And prevention, individuals in the hearing room are at least six feet apart. As a result theres no room for the public to attend in person. Representatives of the press are working as a pool to relay the revisions to colleagues. The hearing may be watched online. Unedited recording will be available on the committees website. Witnesses are participating in Video Conference in a onetime exception. Some senators including the chairman are participating via Video Conference. Senators, weve been advised may remove their masks to talk into the microphone when theyre in the hearing room as theyre six feet apart. Im grateful to the rules committee, the capital police, Committee Staff, and everyone all for their hard work to keep us safe. In our hearing last thursday, i said that all roads back to work and back to school run through testing. And that 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 part, 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 many members of our committee had cited as an example of a country that had tested well. According to dr. Deborah birx, the United States were double testing the month of may which should get us up to about 10 million tests conducted. Heres what i mean by impressive here in tennessee where i am today. First, anyone whos sick, First Responder or health care worker, can get tested. Our governor bill lee is also testing every prisoner, every resident and staff member in a nursing home, offered weekend drive through testing, done specific outreach for testing to low income communities. A tennessean can get a free test at the local Public Health department. The governors slogan is if in doubt, get a test. Governor lee sent his goals to the federal government as every state has done. The federal government is helping him make sure 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. Governor hopes to increase that by 7 in may. Thats one of the best in the country. This impressive level of testing is sufficient, we believe, to begin phase one of the going back to work which as i said last week is not nearly enough to provide confidence to 31,000 students and faculty members, what we hope will show up at the university of tennessee campus in august when school starts. Last week i talked with ut knoxville chancellor about that. We said what would persuade those 31,000 students as well as the 50 million k12 students in the country and the other 5,000 university students, what will persuade them to go back to campus in august . Thats where the new shark tank comes in, dr. Collins at the institute of health calls it rad x. We had our hearing about that on thursday, a remarkable scientific exercise to take a few early stage concepts that are swimming around in what we call that competitive shark tank to 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 that students will go back to school in august. For example, the fda authorized last week its first diagnostic test using saliva that a person provides at home instead of a nose swab or blood. It authorized its first antigen test. Were hearing a lot about those like the ones used for flu or strep throat which involves the swabbing of the nose and you can get the result in just a few minutes. Another proposal not yet approved is to put in your mouth a sort of lollipop sponge, take a photo of that with your cell phone and send that to your doctor. If it lights up, youre positive. A university might send that lollipop to a nearby laboratory which could be a gene sequencing laboratory which can deal with thousands of those samples overnight. 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. But such widespread screening of entire campuses, schools, or places of work will help identify those who are sick, trace down those who are exposed. That, in turn, should help persuade the rest of us to go back to school and back to work. In addition to more testing, i expect dr. Fauci will 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 countrys never done before which is to start manufacturing a vaccine before it actually has been proven to work in order to speed up the result in case it does work. Those vaccines, those treatments, are the ultimate solution. But until we have them, all roads back to work and school go through testing. The more tests we conduct, the better we can identify those who are sick and exposed and we can quarantine the sick and exposed instead of trying to quarantine the whole country. In my opinion, this will require millions of new tests, many from new technologies. Some of these will fail, but we only need a few successes to get where we want to go. Thats why i said on thursday that what our country had done so far in testing is impressive but not nearly enough. First squeeze all the tests we can out of current technologies. Next try to find new technologies to help us 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 States senate. 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 are preexisting conditions, minority population. Let me go back to the march 3rd hearing that 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 this is march 3rd march 1 that the outbreak will reach severe proportions in the United States or affect many regions at once. With its top notch scientists, modern hospitals, and sprawling Public Health infrastructure, most experts agree United States is among the countries bestprepared to prevent or manage such an epidemic. That was the New York Times on march 1. A lot of effort has gone into trying to make our country wellprepared. Over the last 20 years, four president s, several congresses in response to 9 11, bird flu, katrina, ebola, h1n1, mers 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 stock pile, created assistant secretary for preparedness. It created incentives for the developments of vaccines and medicines that were using today, strengthened the centers for Disease Control created barda. Thanks to the leadership of senator blunt and senator murray. All this was part of a shared goal. Democrats, republicans, several congresses, four president s tried to get ready for what were going through today whether it was known like anthrax or unknown like covid19. But despite all that effort, even the experts underestimated covid19. This hearing is about how we improve our response to this virus as well as the next one. 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 what can we learn from the fast tracking 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 extra hospital beds without cancelling elective surgery, hurting other patients, and bankrupting hospitals . Whose job should it be to coordinate supply lines so that protective equipment and supplies get where theyre supposed to go when theyre supposed to go . Whats the best way to manage the stock pile . My preacher once said im not worried about what you do on sunday. Its the rest of the week that concerns me. Im afraid that during the rest of the week, between pandemics, we relax our focus on preparedness, we become preoccupied with other important things, our collected memory is short. Just three months ago, this country was preoccupied with impeaching the 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 wellprepared for the next pandemic. If there is to be finger pointing, hope theyre pointed in that direction. Were fortunate today to have four distinguished witnesses with the heart of the response in the coronavirus. Were grateful for their service to our country. Ive asked them each to summarize their remarks in five minutes. Then well have fiveminute round of questions from each senator. Ive agreed well end our hearing about 12 30 after we have a full round of questions. Every senator will have a chance to have his or her five minutes. Senator murray will then have an opportunity to ask the last question or to close the hearing, and i will then close the hearing. There will be 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 the solution to this pandemic. There is not enough money available to help all those hurt by a closed economy. All roads back to work and back to school lead through testing, tracking, isolation, treatment, and vaccines. This requires widespread testing. Millions more tests, created mostly by new technologies to identify those who are sick and who have been exposed so they can be quarantined by containing the disease in this way give the rest of america enough confidence to go back to work and school. For the near term, help make sure 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 containing the disease in this way give the rest of america enough confidence to go back to work and back to school. Senator murray. Well, 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. And as everyone works to take appropriate safety precautions today, i would like to thank not only our witnesses for joining us today, but also our Committee Staff for working to set up a safe format for members and witnesses 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. And families need us to take this opportunity to dig into the 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 testing and allowed inaccurate Antibody Tests to flood the market. Corruption and political interference have impeded efforts to secure desperately needed personal protective equipment 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 Last heard from these witnesses on march 3rd, we have seen over 900 deaths in my home state of washington, over 80,000 deaths nationally, 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 meeting those needs, and how we actually get there. One thing thats abundantly clear, 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 initial 25 billion testing fund and a 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 for supply and funding needs, one that actually addresses the issues were seeing on Testing Capacity and distribution and disparities and building out our Public Health system and makes clear to states and tribes, 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 lines. And we will need far more for other 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 . 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 existing 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 countries 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 have the department of labor set forward a rule that makes clear worker safety is not optional. Mr. Chairman, i hope this committee can hear about those Critical Issues from secretary scalia and secretary devos and other experts in the days ahead. This is especially important to protect nurses and residents at our Nursing Homes where weve seen some of the most deadly outbreaks. And as the rash of outbreaks at meat packing plants shows, this isnt just an issue for the health care industry. It is an issue for everyone. And just as we need a plan before we can start to reopen, we also need a 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 asked 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. So some, including the white house, say weve already provided enough economic relief. My question to them is what good is a bridge 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 addressive relief package and we need to make sure our prioritys 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 well being as a top priority. Thank you, mr. Chairman. Its an important hearing. I know a lot of people are watching for the first time. I hope they notice we have 23 members of this committee, one more republican than democrat. We have some very strong views but are 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. 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. Hes director of the National Institutes of allergy and Infectious Diseases at the National Institutes of health. Hes held that position since 1984 which meant hes advised six president s and worked on hiv aids, influenza, ebola, and other Infectious Diseases. He was involved in treating ebola patients at nih and also worked on vaccine trials for ebola. Next, well hear from dr. Robert redfield. Hes director of the u. S. Centers for Disease Control and prevention which has its headquarters in atlanta. More than 30 years hes been involved with Clinical Research related to chronic human viral infections, Infectious Diseases, especially hiv. He was the founding director of the department of retroviral Research Within the u. S. Militarys hiv research program. He spent 20 years with the u. S. Army medical corp. Third, admiral brett, assistant secretary for health at the u. S. Department of health and human services. That puts him in charge of Public Health policy recommendations. Hes taken on the responsibility for coordinating testing and focused on the increaseing number of tests that we can do with existing technology. His federal Service Includes a variety of activities with our Defense Department and advanced research. Throughout reduction he was part of the Blue Ribbon Panel to reform the u. S. Veterans health system. Finally, well hear from dr. Stephen hahn. Hes commissioner of the food and drug administration. 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. He was the senior investigator at the National Institutes of health. Hes commander of the u. S. Public Health Service board. Now well ask each of our witnesses to summarize their remarks in five minutes. Following that, each senator will have five minutes for questions and answers in order of seniority. Dr. Fauci, lets begin with you. Welcome. Thank you, very much, mr. Chairman, Ranking Member murray, and members of the economy tee. 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 we have is four fold. One to improve the fundamental knowledge of the virus and the disease it causes. Next, to develop new point of care diagnostics. Next, to characterize and test the reputics. And finally, the most safe and effective vaccines. First, with regard to diagnostics, as you probably heard from dr. Francis columns last thursday, the nih has developed rapid acceleration of Diagnostics Program with a regard to that program up to half a billion dollars to support the development of covid19 diagnostics. It is a National Call for Innovative Technologies that will be evaluated in a shark tanklike 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. But let me emphasize that there are a number of Broad Spectrum antivirals that are in various stages of testing. In addition, well be looking at convalescent plasma which is plasma from individuals who recovered from covid19 to be used in passive transfer either in prevention or treatment. In addition, hyperimmunoglobulin which can be used as a gama globulin shot. Well be looking at repurposed drugs as well as immunebased therapies and host antibodies. Let me take a moment to describe the remdesivir placebo controlled randomized trial which was done internationally with the power of more than 1,000 individuals in sites throughout the world. It was hospitalized patients with lung disease. The end point was primarily time to recovery. The result was statistically significant but really modest and we must remember it was only a modest result showing that the drug made a 31 faster time to recovery. We hope to build on this modest success with combinations of drugs and beat that drugs. Moving on to vaccines, there are covid19 vaccines in clinical development. The nih has been collaborating with a number of pharmaceutical companies at various stages of development. I will describe one briefly which is not the only one but one we have been involved in heavily developing. Its a messenger rna platform. You might recall in this committee that in january of this year i said it would take one year to 18 months if we were successful in developing a vaccine. The nih trial moved very quickly. On january 10th, the the sequence was known. On january 11th, the Vaccine Research 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. The phase one will directly go into phase 23 in late spring and 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 and hope to have multiple winners. In other words, its multiple shots on goal. This will be important because this will be good for global availability if we have more than one successful candidate. We also, as the chairman mentioned, will be producing vaccine at risk 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 enhance the negative effect of the infection. The big unknown is efficacy. Will it be present or absence, and how durable will it be . Finally i want to mention the nih has launched a publishprivate partnership called 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 uss quickly to an end to this terrible ordeal were all going through. Thank you very much. Happy to answer questions later. Thank you, dr. Fauci. Dr. Redfield. Good morning chairman alexander and Ranking Member murray and members of the committee. Our nation is confronting the most serious Public Health crisis in more than a century yet were not defenseless. We have powerful tools to fight this enemy. We have tried and true effective interventions such as early identification, isolation, and Contact Tracing combined with important mitigation strategies including social distancing, frequent hand washing, and face covering. These Public Health tools have and will continue to slow the spread of covid19. I appreciate the opportunity to provide a brief overview of some of cdcs work in response to covid19. Cdc has been working 24 7 to combat the pandemic. Public Health Partners in building core capabilities, particularly work force, laboratory, and data and protective. Epidemiologists are conducting tests. Our Laboratory Experts are performing serological testing to better define the extent of asymptomatic population. As local leadership makes decisions to reopen, theyll require varying degreece of federal support. Each location will be different and will face unique circumstances. Cdc has conducted a state by state assessment of pub ligament health testing, capacity, and Contact Tracing capacity as well as surge plans. Cdc is providing Technical Assistance and funding to the state provided through the supplemental cares act. Were working directly with the state Public Health leaders to define their needs for testing and testing devices, supplies, and manpower, surveillance, Data Collection and reporting, contact trace, Infection Control, and outbreak investigation. I want to take 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, well address the testing components of the response in greater detail. Contact tracing, increasing state and territorial 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 for the states as they hire and build a work force necessary to be fully prepared to effectively respond to the Public Health challenges posed by the pandemic. This will be an expansive effort. Surveillance. Our nations Surveillance Program is built on a combination of systems including existing respiratory viral disease Surveillance Systems have been combined with research lab platforms in our case reporting form system. Krdc is adapting these and optimizing 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 Program to include active surveillance among those that are most vulnerable such as individuals in longterm care facilities, inner city clinics, and homeless shelters. We need to rebuild our nations Public Health infrastructure, data and Data Analytics. Now is the time to put it in place for the 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 committee of the dedicated cdc staff who have deployed every corner of this nation to fight covid19. More than 4,000 employees have deploy deployed here and globally. Science and data continue to be the backbone of cdc 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. The battle continues, but we are more prepared. We need to stay vigilant with social distancing. It remains imperative. We are a resilient nation and i am confident we will emerge from this pandemic stronger together. Thank you. Thank you, dr. Redfield. Admiral, welcome. Here to provide you with an update on nations progress in testing for covid19. On march 12th, secretary azar requested that i lead the covid19 testing efforts within hhs including the 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 test performed to date in south korea. To reach this point, 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 drive through testing sites in locations prioritized by the cdc. These sites have been a profound success, testing over 167,000 highrisk individuals and demonstrating a prototype that is being duplicated multifold in nearly every state. Next, the administration leveraged trusted retailers including cdc, rite aid, walmart, kroger, and health mart who 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 tubes, we first supply the global chain through air bridge. We work with manufactures 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 title three 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 states and local plan. Next, our federal Multidisciplinary Team conducted multiple calls with leadership from each state to set statespecific testing objectives. Collectively, states and territories established an overall goal to perform 12. 9 million tests over the next 4 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 tube 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 assays 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 tests like the first in class antigen test authorized by the fda just last friday. They anticipate being able to distribute 300,000 tests per day within just a few weeks. So, by september, taking every aspect of development, authorization, manufacturing, and supply chain into consideration, we project our nation will be capable of performing at least 40 to 50 million tests per month if needed at that time. And if new technologies are authorized like whole genome sequencing approaches or any Novel Solutions uncovered by nihs new diagnostics initiative, that number will be much higher. Finally i want to acknowledge and express my heart felt gratitude to the officers of the u. S. Public Health Service corp. , the uniform service i am empowered to lead. Men and women have deemployed in support of this pandemic on the cruise ship in japan to our military bases repatriating america to our airports to fema and task forces to nursing facilities and to field hospitals in hard hit communities across our nation. I thanks each and every one of these officers and they families and on their behalf i thank the members this committee for supporting our Training Needs to supplement our ranks in future national emergencies. Thank you for the opportunity to provide these remarks. Thank you, admiral giroir. And now dr. Stephen hahn, our fourth and final witness. Chairman alexander, Ranking Member and 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 government response to this pandemic. The fda has worked to facilitate the development of medical Counter Measures to diagnose, treat and prevent covid19. Weve worked closely with laboratori laboratories, manufacturers, academia, product developers, companies that dont even make medical products but want to pitch in. For example, by 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, the urgent need to make medical products available with the provision of a level of oversight that helps ensure the safety and effectiveness of those medical products. I would like to tell you what the fda is doing at this point for americans to return to work and school. It starts with testing as others have mentioned. The fda has worked with more than 500 developers, who have or said they will be submitting requests for covid19 tests. This includes some newer technologies that heretofore have not been used as part of diagnostic tests in response to a pandemic. 92 emergency use authorizations for test kit manufacturers and laboratories, and weve been informed by more than 250 laboratories they have begun testing under the regulatory flexibilities we outlined in march. We are conducting rolling reviews of ua submissions so we can quickly authorize tests in which the data supports n. 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 providing accurate answers. We are also monitoring the marketplace for fraudulent actions to protect the Public Health. We are working to provide more clarity about which tests have been reviewed and authorized by fda and which have not. Seroligic tests will play a role. Serologic tests measure the amounts of proteins or antibodies in the blood when the body is responding to an infection like covid19. These tests can help identify individuals who can overcome an infection and have developed an immune response. We will continue working with labs, manufacturers across the government to find a balance between the assurance 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. The fda is working closely with our fed partners including the nih, vaccine developers, manufacturers and experts across the globe. We intend to use regulatory flexibility to help ensure the most Efficient Development of a safe and effective vaccine to prevent covid19. Until a preventative vaccine is approved, however, we need medical products to bridge the gap. The fda has been working for several months to facilitate the development and availability of therapeutics as expeditiously as possible, and weve created an Emergency Program for this acceleration called the Coronavirus Treatment Acceleration Program or ctap. We had to reassign staff to work with urgency to review requests from companies, scientists, doctors who are developing therapies and using every available authority and regulatory flexibility thats appropriate to facilitate the development in a safe and effective product to treat covid19. A variety of therapeutic areas are being evaluated as mentioned by dr. Fauci and others as well as convalescent hyper immunoglobulin. As dr. Fauci also mentioned we recently announced the trial of remdesivir and treatment of hospitalized patients with covid19. Two other promising treatments that i mentioned are the antibody rich products, convalescent hemoglobin. We are working aggressively with stakeholders to facilitate the development of a device which if shown to be safe and effective could act as a bridge therapy to the development of a vaccine. We recognize therapies need to go handinhand with ensuring there will be sufficient supplies for our country. So were also working with manufacturers to make sure that this supply chain is robust. Mr. Chairman, Ranking Members of the committee, please know that in the fda you have a dedicated team of some of the nations finest scientists, Health Care Providers and health care professionals. We are guided by science and data and we wont let up until we facilitate the development of products our nation needs to get back to work. I look forward to your questions. Thank you, dr. Hahn and thank you for your expertise to your dedication to our country and your hard work. Well now begin a round of fiveminute questions from each senator on the committee alternating between republicans, democrats. Each senator has if youre videoconference a time clock at the bottom. I would ask you to stay within five minutes for your questions and answers. I will start. I have a question for dr. Fauci and then admiral giroir. Doctor, lets look down the road three months. There will be about 5,000 campuses 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 Tennessee knoxville or the 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. If you could save half of my five minutes for dr. Giroir for testing, i would appreciate it. Thank you very much, mr. Chairman. Well, i would be very realistic with the chancellor and tell him that when were thinking in terms its a her in this case. I would tell her, im sorry, sir, 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 ef kaficac was modest. Not yet or maybe ever to be used either yet as treatment. So if the issue is the young individuals who would be going back to school would like to have some comfort and a treatment probably a thing that would be closest to utilization then would likely be passive transfer of convalescent serum. Were not talking about necessarily treating a student who gets ill but how the student will feel safe in going back to school. If this were a situation where we had a vaccine that would really be the end of that issue in a positive way. But as i mentioned in my opening remarks 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 with what we discussed earlier about testing. So im about halfway through the remarks. I would like to pass the baton to admiral giroir who would address the question of the availability of testing and what role that might play in returning to school. Thank you, sir. Thank you, dr. Fauci. Admiral giroir, you said while were doing about 10 million test this is month we might be as high as 40 million or 50 million by september. Which is a significant increase. If im chancellor of the university of tennessee could i develop a strategy where i say to my students we have antigen tests, which is quick and easy. You want everybody to come by and take it once before you begin school that will at least let everybody know that on that day weve isolated anybody who is positive and then we can continue to monitor. Is that strategy possible in august and september . Thank you, mr. Chairman, and i may reserve 20 seconds for dr. Redfield as well. The strategy that will be employed depends heavily on whats the Community Spread at the time. If theres almost no Community Spread, your strategy will be different. If theres high Community Spread it will also be different. Yes, technically we have have the ability. We expect 25 miliclion tests available. Its possible to test all of the students, or it is much more likely there would be a surveillance strategy done where you may test some of the students at different times, be given theres no circulation and that would be done in conjunction with the cdc and the local health department. There are strategies still needing to be validated but a pooling sample. We know in some experimental laps 10 or 20 samples can be pulled. Essentially one test could test 20 students. And finally there are some experimental approaches that look interesting if not promising that waste water from an entire dorm or an entire segment of a campus could be tested to determine whether theres coronavirus in that sewerage, the waste water. There are other strategies being developed and i would like to give 20 seconds to dr. Redfield who really will be working on the strategy of how to employ the tests given different Community Spread. Dr. Redfield . Yes, just some quick comments, sir. First, i think its important to evaluate critically the role of changes in social distancing on College Campuses and schools and the situation, not to forget the importance of what weve learned. Clearly also developing Aggressive Program for wellness education, making sure people understand when theyre symptomatic they need to seek evaluation. I think we are going to have to look at the role of testing. I think there will be an Important Role of testing in this circumstance, and i think it will be individualized based on where these different schools are, how much infection im going to wrap it up there so i can set a good example for the other senators with their five minutes. Senator murray . Thank you very much, mr. Chairman, and thank you to all of our witnesses. Dr. Fauci, you have warned of needless suffering and death if we push to reopen too soon. The president has actually been sending the opposite message. I want to ask you today what is the most Important Message you 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, ms. Murray. We have a framework of how to safely open america again. There are several checkpoints depending on the dynamics of an outbreak in a state, city or area, that would determine the speed and the pace with which one does reenter or reopen. So my word has been, and ive been very consistent, i get concerned if you have a situation with a dynamics of an outbreak in an area are such that you are not seeing that gradual over 14day decrease that would allow you to go to phase one and then if you pass the checkpoints of phase one go to phase two and phase three. What 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 we will see little spikes that might turn into outbreaks. So, therefore, i have been very clear in my message to try to the best extent possible to go by the guidelines which have been very well thought out and very well delineated. So if a community or a state or a region doesnt go by those guidelines and reopen, the consequences could be pretty dire, correct . The consequences could be serious particularly, and this is something that i think we should Pay Attention to that states even if theyre doing it at an appropriate pace, which many of them are and will, namely a pace 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 the 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. Its not only doing it at the appropriate time but the appropriate constraints but having in place the capability of responding when the inevitable return of infections occur. Well, thank you for that. Its very clear in order to do that we need knowledge, which is about testing and this administrations approach to testing has really been plagued by unrealized goals and disregard for problems within that supply chain. Last week an average of 250,000 tests per day, that is a small fraction of what we need. And yesterday President Trump had the gall to declare the u. S. Prevailed on testing in a press conference that was filled with misinformation. Dr. Giroir, Public Health experts do not think the u. S. Has prevailed. Im glad you committed to states, including my home state of washington, will receive enough tests to meet 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. And we know testi ining needs w continue 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 into law, will that Strategic Plan on testing include specific numeric targets for Testing Capacity, supply chain capacity and projection of 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 with over 12 million tests. We think the targets will be good in may and june. As dr. Fauci said, we really have to be evidence based. We expect the targets to go up as we progressively open as communities go through phase one and then into phase two and certainly those numbers will need to go up significantly again in the fall when we potentially have influenza circulating with covid. The targets will need to change based on the evidence that we see. We are highly committed to securing the supply chain. Weve worked daily with every manufacturer. Im pleased were able to get ahead of the states so we can supply them what they need so they have those assurances. There will be no doubts about that. When you put out that specific plan that you are required to do we will see numbers that you are going to tell us that you will reach, targeted for testing and supply chain capacity and projection instead of just saying we hope to have a million this week, next week, you will give us the specific targets, correct . Ill say, yes, maam, we know the specifics. We know the specific amounts of tests we have over the summer. How many we need . Yes, maam, we developed the need statement by working with the states individually with epidemiologists, with the cdc so overall in may well be testing 3. 9 of the u. S. Population. Over time, senator murray. How many we will need not just for may but in the coming months so that we can be prepared to have them . Yes, maam, and not to be repetitive but we need to be evidence and data driven. What we see in may and june will drive the goals we have. We need to be very humble about this. To look at the data. Testing needs will go up as we progressively open and we will do our best to predict that. We have to see what the data and the evidence shows at the time. Mr. Chairman, what our Strategic Plan requires is 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. Thank you, mr. Chairman, and i appreciated your Opening Statement where you had very succinct list of preparations we need to learn from this pandemic for the next one. Not only should we be working on this and preparing but we need to look and i think weve learned a lot. Were fighting a virus at the same time we are learning about it. We need to be nimble and be prepared for the second wave that could go along with the flu system stretching our Health Care System even more than it already has been. Admiral giroir, i thank you for your comments. I think theyve been comforting about what has been done and what can 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 looking for. For questions, dr. Hahn, our understanding of the clinical picture of covid19 continues to evolve. What first looked like a respiratory illness seems much more comprehensive, potentially affecting the heart, the brain, the kidneys. How does this impact the ability to evaluate the appropriate clinical end points for review of vaccines . The evolving clinical picture and the way this is manifesting around the country clinically does, in fact, inform the end points that we will work with developers of therapies on so that we can get the absolute most efficient and most Accurate Information in 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 address those questions. What are the appropriate end points . Ill give you an example. We do know that in some circumstances patients who had severe covid disease have developed thrombotic or clotting episodes. We prioritize a review of agents we think might be beneficial and the clinical end points for those trials will be different than an agent thats an antiviral like remdesivir where were looking at time to recovery. We want to adapt it to the type of therapy put before us. Thank you. Another question to dr. Hahn. We have made a lot of progress in Vaccine Development already. Domestic is a significant gap in the pandemic preparedness. What has hhs done in advance of potential Vaccination Campaign to ensure that we have sufficient capacity to administer a vaccine . This is an important point because its not just about the vaccine or hopefully vaccines developed. Its all about its also about the supplies needed and a plan for administering the vaccine. There is a program that includes dr. Collins, dr. Fauci, his colleagues at nih, the department of defense as well as other members of hhs and fda. Helping coordinate that and working closely with dr. Fauci and his team. Weve created a chart to look forward what are the necessary supply chain issues, syringes, needles, et cetera, depending on the various vaccines being developed how many times they have to administer. So weve been leaning in on this supply chain. To ensure when a vaccine is ready to go we will have the necessary supplies to administer it. I have a couple more questions but, again, the clock is not visible there. I suspect ive used up my time. Ill submit those in writing. Senator sanders . Thank you very much. Let me thank the panel for the hard work and for being with us today. It is sad we have a president of the United States, the leader of our country who from down 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 and, among other things, at a time we need International Cooperation cut funding for the world health organization. Let me say we understand facts are terribly important. Not everybody that we dont fully understand all of the ramifications of the covid19 epidemic. But let me ask dr. Fauci a few questions, if i might. The 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 going to be 50 higher, but most of us feel that the number of deaths are likely higher than that number. Given the situation particularly in new york city when they were really strapped with a serious challenge to their Health Care System there may have been people who died at home who had covid and werent counted because they never really got to the hospital. I think you are correct that the number is likely higher. I dont know exactly what percent higher but almost certainly its 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 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 frequently asked question. I think the possibility does exist. However and the reason i say that, when you talk about will this virus just disappear, and as ive said publicly many times, that is just not going to happen because its a highly transmissible virus. Even if we get better control it is likely there will be virus somewhere on this planet that will eventually get back to us. So my approach toward the possibility of a rebound and a second wave in the fall is that, a, its entirely conceivable and possible it would happen. B, i would hope that between now and then given the capability of doing the testing youve heard from admiral giroir and the ability of us to stock up on personal protective equipment and the workforce of the cdc under dr. Redfield will put forth 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 much less. We have heard a lot of discussion about vaccines, everybody in congress and in this country wants a vaccine, we want it as quickly as possible. Let me ask the honorable fda commissioner, sir, if god willing, a vaccine is developed and if were able to produce it as quickly as we all hope we can, i would imagine that vaccine would be distributed to all people free of charge. Make sure at least everybody in america who needs that vaccine will get it regardless of their income. Is that a fair assumption . Senator, i certainly hope so. The fda is very committed to making sure all populations in the United States including those most vulnerable are included in the Clinical Trials. 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. Are you guaranteeing the American People today that vaccine will be available to all people regardless of their income . Sir, the payment is not a responsibility of the fda. I share your concern that this needs to be made available to every american. Does anybody else want to comment on that . Mr. Giroir, do you think we should make that vaccine when it is created available to all regardless of income, or do you think poor and working people should be last in line for the vaccine . Im sorry, senator, were you asking me . Yes, i was, sir. Yes, i was. No, i 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 or preventive is available that it reaches all segments regardless of their ability to pay or any other social determineants of health that there may be. Good. So what youre telling the American People today regardless of income, every american will be able to gain access to that vaccine when it comes . They should gain access to it. You represent an administration that makes that decision. I will certainly advocate that everyone is able to receive the vaccine regardless of income or any other circumstance. Youre over time, senator sanders. Thank you, mr. Chairman. I dont want to cut senators off and its hard to see the time clock but if we could stay as close as possible to five minutes, all the senators can get their questions in. Thank you, senator sanders. Senator burr . Thank you for what youve done for the people in this country and their safety and people around the globe. Dr. Fauci, youve been at a majority of the press conferences. Has anybody ever asked you to take the foot off the gas of trying to find a cure or any type of Counter Measure . No, senator, not at you will. We at nih, as you know, have been right from the very beginning put our foot right on that accelerator in every aspect including the development of vaccines in therapeutics. As i described in my Opening Statement we actually started that in january, literally days after the virus was known. No, i have never been told by anyone to pull back on the development of any Research Project weve been involved in. Thank you, dr. Fauci. This question is for dr. Redfield. We have authorized in this committee and appropriated out of congress multiple times over the last few decades money and you talked about it. In the past four years from fy16 to fy20 its been 23 million a year and with the c. A. R. E. S. Act is over a billion dollars. Weve seen the private sector go out and use Data Available to track the progress and spread of coronavirus around the world. Why has the cdc not contracted with private Sector Technology companies to try to use their tools for biosurveillance . 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 Analytics which were appreciative of the additional Funding Congress has given. This is under critical review now. Trying to make the availability in all of our jurisdictions across the country. In april of last year june of last year we reauthorized the pandemic which authorized 30 new employees at cdc in surveillance. As of april zero of those had been filled. How many would this committee authorized been filled today . I know our staffs have been in discussion and i know were in the process of continuing to try to figure out how to move that forward, sir, if i can get back to you on it. You brought that to light. Well, i brought it to light the first of march and now were in midmay. Im hopeful we wont just talk about surveillance well execute it and focus the unbelievable amounts of money. Dr. Fauci, let me come back to you. This is one of the fastest Development Time lines weve ever seen for vaccines and the American People and hopefully people around the world will be the beneficiary of what you find and the licensure of the product. Dr. Hahn, if you have anything to add after that to this, please do. Dr. Fauci . Thank you very much, senator burr. A couple things are inherent, first of all, theres no guarantee that the vaccine is actually going to be effective. You can have everything you think is in place and dont have the immune response thats protective and do you rememberably protective. One of the big unknowns it will be effective. We will get an ef kaficacy sign. One thing well be able to get around by doing the tests properly is do you get an enhancement effect . A number of vaccines, two in particular, when the vaccine induces a suboptimal response and when a person gets exposed they actually have an enhanced pathogen sis of the disease. Those are the two major unknowns. I still feel optimistic we will have a candidate that will give some degree of efficacy, hopefully a percentage enough that will induce the kind of herd immunity that would give protection to the people at home. Dr. Hahn, anything to add to that . Yes, thank you for the question. The obstacles are being met by the approaches taken out of hhs and that is a common pathway so we can assess one vaccine against the other and then a master protocol that allows for a common control group and an assessment of very common end points. We will evaluate approximately ten candidates and then in the phase one and phase two studies and take four to five into phase three studies in this effort. I think those are the obstacles that will allow us to ensure safety and effectiveness. Yesterday North Carolina started to publicize the recovered numbers, those individuals who had coronavirus but have recovered. Its my hope that nationally we will start reporting the recovered numbers. I think thats important for the American People to hear. I yield back. Thank you, senator burr. Senator casey. Thank you for the hearing as well as Ranking Member murray. I wanted to start today with a question regarding Nursing Homes, in particular across the state like ours weve had, as you might know, a high number of cases in pennsylvania. At last count over 57,000 cases. The number of deaths have gone above 3,700 and, 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 the death of a resident of a nursing home or worker. I want to start 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 senator wiyden and i sent you a letter dated april 2nd directed to you as well as the administrator of the centers on Medicare Medicaid services. 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, to the workers as well as to the community and Public Health officials. It took you about a month to respond to that. In your response you didnt give us any information about the time lines. These families need this information. Now were told by the cms administrator after pressing her, senator wyden and i did. This information may not be available until the end of may. I need to hear from you why has there been a delay, a threemonth delay in basic information that families and people within a Community Need about the outbreaks in Nursing Homes. Tell us when we will see that information. Youve highlighted one of the great tragedies weve all experienced together, clearly the longterm care facilities have been particularly high hit by this pandemic. Several things have been done and i can get back to you in terms of where theyre at in terms of activation. Really all Nursing Homes now are required to report cases in either individuals that are patients there or staff to the cdc. Second secondly a policy in place that all Nursing Homes are required to notify members of that nursing home of the existence of covid in that nursing home include family members. Verify in terms of if thats today or next week. One of the most important things we talk about key and reopening as tony mentioned. We need to be to do tracing. The other thing we really need to do is surveillance. This virus does appear to have a high propensity for asymptomatic infection which means our traditional ways of identifying cases will be blunted. Were developing a national Surveillance System and to do surveillan surveillance, the cdc will be doing that in partnership. I think will have the responsibility to do it within the inner city clinics that are selected and Health Service clinics. This is critical. We get in front of this and do comprehensive surveillance of everybody in these Nursing Homes. Weve also done aggressive outreach in all of them and enhancing Infection Control procedures, et cetera. The cdc has been out to help with that and the guidance. Ill get back to you im confident its already operational but i need to doublecheck to make sure. Theyre all report to go cdc now any infection in workers or patients and are required now to notify other members in 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. My concern is states or cities or regions their attempt, understandable, to get back to some form of normality, disregard to a greater degree the checkpoints that we put in our guidelines but when it is safe to proceed in pulling back on mitigation. I feel if that occurs there is a real risk you will trigger an outbreak and may not be able to control which, in fact, paradoxically will set you back not only leading to suffering and death but could even set you back on the road to trying to get economic recovery. Turn the clock back rather than going forward. That is my major concern, senator. Thank you, doctor. Thank you, mr. Chairman. Thank you, senator casey. Senator paul . Dr. Fauci, it has been shown monkeys infected with covid19 cannot be reinfected. Several studies have also shown that plasma from recently infected coronavirus patients neutralizes the virus and lab experiments. In addition influential of convalescent plasma based on the idea recovering coronavirus patients are developing and it can be beneficial as donated. Studies show the recovery of covid19 patients from the asymptomatic to the very sick are showing significant antibody response. Studies show that sars and mers and yet the media continues to report that we have no evidence patients who survive coronavirus have immunity. I think the truth is the opposite. We have no evidence that survivors of coronavirus dont have immunity and a great deal of evidence to suggest that they do. The question is linked to Health Policy and workers who have 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 now have immunity. They likely wont get it again and instead of being alarmed by media reports there is no evidence of immunity. Can you help set the record straight that the scientific record as being accumulated is supportive that infection of coronavirus likely leads to some form of immunity, dr. Fauci . Thank you for the question, senator paul. Yes, you are correct, that i have said given what we know about the recovery upon coronavirus in general or even any Infectious Disease with very few exceptions that when you have antibody present it likely indicates a degree of protection. I think its in the semantics of how this is expressed when you say has it been formally proven by longterm Natural History studies which is the only way you can prove, one, is it protective which i said and would repeat, is likely that it is but also what is the degree of antibody that gives you that critical level of protection and what is the durability . As i often said and repeat you can make a reasonable assumption that it would be protective but Natural History studies over a period of months to a year will then tell you if thats the case. I think thats important. The vast majority of people have immunity instead of no evidence, the w. H. O. Fed into this by saying no evidence of immunity and theres every evidence stacking up. A lot have shown it is unlikely you get it again in the short term. With regard to going back to school one thing left out of that discussion is mortality. Shouldnt we be discussing what the mortality of children is . The mortality for 0 to 18 approaches zero. It almost approaches zero. Between 18 and 45, the mortality in new york was 10 out of 100,000. So really we do need to be thinking about that. We need to think what happened in sweden where the kids kept going to school. The mortality rate is less than france, less than italy, less than spain, less than belgium, less than the netherlands, about the same as switzerland. Basically i dont think theres anybody arguing that what happened in sweden is unacceptable. I dont think any of us are certain when we do these modelings, more people have been wrong than right. Were opening up a lot of economies around the u. S. And i hope that people predicting doom and gloom, oh, we cant do this, will admit they were wrong if there wasnt a surge n. Rural states we never really reached any sort of pandemic levels in kentucky and other states. We have less deaths in kentucky than in an average flu season. Really outside of new england weve had a relatively benign course nationwide. I think the one size fits all is ridiculous. We ought to be doing it School District by School District and the power dispersed because people make wrong predictions. The history will be wrong prediction after wrong prediction starting with ferguson in england. We ought to have a little bit of humidity in our belief that we know whats best for our economy. As much as i respect you, i dont think youre the end all. We can listen to your advice but people on the other side say theres not going to be a surge and we can safely open the economy. If we keep kids out of school for another year whats going to happen the poor and under privileged kids are not going to learn for a full year. I think we should look at our kids getting back to school. I think its a huge mistake if we dont open the schools in the fall. Thank you. Mr. Chairman, can i respond to that only though there are only 32 seconds left. Yes, and you might make it clear whether or not you suggested that we shouldnt go back to school in the fall. First of all, senator paul, thank you for your xhenlcomment. I have never made myself to be the end all. Im a scientist, physician and Public Health official. I give advice according to the best sign particular evidence. There are a number of other people who come into that and give advice more related to the things you spoke about, about the need to get the country back open again and economically. I dont give advice about economic things. I dont give advice about anything other than Public Health. The second thing is that you used the word we should be humble about what we dont know. I think that falls under the fact we dont know everything about this virus. And wed better be very careful particularly when it comes to children. The more and more we learn were seeing things about 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 similar to kawasaki syndrome. I think we need to be careful were not cavalier in thinking children are completely immune to the deleterious effects. Youre right in the numbers that children in children do much better than adults and the elderly and particularly those with underlying conditions. I am very careful and hopefully humble in knowing i dont know everything about this disease. Thats why im reserved in making broad predictions. Thank you, senator paul. Thank you. I want to cover a lot of territory in my five minutes. I would certainly be appreciative of concise answers. I want to start with dr. Redfield. Dr. Redfield, the current testitest ing protocols at the white house presents a model for other essential work places. Im sorry, senator, you broke up at the beginning of your question. If you could just say it again. Im sorry. Yes, dr. Redfield, do you think that the testing protocols currently in place in the white house present a model for other essential work places. Well, thank you for the question. I think one of the important things you bring up is the essential worker guidance the cdc put out and i think it was originally modeled on Health Care Workers where there was significant shortages. Im asking if you think the white house protocol testing are a model for other essential work places. I would say i think each work place has to define their