and the data points are increasingly clear. For Older Americans and those with chronic conditions like diabetes and high blood pressure, this virus remains a threat. A dangerous threat. A recent report suggests that in new york roughly 90 of the fatalities had underlying issues, twothirds of fatalities were 70 years or older, 95 over the age of 50. And in South Carolina, the median age of patients who died from the virus, 76 1 2. Nearly twothirds of fatalities have been patients older than 71 and in nearly 90 were over the age of 60 and roughly 98 in South Carolina are over the age of 50. Contrast that with those aged 20 and younger where weve seen no deaths, fewer than 1 of deaths in my state have been under the age of 40. Every single death is a tragedy. Every single one. And we mourn with our Family Members who have lost their loved ones. Were taking every measure to protect our older south carolinians as well as those with underlying conditions. But when we set out to flatten the curve by taking aggressive unprecedented measures, like staying at home orders and mass Small Business closures we didnt set out of the goal of preventing 100 of the fatalities. That would be unrealistic. It is impossible. And we didnt set out to keep quarantine in place until we found a safe and effective vaccine that would take too long. Dr. Redfield your agency put out a graphic that showed two curves, one spike heavily and without protective measures and the other flatten the curve showcases with those measures in place and the whole point which the graphic illustrated was to make sure that we did not exceed hospital capacity. So while i respect the need for caution, we are too often presented with a false dichotomy, either saving our economy or saving lives. Weve seen the goalpost around flattening the curve move and that is unfortunate because at the same time business have collapsed, mental and physical health have declined. Deaths of despair escalate, education and outcomes nosedive as we wait in our living room praying for good news around therapies and around vaccines. We set out to flatten the curve and i think weve done a pretty good job of that. We need to do better. We will do better. My question, dr. Fauci, is as we start the process of moving towards reopening South Carolina, what else would you suggest that we could do to protect our most vulnerable populations . Thank you, senator scott. You gave a really very eloquent description of what i think is wou would be a model way to approach this. You have put things in place i think would optimize your capability of reopening and i was as i was thinking as you were speak, i would almost want to clone that and make sure other people hear about that and see what youve been doing. The issue of your direct question to me about the vulnerable populations is that as we have said in our guidelines, and it looks like you are ready to progress carefully because you put into place a very good system, that the vulnerables, the elderly and those with underlying conditions, should be those who at the very last lifting of mitigations should be those who are left in a situation where they might be in danger of getting infected. In other words, protect them right up until the very end of the relaxation of your mitigation. Because as you said very correctly, those are the individuals that are the most vulnerable for the morbidity and the mortality. So those are individuals, particularly i might say, sir, in the minority group, the africanamerican and hispanics who for a variety of situations that are the social determinance of health have a greater likelihood of not only getting infected but also having the underlying conditions that would make their risk for high degree of morbidity and mortality higher. So it looks like youre doing things very well and i would encourage you to continue and to follow the guidelines as you get closer to normalizing your state. Thank you. Thank you, dr. Fauci. And ill close with this since im out of time. Thank you for the many conversations that you have and i have had about those vulnerable populations to include minorities an our senior citizens. I will say without any question when you look at Nursing Homes, typically africanamericans and hispanics are the certified nursing assistants providing care for the Elderly Population so your focus on those two very vulner groups is much appreciated. Thank you for your expertise. Thank you, senator, scott. Senator smith. Thank you so much, chair alexander and Ranking Member murray and thanks to all of you for being here today and for your service. Dr. Fauci, i have to say, you are in the unenviable position that many minnesotans trust to give us the straight scoop and tell us what is really happening. Youre about the facts and not about the politics and that is a good thing. So i have to start by asking a question that i think a lot of americans want to know which is how are you doing . How are you holding up . It has been an unbelievable effort. . Im doing fine, senator, thank you very much for asking. This is such an important problem. It transcends all of us individually and has to be working as a team and i enjoy very much working with nur senators and the governors because it is at the local level that well make this thing work. So im fine. I appreciate your concern. Well, a lot of people are thinking about you and are grateful for your service as we are for all of you. So were gathered together to think about what we need to do to reopen our economy. And i think first about what is happening in my home state of minnesota where agriculture is such an important part of how our state works. It is a part of our history and our future. Pork processors right now are looking at the reality of euthanizing thousands of hogs a day. Because there is no place to process them because of what is happening in the Processing Plants. And the working people who do the hard work in those Processing Plants are getting sick. So here is one story, this is one worker, the startribune wrote about this names joemar dejesus and is a mom that works for a contractor that do the cleaning in the Processing Plant and she works for 14 an hour, seven hours a day and five days a week and she sanitized the machines that process the meat into ground meat and she started feeling sick on april 11th but kept going to work and on april 21st when one of her coworkers fainted as she told her supervisor that she felt sick and so she was told to go home. But if she didnt show any signs of illness she should come back. She went to the doctor and paid 115 to get a test and found out a few days later that she was covid positive and shes still at home, not getting paid and they doesnt have Health Insurance. And nearly two weeks ago President Trump deployed the defense production act to keep these Processing Plants open. But the usda gave limited guidance about what would be safe for those workers. It said, for example, in response to testing, which is such a big part of what weve been talking about today, they said, this is a quote, the facilities should consider the appropriate role of testing in workplace Contact Tracing of covid19 positive workers in a work site and assessment. So, dr. Fauci, as we think about how we move forward, we all want to open up the economy, what guidance would you give us in the situation like this here in minnesota . Well, i can give you my common sense guidance, although this is not the area of my expertise. It is more in others but it would seem if you want to keep things like packing plants open, that you really have to provide the optimum degree of protection of the workers involved, the ability to allow them to go to work safely, and if and when individuals get infected to immediately be able to get them out and give them the proper care. So i would think when you are calling upon people to perform essential services you have the moral responsibility to make sure theyre well taken care of and well protected and again, that is not an official proclamation, that is just me speaking as a physician and as a human being. Well, thank you, dr. Fauci. And i think that you speak as a human being but also speak as the chief epidemiologist of our country and the person that we all trust and this is the point that i want to make and drive home with everybody, which is this is the kind of guidance that we should be getting and following and these are the tools that we have got to have in our country if were going to reopen our economy as we all want to do. And this we move forward with reopening our economy and yet we still have circumstances like we had in these Processing Plants in another places around the state we are going to be right back where we started and except even in the worse place as i think you pointed out, dr. Fauci. Thank you, senator. And again, it really does relate to one of the questions that one of your colleagues senators asked me before. That one of the things that i keep emphasizing and ill just repeat it again because it is important, that when you are in the process of opening up and pulling back on mitigation, you really must have in place the capability of responding when you do have the inevitable upticks in cases. That will absolutely occur. It is how we deal with it and how successful we are in putting the clamps on it that will prevent us from getting the kind of rebound that not only from the standpoint of illness and death would be something that is unacceptable, but it will set us back in our progress towards reopening the country. Thank you very much, senator smith. Senator ron. This hearing and the participants in it. Admiral giroir, im going to take off where senator hassan spoke. I understand that politicians are going to frame data in a way most positive politically because they expect that from admirals but yesterday you celebrated we had done more tests per capita than south korea but ignored fact that they accomplished theirs at the beginning of the outbreak and we treaded water in february and march and as a result by march 6th the u. S. Had completed just 2,000 tests whereas south korea had conducted more than 140,000 tests so partially as a result of that they have 256 deaths and we have almost 80,000 deaths. I find our testing record nothing to celebrate whatsoever. The fact is their test numbers are going down, down, down, down now because they dont have the kind of outbreak we have. Ours are going up, up, up and that is important as we think about the future. On a separate topic, my impression is that with regards to a where im critical of what we have done on testing, on vaccine we have done a darn good job moving ahead aggressively. The president said the other day president obama is responsible for our lack of a vaccine. Dr. Fauci, is president obama or by extension, President Trump, did they do something that made the likelihood of creating a vaccine less likely . Are either President Trump or president obama for the fact we dont have a vaccine now or in delaying it in some way . No, senator, not at all. Certainly, president obama nor President Trump are responsible for our not having a vaccine. We moved, as you said i described it in my Opening Statement rather rapidly where no one has gone from knowing what the virus was to a phase one trial as fast as we have done. So i dont think thats something that one should say anybody is responsible for doing anything wrong on that. I think thats right. Thats the correct way to do it. Thank you. That was my impression. I was surprised by the comment, but that was my impression. Dr. Redfield, we wrote a letter to you expressing our dismay at the lack of Real Time Data at the cdc. Im talking about granular, demographic, hospitalization, treatment data. How is it possible in this day and age that the cdc has never established such a real time system with accurate data . What can congress do to rectify that so we never have to look at Something Like this again . Sorry. Senator, thanks for the question. I think youve hit one of the [ no audio ] Data Analytics and predictive data analysis. Congress has providing funding for data modernization. Where he in the process of implementing the reality is, theres an or okayarchaic syste. This nation needs a modern data analytic system that can do predictive analysis. I think its one of the many shortcomings have been identified as we went through this outbreak. I couldnt agree with you more. Its time to get that corrected. Thank you. Help guide us as to what we need to do to make sure that happens. I presume its not build it ourselves but work with companies that have that capacity and use that capacity in our favor. Dr. Fauci, one last thing, which relates to a virus. I know im asking you the impossible question. Were all hoping for a vaccine, obviously. Its the objective of our administration to get it as soon as they can and from what i can tell, theyre pulling out all the stops to do exactly that. Given our history with vaccine creation for other coronaviruses, how likely is it . Is it extremely likely were going to get a vaccine within a year or two . Is it just more likely than not . Is it a long shot . Its not a long shot. It is more likely than not that we will. Because this is a virus that induces an immune response. People recover. The overwhelming majority of people recover from this virus. Although, there is morbidity and mortality in certain populations. The fact the body is capable of spontaneously clearing the virus tells me that at least from a conceptual standpoint, we can stimulate the body with a vaccine that would induce a similar response. So although theres no guarantee, i think it clearly is much more likely than not that somewhere within that time frame we will get a vaccine for this virus. Thank you. Mr. Chairman, i yield. Thank you, senator romney. I want to thank the witnesses for their patience. We have four more senators. Senator jones. Thank you very much, mr. Chairman. Thanks to our witnesses for your being here virtually and also for your Incredible Service during this time. I want to follow up real quick with an additional statistic that senator romney talked about with regard to south korea. That is the fact that we are a nation that has about six times the population of south korea but yet we have about 310 times the number of deaths from this pandemic. I think we have to be very careful in making comparisons around the world comparing the United States to other countries. Dr. Redfield, i want to follow up just a little bit with what senator murkowski and i think senator cane talked about Contact Tracing and where we are going. I understand that you are working with states to try to develop plans for reopening. The testing is important. The Contact Tracing is important. But using that data as well is also going to be important in terms of the quarantine plans that senator murphy talked about, childcare facilities to have allowed people to put their kids in a facility while they are still go back to work. All of those issues, including maybe even facilities like Vacant Hotels or motels that may be used for selfisolation, how is this plan being developed within the cdc . Are those plans individualized by state . Will we as a member of congress be have access to the plans . How are states to going to pay . My state is already using the money that we have given them as a wish list. They are talking about building 200 million state house as opposed to developing the tests and doing the Contact Tracing. I would like to drill down a little bit on how these plans are going to develop, what access we will have to have those plans and be able to see them. Thank you very much, senator. This is obviously, as i said before, this is a critical component of us taking this time that we have now to get prepared for next fall and winter. Building that comprehensive Contact Tracing capacity. Were working individually with the leadership of the state Health Departments, local Health Departments, territorial and tribal, to let them what they think their capacity needs are. Those discussions have happened. Theres been a variety of on testing and Contact Tracing. Cdc is in position that we have reprogrammed our individuals that we have across the country help each of the states. We have augmented that with personnel that we are bringing on board state by state. The money that congress appropriated into the states so they can begin to start thinking about, how do they want to capability. Then, of course, it was mentioned that were Government Programs each group is going to Contact Tracing piece to what they think their needs are. I think it is going to be similar to what we hear from the senator from South Carolina. These are significant increases. They will increase again. The point you brought up we already americans from around the country quarantine as you know military bases. Many of the state and local Health Departments where do they put somebody isolation who is homeless . How do you develop those systems . This has to be part of it. There are certain intrinsic hotels. The point you made by one of the other senators is so important. About individuals that meat packing individual that has to go home and selfisolate. Go home and about 12 other people. Mechanisms brought in way to identify cases do the appropriate Public Health measure. These have to be comprehensive. I see no reason why these are not transparent documents as they get a tribute to what the congressional support so far. 1. 6 billion into the resources we have gotten. Its fundamental. People underestimate how important it is that we have a highly functional, comprehensive, aggressive Contact Tracing program so the we dont have thank you, dr. Redfield. I appreciate it. It sounds to me like we have a lot of work to do. So thank you. Thank you very much, senator jones. Senator braun. Thank you, chairman. Theres been so much discussion about testing in general. I listened to senator romney earlier, i think senator cane mentioned it. Everybody has. Do you remember when we first met, i said is the fda going to be more entrepreneurial . Talking then about how we fix the Health Care System in general. Now this has brought it into clear focus. I have a time line that im going to submit for the record that shows from january 24 through march 5. I want to emphasize what senator burr asked earlier, has the administration ever put an impediment in front of trying to get to testing . This will end up in a question in a moment. There was a span of time from january 24 through march 5 that i hope the American Public looks at. It gets back to whats wrong with our Health Care System in general. Early testing, from what im seeing, was created by the fact that the cdc said it was going to do its own test, the south korea test that gets cited so often was not going to belooked at. We were going to do our own. The long and short of this is that for nearly a month, this was in that bureaucratic swirl. The fda prevented private and Academic Development of tests for weeks. The cdc denied access to functioning tests, as i cited, in south korea. This created, through all the red tape and bureaucracy, to where we had to come up with a one size fits all approach due to the uncertainty of the virus. We are stuck with that now. I dont want to dwell on that, necessarily, because i think those were mistakes that we made. Im tired of having it heard that its the administrations fault. I would like to ask this question. In that spirit of what we talked about during your nomination process, here going forward, we will shed some of that stodg stodginess . I fear if we treat through bureaucracy how we did the early period of test, we can belabor this into the future and at that point theres going to be not only the carnage from the disease itself but from the economy to deal with. I would like your comment on that one month stretch, what accountability the fda and the cdc have. And then whether it looks better in terms of moving more quickly into the future. Thank you, senator braun, for the question. Our time line of that period demonstrates that we began working with Test Developers beyond cdc on january 24 and had double digit number of Test Developers working with us. One of the issues that we identified was, in fact, availability of the virus and other supplies to get that Test Development done in a timely fashion. I completely agree this is an opportunity for us to take a look and determine how we can do things better. I think thats a really important thing for all of us to do and certainly the fda can promise you will do that. Looking forward, sir, i can commit to you that we will look at every one of our regulatory authorities. We have done so during this outbreak. We have provided significant flexibility and have tried to provide the right balance between regulatory flexibility and enabling of the great Test Developers and Therapeutic Developers in this country with the need to ensure that our Gold Standard of safety and efficacy is in place. We have leaned in with manufacturers. We have learned a lot from them as well as the other stakeholders. We will continue to look. We will, i commit to you, sir, implement the changes that are necessary to make sure we can act in a more nimble way but still protect the safety and efficacy of medical products. Thank you. Dr. Fauci, taking a page from your antiaids playbook that implemented a formal, clearly defined treatment review pathway, can we do that for covid19 in a similar parallel track that you put into place back then in the 90s . In fact, ive got a bill called the promising pathways act that is based upon that protocol you put into place. Can we do that to more quickly get through to therapeutics and vaccines here with covid19 . Well, its a different story with some similarities. If you are referring to the parallel track i put into place back in the late 80s, which was when there was no availability of drugs at all for hiv and when we were testing drugs within a protocol that we would make it available outside of the protocol in what has ultimately turned out to be compassionate use. So what he we did is we didnt want to interfere with the integrity of the protocol to determine in a controlled way what was safe and what was effective. But there was a dire need for some sort of accessibility to those drugs outside of the Clinical Trial for those who might even have some chance of having it. In fact, that was really in many respects the birth of the really firm concept of compassionate use. Theres a version of that which i will hand over to commissioner hahn that is when you have expanded access in emergency use authorization with drugs that have not yet been fully proven in a Clinical Trial. Theres an analogy and similarity in the 1980s and whats being done now. Steve, if you want to comment on that. I think thats right, dr. Fauci. The emergency use authorization process by statute allows us to have flexibility and assess the risk benefit ratio in a Public Health emergency. We have done that on three occasions and continue to look at those requests as they come in. Thank you very much. Thank you, senator braun. Senator rosen. Here i am. Thank you, mr. Chairman, for bringing this hearing. I want to thank the dedicated Doctors Today for their lifetime of work and study and passion. We are a grateful nation for all of your life long commitment in fighting disease, not just the United States, but around the world. As i talk to nevadans about safely reopening the economy, one question that frequently comes up is, when are we going to have a vaccine, like everyone talked about. In nevada, travel and tourism are the life blood for us. The Jobs Associated with those industries can only fully come back if we know its safe to travel and visit our work and our hotels, casinos, restaurants and attractions. Ultimately, to make this happen, we have to build confidence in our visitors that its safe. We need a vaccine. That research is important. However, understanding that this takes time to develop and ensure safety and efficacy, i would like to hear more about what research is happening regarding preventative Medication Research that could be helpful in the time frame before a vaccine. Especially before one is widely available. I would like to ask if this could be part of the path helping us begin to reopen our economy safely and bring visitors not only back to nevada but across our country. Dr. Fauci, what research is happening to identify potential antibody preventative treatments or other therapeutics . If the right antibody can be identified, could this be used as a preventative medication to block covid19 from latching on to the cells like the treatments for rheumatoid arthritis, asthma or other diseases . Would preventative Medication Options like this help complement the effectiveness of a vaccine once its available . Thank you for that question, senator rosen. Thats an excellent question. In all of the therapeutic interventions that we are developing you mentioned several of them. They could be direct, anti vivi, but thats just one of a number of possibilities since there are several viral targets in the replication cycle. Using convalescent plasma in a preventative modality as well as antibodies in a preventative modality are, in fact, all feasible and will be pursued in parallel with the development of a vaccine. The model of using drugs and other interventions effective for treatment is really a Great Success story in the issue with hiv aids. Many of the interventions that were developed for the full treatment of an infected person are effective in preventing infection of hiv. So thats the kind of model that we work out in parallel with treatment for disease. Using as treatment as prevention. I believe that will be a part of our effort at the same time as were putting a full court press on trying to get a vaccine. So its an excellent question. Very relevant. I know i have a short time left. I will abbreviate this. The second most important question that i get not just from First Responders and people worried about work, but generally what does the next generation of ppe need to look like for all of us as we go about our lives . Not just as workers, depending on your work, you may need something stronger, more specific, but as all of us as we want to shop or out to eat or whatever those things are, get on an airplane. Should masks be made of a certain material . Gloves, hankerchief han are han effective . The best ppe for the general public if possible right now is to maintain the physical and social distancing. As we have said i think all of us would agree there are certain circumstances in which it is beyond your control when you need to do necessary things like go to the drugstore and get medication, go to the Grocery Store and get your food. You need some supplement to physical distancing. Some time ago, the recommendation was made i believe it was dr. Redfield at the cdc who said about getting some sort of a covering we dont want to call it a mask. Back then, we were concerned we would take masks away from the Health Care Providers. Some sort of masklike facial covering i think for the time being should be a very regular part of how we prevent the spread of infection. In fact, the more as you go outside right here where im sitting in washington, d. C. , you can see many people out there with masks on. Which gives me some degree of comfort that people are taking this very seriously. Thank you. Senator loeffler. Thank you all for being here and for your service. Before i start my questions, i want to recognize the u. S. Representative to the world health organization. Mitigating a resurgence of this will take global cooperation. In order to do that, we need accountability and transparency at the w. H. O. This organization was established to ensure the timely flow of accurate, unbiased information on Global Health emergencies just as this. Reforms must be made to restore the trust that we need here. I hope you will work with our allies to push for these reforms. This question i have two questions. The first is for dr. Redfield. Dr. Redfield, georgians are wondering how we got here today, 1,400 deaths, a third of georgias work force out of work. Im concerned about the coverup and misinformation coming from china and their efforts to suppress life saving information at the outset of this outbreak. As we continue to reopen our economy safely, we have to take steps to ensure that another outbreak cannot take hold of the world in this way. I understand cdc has worked with the chinese cdc on Global Health security for decades. You can comment can you xhents comment on the s this virus emerges . Thank you very much, senator. I want to beiecho how important Global Health security is as a National Security priority for this nation. Were going to need to be able to be able to respond to that as long as we are a nation. Cdc has had relationships with many countries around the world. We have offices in over 45 countries right now. One of those happens to be china where we have a cdc with the chinese cdc. We have worked together for decades, particularly on influenza and emerging Infectious Diseases. Thats been a very productive collaborative scientific interaction. When this original outbreak of pneumonia of unknown etiology came from the original seafood market, there were discussions with u. S. Personnel i had discusses i think cdc as myself, january 3 we discussed this. We had very good interaction. Thats different than the broader Chinese Government level. Thank you, dr. Redfield. I have a final question for each of our great Witnesses Today. Its one that my constituents often ask me. The mainstream media, some of my colleagues in the senate, seem to want to paint each of your relationships with our president during this wartime effort as confrontational and lacking consensus. Can you say here to the American People today whether this is true or untrue . I have seen a very coordinated effort to address this with the administration to combat this pandemic. Can you give me a sense of whether this what the characterization is whether its true or untrue . Thank you. I would ask dr. Fauci to answer that first. There is certainly not a confrontational relationship between me and the president. As i mentioned many times, i give advice and opinion based on evidencebased scientific information. He hears that. He respects it. He gets opinions from a variety of other people. In no way in my experience over the last several months has there been any confrontational relationship between us. Thank you. Dr. Redfield, dr. Hahn . Again, i would echo what dr. Fauci said. Were there to give our best Public Health advice. Thats what we do. Its ground fed in data and science. Ive always felt free to give the best Public Health advice that i think needs to be given at the time. Its been done in a very professional way. Senator leaoeffler, this is steve hahn. I have not had a confrontational relationship with the president. He asks questions. I have given him my honest answers rooted in data and science. He has listened respectfully to those. Incorporating that into his decision making. I have nothing else but to echo my colleagues. We work very closely together, all the scientists, all the physicians, of course, ambassador birx. We have a productive working relationship with each other and with the president and vicepresident. It would not be confrontational. I feel that we have the ability to honestly state our opinions and recommendations. Thats been that way since the beginning. Thank you, senator loeffler. Senator murray, do you have closing comments . I i have two quick questions. Sure. Dr. Fauci, while President Trump claimed otherwise, theres no question that an essential part of reopening our economy safely and successfully, is developing a vaccine for covid covid19. We need to plan now to deploy a vaccine once its proven safe and effective. But its absolutely crucial this planning process from the Clinical Trial to distribution recognizes and addresses racial and ethnic disparities in our Health Care System that as we all know for too long have been overlooked and unacknowledged in this country. We have to ensure equitable access to this vaccine for every. Dr. Fauci, let me start with you. What steps is nih taking to make sure that Clinical Trials for covid19 vaccine and therapeutics account for racial and ethnic disparities . Thank you very much. Thats a very relevant question, senator murray. In fact, in the design of our Clinical Trials and the sites that we have chosen in our Clinical Trial network, its going to be very representative of being able to get minority populations and populations at most risk to be part of the trial so that we know during the trial what the relative efficacy as well as potential adverse events. Its something we started in the days of hiv, when we tried to get good demographic representation. Were going to do that with these trials. Thank you. Dr. Hahn, tell me what steps fda is taking to make sure the United States is prepared to produce a sufficient number of vaccines, including the necessary manufacturing, supply chain capacity, for viles and stops a s sir syringes. Thank you. Sharing of data with the agency nih and manufacturers so we can understand what the capacities are, what the needs are from the supply chain and then how to actually share that so that if one manufacturers vaccine doesnt go forward, we can use the capacity of that manufacturer for another vaccine. Im happy to report that the work of dr. Fauci has led to that effort. We developed, as i mentioned before, this gant chart that describes the steps, including the supplies you described. Its complicated in that we may well have hopefully five to seven candidate vaccines that may need different supplies associated with them. We have been up front identifying the supplies, where they are available and then working with the manufacturers to make sure they are available. Thank you. Thank you very much. Mr. Chairman, thank you. Thank you to all of our witnesses for joining us today. It is clear to me we have more work to do before we can safely get back to work and school and some semblance of normal life in our country. We still need testing to be fast, free and everywhere. We need the white house to lay out a Detailed National plan to make that happen. We still need adequate personal protective equipment, for our Health Care Workers and for workers at our businesses and at schools when the time comes. We need guidance from our experts so our communities have the information that they need to reopen schools and businesses safely, confidently and competently. Public Health Workers and Health Care Providers have the information they need to keep patients and communities safe. While experts have been clear that the day we can safely reopen may be a ways off, theres plenty for us to do in the meantime. Both to plan ahead, for example, to make sure once we have a safe and effective vaccine we can produce and distribute it to everyone quickly, and at no cost and to make sure there are Mental Health resources for everyone who is coping with the challenges that are presented by this virus. From the stress of physical isolation, loss of income, to the trauma and anxiety of patients and workers on the front lyoines. I will press to provide the action and leadership we need. I hope that we will continue to have the opportunities like this to hear directly from the experts and ask pressing questions about how to get our country through this crisis. Its clear we have a lot further to go, a lot more to do. So i hope that as our efforts continue, we will bring many of you back, our witnesses, for another hearing soon. Thank you to all of you for joining us today. Thank you, senator murray. Ive got a clarification question and a couple of comments. Then we will thank the witnesses and wind up our hearing. My clarification, i want to make sure i didnt create confusion by the way i asked the question about going back to school. I asked dr. Fauci first about treatments and vaccines and then about testing. What i thought i heard was that dr. Fauci said that vaccines are coming as fast as they ever have but it will be later in the year at the earliest before we see that. Theres some treatments that have that are modest but are promising. There could be more. But that doesnt mean you shouldnt go back to school. That would be more for testing strategy, am i right, dr. Fauci . You didnt say you shouldnt go back to school . No. Absolutely not. What i was referring to is that going back to school would be more in the realm of knowing the landscape of infection with regard to testing and it would depend on the dynamics of the outbreak in the region where the school is. I did not mean to imply at all any relationship between the availability of a vaccine and treatment and our ability to go back to school. You are quite correct. Thank you. What i heard from the admiral was that you are ramping up current technologies, you are hopeful for the National Institutes of health, but you would expect to have the capacity in the fall of 40 to 50 million tests a month and that ought to be adequate for the principal of a middle school or the chancellor of a campus to design a testing strategy that could provide, for example, to screen all the students if necessary . Is that correct . Yes, sir, mr. Chairman. We want to make as many tests available as absolutely possible. What i said is what i feel comfortable with knowing the production schedule being in the position of being able to work with the fda and cdc that we should have 40 to 50 we will have 40 to 50 million tests available per more that need to be deployed in a strategic way depending on the dynamics in the region. Having testing widely does not nullify the need that we are going to have to change our practices in terms of sanitation, personal cleanliness, distancing, face massmasks, given what the dynamics could be. Thank you for those comments dynamics could be. Thank you for those commentss could be. Thank you for those comments could be. Thank you for those comments masks, given what the dynamics could be. Thank you for those comments. Given that number of tests available in three months or as we ramp up to that number three months from now, that should give every principal, every chancellor of every College Campus we have about 5,000 campuses and 100,000 schools, some reassurance that testing as well as the common sense hygiene practices you talked about could be used to develop a strategy for reopening school in august. Two quick comments. One is, senator murray talked about the national plan, which was in the legislation that we all voted for. Theres a little bit of a push and tug between whats national and whats federal, what washington should do and the states do. I thought its a mistake to say federal equals national. In other words, covid19 is a national problem. But that doesnt mean the federal government is supposed to do everything. For example, in testing, the law requires states to tell you what their plans are, what their needs are and then you said that durth mon during may, had state plans that identified 12. 5 million tests and you thought you could help meet that. You have noticed some supplies the federal government is buying and allocating to the state. We dont want to get in a situation where we are telling all the states what to do. Governor lee doesnt want you to tell him what to do. He wants to tell you what he is doing. Let you comment on it. I dont think Governor Cuomo wants President Trump telling him what to do. A push and tug between what washington does and what the states do, i think we have a testing, Contact Tracing, isolating National Strategy and plan led by the governors, designed by the federal government as a National Effort and then the National Effort clearly is to do the research for treatment and the vaccines. What we heard is thats coming along on a faster track than we have ever seen before. Finally, i want to reiterate i thought this was a very helpful hearing. I thank the senators for their questions. I think anybody who took the time to watch would be impressed by the diversity of opinion and the honest answers we got from four really remarkable experts who are in the midst of this every day. I want to reemphasize what i said earlier, that i intend to make sure that we focus, senator murray suggested we need more hearings. I agree with her. As we deal with this pandemic, we need to make sure were ready for the next one. What can we learn about faster treatments and vaccines for the next one . What can we learn about the stockpile, what ought to be in it, manage it for next one . What can we learn can we learn anything about having hospital beds so we dont have to shut down hospitals and bankrupt them in order to create beds for sick people from the pandemic . What about states and hospitals that sell off their ppe in between pandemics . How do we keep our focus in between pandemics when we are have so many important things to be worried about in this country . How do we make sure we in congress sustain and fund all the things we need to do . I want to make sure that we do that this year. We are collective our collective memory is short. While were worried about this, we need to not only deal with this crisis but get ready for the next one. I thank the witnesses for their extra time. I hope they get a sense that our job is to create an environment in which you can succeed. Because if you succeed, our country succeeds. Which is what we desperately want. The hearing record will remain open for ten days. Members may submit Additional Information for the record within that time if they would like. Thanks to everyone for being here today. The hearing is adjourned. Thank you, very much, mr. Chairman. Thank you, senator murray. If you missed any of our live coverage of the Senate Health committee hearing, its available to view online at cspan. Org. We will reair this tonight at 9 00 p. M. Eastern on cspan. The white house scheduled a briefing today due to start at 2 00 p. M. Eastern. We will get you there live when it does start. Until then, we will go back to the start of todays hearing with dr. Fauci and other members of the White House Coronavirus task force. Good morning. The committee on health, education, labor and pensions will please come to order. First some administrative matters based on the advice of the attending physician and sergeant at arms