Transcripts For CSPAN3 CDC Director Robert Redfield Testifies On Coronavirus Response 20240712

This hearing will come to order. I would like to welcome dr. Robert redfield, director of the centers for Disease Control and prevention and we thank you for being here this morning. Dr. Redfield, to discuss the cdc and the on going response to covid19. I also want to welcome the subcommittee members, Ranking Member congressman thomas pole and our full Committee Chair. I want to thank you to the subcommittee members here in person as well as subcommittee members who are participating by secure video teleconference. Before i move to my Opening Statement, and because this is our first labor hhs and education appropriation subcommittee hearing with some members participating remotely, i would like to begin by offering a brief explanation of how it will work in order to benefit both members and the public. This hearing room has been configured to maintain the recommended six foot social distancing between members, witnesses, and other individuals in in the room necessary to operate the hearing. Which we have kept to a minimum. Some members have opted to use secure video teleconferencing which is loallows them to partie remotely. Once you start speaking, there will be a slight delay before you are displayed on the main screen. Speaking into the microphone activates the camera. Displaying the speaker on the main screen. Do not stop your remarks if you do not immediately see the screen switch over. If the screen does not change after several seconds, please make sure you are not muted. To minimize background noise and ensure that correct speaker is being displayed, we ask that the members who are participating by video remain on mute until it is your turn to ask questions. Please remember to mute yourself at the conclusion of your question. Should you seek additional time, please unmute yourself so that i may recognize you. I want to remind all members and witness thats the five minute clock still applies. If there is a technology issue, well move to the next member until the issue is resolved and youll retain the balance yf you are time. For members using the video option, you notice a clock on the bottom of your screen that will show how much time is remaining. A one minute remaining at one minute remaining, the clock will turn to yellow. At 30 seconds remaining, i will gently tap the gavel to remind members that their time is almost expired. When your time has expired, the clock will turn red and i will move to recognize the next member. In terms of speaking order, well follow the traditional order beginning with option statements from the chair and Ranking Member and a full Committee Chair and Ranking Member. We will then hear from our witness dr. Redfield. Members present at the time of the hearing, the hearing is called to order, will be recognized in order of seniority. And finally, members not present at the time the hearing is called to order. Now i would like to move to my Opening Statement. Before i make opening remarks, i want to reflect on today. This afternoon there is a Memorial Service for george floyd. For the last few months around the pandemic, we have been talking about how to get back to normal. However, what we can hear and the chants for justice and the cries for equality is that going back is not good enough. This moment exposes so many wrongs, deep inequality, and racial wrongs. And that as we fight the covid19 virus before us now, we must also fight the virus of injustice. Good morning. Welcome to the labor health and Human Services and education appropriation subcommittee. This is our second hearing to oversee the federal response to the coronavirus. And it is bipartisan. Let me commend my colleagues on both sides of the aisle including the Ranking Member, congressman tom cole. With us this morning is dr. Robert redfield, director of the centers for Disease Control and prevention. The cdc. Thank you, dr. Redfield for joining us today. Our nation is in turmoil. The coronavirus is the biggest Public Health crisis we have experienced in at least a century. To be blunt, the federal response had been inconsistent and incoherent. A major focus to have days hearing is getting a better understanding of what has gone right and what has gone wrong these past five months. We need to learn from mistakes, not repeat them. We cannot stop the risk from this virus overnight. But in the months to come, we can spare the American People from unnecessary misery, illness, and death. In a typical Public Health emergency, and historically, the response would be led by the cdc. Our nations foremost pub Health Agency based on science and Public Health expertise. Im alarmed that this administration has side lined the cdc in our response to the pandemic and chosen political expediency over Public Health. As a result, the u. S. Has had the worst response to coronavirus of any country in the world. And it is particularly egregious because our Public Health system should have been better prepared than any other in the world. Over the last three years on a bipartisan basis, this subcommittee increased annual funding for the cdc by approximately 1. 1 billion. An increase of 17 since 2017. That included the first year of a new Public Health dada Modernization Initiative which will transform how the cdc collects, uses, and analyzes Public Health data. We also created an Infectious Diseases Rapid Response reserve fund to enable the cdc to respond to outbreaks quickly, to protect Public Health. Ranking member cole and i have worked closely together, understanding the challenges to create that reserve fund and it was critical to funding early response activities at the outset of this pandemic. Since march, the congress has provided 7. 5 billion in emergency supplemental funding directly to the cdc. And i might add, in bipartisan fashion, but instead of Public Health expertise driving our response to the pandemic, it appears cdc has been side lined for political interests. That is dangerous there are projections going that 30,000 more could die each month. That would mean another 100,000 dead over the summer months. Yesterday the New York Times released a powerful and well researched expose of the consequences of the lapse in the work of cdc. The piece opened the quote long considered the worlds premier Public Health agency, the centers for Disease Control and prevention has fallen short in its response to the most urgent Public Health emergency in its 74year history. From the moment this pandemic reached our shores, President Trump and his administrations response has been he wouldfully inadequate, advocating all responsibility. There was never any coordinated flo plan to address the pandemic and under this dangerous lack of leadership, our nation surpasses 100,000 deaths from covid19. The most of any country in the world. When it comes to crucial details, like acquiring tests and supplies, setting goals for how much of the population should be tested, facilitating Contact Tracing and isolation efforts, and ensuring communities that have been hit the hardest are given the support they need, there is no National Coordinated strategy. Our federal response cannot be defended from a Public Health perspective. They have found ways to keep people in other countries safe. It appears as if the United States is just admitting defeat. Is that acceptable . Or simply accepting the preventable deaths of hundreds of thousands of americans to covid19 . If the administration is asking us to accept that, in my view, the answer is a decisive no. For us to keep our people safe, our response needs to be led by the scientists and the Public Health experts at cdc. Our response needs to be based on reliable Public Health principles, not political appointees in the white house. It is our expectation that Public Health expertise must be at the forefront of our National Response. We need answers to vital questions. Why has the administration accepted the worlds worst outcome and a level of preventable death that would have been unconscienceable a few months ago . How is our country going to reopen when there is not a coordinated nationwide effort to test, contact trace, and isolate cases . Why are states disregarding cdcs guidelines for reopening business and social activities . Why are cdcs guidelines not at the forefront . Why did cdcs guidelines on reopening come after states started to reopen or were already reopened . We are asking the cdc to lead the way and uphold its mission. I quote that mission, as a Nations Health Protection Agency cdc saves lives and protects people from health threats. To accomplish our mission, cdc conducts Critical Science and provides Health Information that protects our nation against expensive and Dangerous Health threats and responds when these arise. That is the highest mission and it is the right mission. So let me say affirmatively that this Committee Supports the scientists and the Public Health officials at the cdc. Like dr. Nancy and others who are trying to provide sciencebased guidance to the country, what went wrong . Why has the cdc been left behind . When there was an early declaration of a Public Health emergency by hhs on january 31st . When the doctor said it is not a question of if this will happen but when this will happen, she further said, disruptions to every day life may be severe but people might want to start thinking about that now. Cdc produced high quality indepth publications. You need to take note of this. The cdcs morbidity and mortality weekly reports, the mmwrs, cdc experts have published evidence about universal testing at Skilled Nursing facilities to interrupt transmission of covid19. As well as critically important work about super spreading events which are responsible for trans mitti transmitting the majority of cases of covid19. They identified the cause of some of the super spreading events, the larger events. The exposure at a choir practice where 61 people led to 32 confirmed and 20 probable cases. Attendees at a church in arkansas, workers in meat and poultry processing facilities. We cannot have a cdc that fails to publish high quality specific technical guidance. We cannot have a cdc that has reports shefput on the shelf ant redriven or redrafted to suit political purposes. We cannot have a cdc that provides spotty Data Collection and reporting. We cannot have a cdc that fails at transparency. We need federal leadership that is guided by Public Health, by that expertise, real time, rigorous and transparent. We need cdc and we need scientists and the Public Health experts leading the way for all of us. And i am angry that their experience and commitment have been pushed aside for a political agenda. That must change. And i believe the congress has to change it. And we have to redirect the current course to set us on the path forward. So i look forward to this important conversation and appreciate dr. Redfield, your being here. I appreciate the same for all of my colleagues. And now i would like to recognize the Ranking Member of the subcommittee congressman tom cole for any opening remarks that he would like to make. Thank you very much, madam chair. Want to begin by thanking you for holding this hearing in the middle of a difficult time and you to be commended for it and certainly dr. Readfield being here. I want to associate my remarks myself with your remarks about the tragic death of mr. Floyd and, frankly, the Health Care Disparities that this tragic pandemic has shown a bright light on this committee has worked on for many years. I know concerned dr. Redfield as they concern everybody here. And thats going to be clearly a major cask for our Committee Going forward. As it has been the past. But probably with a higher sense of urgency. Good morning, dr. Redfield. I want to thank you again for coming to testify before us today. First, id like to thank you for your Public Service. The director of the cdc is no easy job. But leading your agency through a once in a century event compounds the challenge. You led that agency with a steady hand and Uncertain Times and i want to thank you personally for your leadership. Im going to depart from my remarks a little bit here because i think sometimes when were in the middle of something, its hard to keep it in context. But our performance has not been the worst in the world. Depending on how you want to measure performance. Frankly, im sitting here looking at todays latest statistics and if you want to measure it by the basis of fatalities per million population, then the performance of the United Kingdom is worse. Performance of italy is worse. Performance of france is worse. Performance of space has been worse. Performance of belgium is worse. Those are all advanced countries with sophisticated health care systems. I dont think can you really take the chinese numbers quite frankly for face value. And then beyond that, i say this with no criticism of the countries involved, but i do worry a lot about india and pakistan, that part of the world. I worry a lot about subsa hahar africa. Were going to see the numbers are probably worse in those places than they are in the United States. Simply because we have a more sophisticated health care system. So i have no problem with being critical or putting a flashlight on anything. I think we learn lessons that way. But, you know, in america we always tend to think were the best or the worst at everything. In this case we may not be the best but were not the worst. I hope we can focus on future steps that we can take together to ensure a sense of safety as our nation returns to work and school. After more than two months of staying inside, the American People need the guidance of the cdc more than ever to help us navigate the path ahead. Efforts to reopen our country and reignite our economic engines should be approached with caution and designed on each states unique circumstances based on sound data. This pandemic has caused unprecedented disruptions to our families, communities, and economy. And it will continue to do so for some time. The strain on our supply chains and the devastating Economic Impact to hardworking americans have created challenges that will take months and in some cases years to address. However, im encouraged to see state and local economies slowly and cautiously beginning to reopen. I also welcome the renewed focus on the need for u. S. Based capacity and resilient supply chains. I look forward to working with my colleagues across the aisle to address the challenges. I also want to acknowledge the robust bipartisan congressional response. In the deeply partisan climate, im pleaseded to see congress and the Trump Administration Work Together across party lines to deliver Critical Resources for the American Public in supplemental funding and support programs like the highly successful paycheck protection program. We set aside our differences and quickly delivered legislative action to address the pandemic. Passing records sums in record times. When the consensus is clear, congress is capable and is as capable as ever for decisive action. The fight against covid19 is far from over. I hope the spirited bipartisan cooperation can continue as we assess our past efforts and determine what more may be needed. While the federal government has provided some short term relief to help individuals, households, businesses and communities, stay afloat during the period of extreme social distancing, our economies need to get moving again. And americans need to get back to work. However, any such efforts to reopen must continue to keep the health and safety of americans at the top of mind and not undue previous progress in slowing this president of the coronavirus. This will indeed be a delegate balancing act. And until there are working treatments, Effective Therapeutics and ultimately a vaccine to control covid19, the risk and the danger of the disease remains. Fortunately, i see Real Progress in all of those areas. Returning to more regular functions and operations requires gradual action, completed in phases and based on data. President trump and the Coronavirus Task force established phased in and data based recommendations and criteria for states on reopening efforts. The administration recognized now is not the time for a one size fits all model for each state theyre leaving key decisions to each governor to make as appropriate for the circumstances of their communities based on their needs, supplies, and local capacity. And as states develop plans, the administration is fortifying the supply chain for testing supplies and ensuring each state as access to the supplies own oft often shipping testing supplies to the state. The federal government must learn from this crisis and actively prepares to face down another pan dem nidemic in the. Im proud that congress generously invested in worthy tools and response resources to strengthen our readiness in recent years, it must be an even higher priority in the days ahead. Though the United States was prepared to face an emergency, you can never be fully prepared for what you dont know is coming. In the future, we must not just prepare for the emergency at hand, but leave our nation better prepared for the emergency ahead. Sustained predictable robust funding for research, preparedness, and u. S. Based capacity are vital components to this approach. And something that the this committee and in a bipartisan fashion has worked on well for several years. I want to thank the chair again for holding this important hearing at this critical time. And i yield back the balance of my time. I want to thank my colleague and take a moment to say that the member that gets the award for traveling the furthest once again is our colleague, Congress Woman butler. I would like to recognize for an Opening Statement the chair of the full appropriations committee. Thank you, chair. I assume this is working and can you all hear my voice. Is that correct, madam chair . We can. Loud and clear. Okay. Okay. Well, i do want to really thank you, my friend, chair, and my friend Ranking Member tom cole for bringing us together. Its a pleasure for me to join you remotely. And dr. Redfield, welcome back before the subcommittee. As the nation faces the crisis of the past century, they have needed the cdc more and thats why im so and it did not suit him time and time again. The president tupushed aside medical experts. And dr. Nancy and the legitimate warning of the stock market. The president encouraged the medicine and even though studies have shown that coronavirus patients receiving this drug were more likely to die. He even raised using disinfect ants causing manufacturers to warn of the danger and spike of calls in Poison Control Centers throughout the country. This is not normal, my friends. This is dangerous. We have lost more than 100,000 souls. Nowhere more than in my own home state of new york and in the strong federal role, new york has been a leader in testing to contain covid19. But this virus does not recognize state boundaries to succeed against the coronavirus and they must take charge. And this nfctiinformation to ges right with many states beginning to reopen, the cdc must remain vigilant to combat the continued increasing cases as well as the expected second wave this fall. The president s preference of a patchwork for 50 different states fighting covid19 on their own will not stop these levels of destruction and will lead to more suffering and death. We need a National Strategy on testing. We dont need a democratic plan. We dont need a republican plan. We need a United States plan and we need it now. We instant ready to support the cdc in recent months this committee provided 7. 5 billion in emergency supplemental funding to cdc to respond to this Public Health crisis. And the house passed heroes act would provide an additional 2. 1 billion. And we will do everything we can, working together, democrat and republican, we have a responsibility to protect the public. I only wish the president would do the same. Thank you, madam chair. I thank the gentlelady. And thank you again for your Public Service but all over the group as well. The testimony will be entered into the record and youre now recognized for five minutes. Thank you very much, chairwoman and Ranking Member cole, distinguished members of the committee. Thank you also for the opportunity to testify before you and again thank you for your Long Term Support of cdc. The covid19 pandemic is the most significant Public Health challenge to face our nation in more than a century. And as we sit here today, this novel virus is weaving its way through our social consciousness, outward expression and our grief. Im deeply saddened personally by the many thousands of lives that have been lost to covid19 in the United States and around the world. And i fully recognize the anguish that our nation is experiencing now. Today i call on the American People to remain vigilant in our collective obligation to protect the vulnerable. To protect your community, your grandparents, loved ones who may be at risk for severe covid19 complications. And we must lessen the impact of covid19 on africanamericans, hispanics, latino, American Indian and alaskan native thats are disproportionately affected by this disease. This nation is not only hearing a wakeup call, rather, were hearing a clambering for equity and healing for a positive permanent change to health and social disparities that exist in our nation. And as communities make plans to cautiously reopen, this means that we need to continue to embrace the now familiar social distancing hand washing and Face Coverings. These actions will allow us to move forward and contain the outbreak along with readily available testing, comprehensive Contact Tracing, timely isolation of known cases and self quarantine to break the chains of trans mission. Cdc is providing communities with Public Health tools to confront this novel vie less. Ki virus. I cant tell you how proud i am of the men and women in the Health Professionals at cdc and how grateful i am for their service and family sacrifice. Cdc deployed over 5,000 personnel to the covid19 response field teams are on the ground providing local Health Officials with expertise and ep teamolog epidemiology and Community Mitigation. We published more than 1500 specialized information and guidance documents so far. And the covid19 website has been consulted more than 1. 3 billion times. Cdc responded to more than 20,000 acquires for doctors and clinicians and we hosted calls that have reached over half a million more. With your support, cdc has been able to award nearly 12 billion to states, territories, tribes, and locations. These funds are being used to enhance diagnosics, Health Care Worker safety and the other important Public Health measures that i previously mentioned. Through our partnerships with cms and the Indian Health service, were deploying teams to the needs of population at the highest risk, specifically those living in Nursing Homes, shelters and correction alpha silts. This outbreak has shown a bright light on the true heroes of the response. They are the Public Health and the health care professionals, the First Responders and the critical infrastructures workers. But unfortunately this pandemic highlighted the shortcomings of our Public Health system that has been underresourced for decades. Never has it been more clear that our nations Public Health i. T. Infrastructure requires modernization to support and collect reportable reliable comprehensive and timely data. When we confront any Disease Threat, cdc and Public Health departments must make real time decisions based on real time data. Data forms the road map and it informs policy. Data is the backbone of any Disease Threat response. As a virologyist and physician, i know the importance of strong clinical laboratories. We must equip our Public Health laboratories with advanced technology and ability to adopt new platforms required in Emergency Response. We must grow the workforce to address covid19 and public threats. Sustained investment in our Public Health system of this nation is an investment not only in health and prosperity for today but for the future generations tomorrow. Preparedness will be critical when flu and covid19 hits the door steps of our hospitals and Health Care Providers this winter. Encourage all americans to be prepared and embrace flu vaccination with confidence for the families themselves and communities. This single act will save lives. As a person of faith, and good conscious, i ask all of you to see the possible. We can and must less enthe health xparts in th Health Disparities in this nation. I leave you with a comment from congressman cummings he used to salt cost of doing nothing isnt nothing. Cdc director and grandfather, i ask you to continue to work with me to build the Public Health system our nation not only needs but that it deserves. The now is the time and i want to thank you for this opportunity and i look forward to your questions. Thank you very much, there r dr. Redfield. They say politics and not Public Health facts of the cdc are driving our nations coronavirus decision. March 13th, President Trump declared a National Emergency. Our nation had 556 new cases and seven deaths. Four days later, he urged American People to follow stay at home guidance. He said we are asking everyone to work at home if possible. Postpone unnecessary travel, limit social gatherings to no more than ten people. Let me show you this chart. On june 2nd, as this chart shows, there were over 20,000 new cases and weve had more than 1,000 new deaths. And President Trump is telling the American People that we are reopening the economy and everything is okay. Our politicians dont seem to make any sense. When we had fewer than 1,000 new cases, we went into a National Emergency. Now we have 20,000 or more new cases a day, yet we are opening up. Based on those inconsistent responses, ive come to a conclusion. In march we made decisions based on Public Health expertise. But now we are basing decisions or making these decisions based on the interests of politicians in the white house. My question these facts and i have several questions im going to try to move quickly, this chart shows the crisis isnt over. Instead, it appears the white house is trying to convince the americans to just accept more risk and death. You run what has been the worlds global Disease Detection and control center. How does this make sense from a Public Health perspective . Im going to ask you to be short, dr. Redfield. There are a few more questions and a lot of folks that want to ask questions. [ inaudible ] we experienced this coronavirus pandemic, were learning every day. I think probably the most critical thing that weve learned is to understand whos most vulnerable to this infection. Weve seen that with the Nursing Homes and elderly and in africanamericans, hispanics, American Indians and native alaskans. And really design our policies to protect those vulnerable individuals. I think thats one of the fundamental lessons that we have learned in the last several months. Thats the policy we have Going Forward. Continue to protect the vulnerable. So yes or no . Does it make sense for us to be doing what were doing when we are looking at a 20,000 plus cases in june 2nd and over 1,000 deaths . So it leads me to believe that we are not following what is based on Public Health expertise but rather making decisions based on what are more political interests. Let me ask you these questions. The this is a yes or no, dr. Redfield do. We have a vaccine yet . We have candidate vaccines under development. But we dont have one yet . We dont have one for deployment. Are we close to achieving immunity across the United States . No. Is there any evidence the virus has become less contagious or is becoming tired of infecting us, yes or no . No. Okay. Are all the states meeting the base test thats the white house guidance laid out for reopening, downward trajectory, documents cases within a 14day period, downward trajectory of positive tests within the 14day period . Chairwoman, of course, these were guidances we p put out and to answer your question, directly, no the all states have met that criteria. We have had a number of states. Let me show you this photograph. This is the lake of ozarks yeah. I the same visceral response, dr. Redfield. Look at this. Look at these folks. This is unbelievable. And youve got this happening in the state of missouri. The white house guidance says that states need to have the ability to trace the contacts of covid19 and results. The state of missouri where this is happening does not have the capacity to do Contact Tracing. Is the cdc tracing everyone who was there, yes or no dr. Redfield . It would be state and we would assist them and the answer is we havent been asked to assist them for that. So we are not Contact Tracing. Even though we have the person we identified the person. I cant answer for the state what theyre dochlgt i will say because of congress support, we are building enhanced capacity across this country to do Contact Tracing and get that capacity fully operationalized by the fall of this year when were going to need it to maintain containment as we get into the fall and winter of 2020. Let me have you look at this photograph. This is i saw the ozark photo. This is the photo from last weeks spacex launch. People gathered on the bridge. Would you put yourself in these types of situations . I think the really important thing of all this is if you point out is that not just to the individuals but to the risk that theyre putting the individuals they go home to. Thats what is happening. That is what is happening. Let me just i try to close with this. 2 1 2 months ago, president started a process of shutting down the economy. Fewer than 1,000 new cases a day. Since then, administrations failure to respond competently squander the opportunity to bring the virus under control, protect the health of the american families. Were being told its safe to reopen. Over 20,000 new cases, over 1,000 deaths. We do not have testing, tracing resources that we need to prevent more deaths. It is no wonder the worlds leading medical journals, the lan it lansit calls the federal response inconsistent and incoherent but the president wants us to get used to this and to pretend its business as usual. Let me just say this to you, dr. Redfield with all the i have such admiration for the work that you and cdc do. But if you and the cdc are driving this bus, youre taking us in a dangerous direction from everything i can tell the cdc isnt in the role youve had in the past, not only arent you driving the bus, but the president seems to have left you at the curb. Thats wrong for cdc. But it is deadly for our country. I recognize my colleague. Thank you very much. I have a different question. Let me start with this. Are other countries in the world based on mortality rates doing less well than the United States . There are countries as you pointed out in your Opening Statement that are not doing as well as the United States. And are those countries reopening for business . There are countries that are reopening. At some point, we put 40 million americans out of work, literally in a matter of the last few weeks. And weve done what we can as a congress and in a bipartisan basis with the support of the administration help those people. We think were making a lot of progress on both therapeutics and vaccine. But people do have to go to work. You do have to have a functional economy at some point. And, you know, again, we did the shutdown, a lot of this was to try to make sure we didnt overwhelm our own health care system. Can you give us a view as to whether or not were anywhere close to that or how is that worked out in retrospect . Thank you. Thank you, congressman. I think that was fundamental. There was an enormous concern that i and others had that this pandemic could have overwhelmed our health care system, particularly in some of our major metropolitan areas such as new york, connecticut, northeast area, northern new jersey. And so there was we saw that. It actually happened in italy. Overwhelmed. We saw that in wuhan, china. They overwhelmed the health care system. When it did overwhelm the Health System, the mortality rate for the covid19 is up and the mortality rate for income the hospital was up. That was the greatest concern. It is we were able to get through that. And in the sense with some augmentation but in general in most jurisdictions we were able to get through that. And i think thats changed. Its not just health versus the economy. Really, it is health versus health. I mentioned that 85 of children now missed immunizations. Around the world, 120 million kids missed the immunizations from measles. There will be more deaths in measle in children than from flu. There is it trying to find the balance as we come back and be able to make sure that we can begin to operationalize not only our employment but our Health System. When you think about all the cancer screenings that have been missed, that are going to have consequences. I think its important to get back, not only our economy back but our Health System back. But to do it strategically and prudently. As i said with, very learned a lot. The key us to right now is to protect the vulnerable. And to focus our energies on that. This pathogen can be deadly with those with Chronic Health conditions and the elderly. I want to go to a topic we discussed many times before and i want to pat this committee on the back because the last five years wee increased funding for nih for 39 for 39 for cdc by c stockpile by 34 , set up the Infectious Disease Rapid Response fund. As my good friend, the chair, noted. In other words, weve done quite a bit. And yet, we were still overwhelmed by what happened. And we are responding right now in a crisis mode with supplementals. Im really concerned about what we do Going Forward. And the administrations original budget obviously was put together with no idea that this was going to occur. So that budget no longer is really applicable, in my view. I want to ask you, looking forward and you referenced this in your remarks what kind of budget do we need in terms of sustained commitment . What areas do we need to focus on . Because again, i know were going to keep passing supplementals. I dont think thats the real answer here. I think we need this really focused deal. Dr. Frieden, your predecessor, came here, talked about the equivalent of what we call an oco account. Its an offbudget account for the military that allows them in extraordinary circumstances to finance military activity, not be limited by the budget. My friend, the chair, and i have talked together about, we have a budget agreement, but maybe cdc, nih, fda, food inspection, strategic stockpile, maybe a few accounts ought to be selected to get outside of that agreement and just do what we need to do, because were going to be dealing with it. So, i would really welcome your thoughts as to what kind of investments we need to make Going Forward and how do you sustain those investments, because i dont like oneanddone supplementals here. I dont think thats going to ultimately its going to help us in a crisis, but its not going to get us where we need to go. Yeah, first i just want to thank the chair and yourself and the committee for the consistent enhancement of our capacity. You know from the very beginning, within the first month of me being cdc director, my assessment was the core capabilities of Public Health that we need both at cdc and throughout this country, states, local, tribal, territorial, is inadequate, and that we really need to be overprepared, not underprepared. And when you asked me what kept me up at night, i would say pandemic flu because i just were just not prepared. I think this is highlighted, even with all the improvements, which i treasure. The data minorization that the chair put forward, fundamental. The reason were having trouble with the issue in Health Care Disparity and understanding how this virus is affecting the africanamerican its because we dont have the data. And getting that data monitorization is fundamental. I feel the same way about laboratory resilience and multiple platforms. The workforce. Well need 230,000 new contact tracers before september. The Rapid Response fund you have put into place, which is critical and i continue to support, and of course, the Global Health security, which i think is the big elephant in the room. You think we werent prepared for this . Wait until we have a real global threat for our Health Security, and i echo your concern. I think its a much greater probability than we have a real defense threat. And so, i think we do have to build that into the longterm base budget and figure out you all to work to figure out how to get that done. I think that the Public Health infrastructure of this nation, which you all know a significant portion of it goes to state, local, tribal, territorial. We fund 50 to 70 of all the Public Health infrastructure in your own state and communities. That needs to be augmented. And truthfully, i meant what i said at the end with my friend, congressman cummings, the cost of nothing isnt nothing. The time is now to do it and get that investment. Thank you. Thank you, madam chair. Its difficult without the clock, but i apologize for that. Thank you. Everyone is here today. Absolutely. Ive got it. Thank you. I now recognize the chair of the full committee, congresswom congresswoman. Thank you, madam chair. And dr. Redfield, its good to hear from you today. New yorks ability to scale up testing has been extraordinary, and were now testing about 50,000 residents each day with more to come. We need every state, however, to take these steps to have a true picture of where infection rates are rising and mitigate the damage. But most states are not even close to new yorks capabilities. Can you tell me, why hasnt the cdc established testing benchmarks for each state to meet . And maybe ill have you answer that. And then, with all due respect, the virus doesnt recognize state lines. We cannot fully protect the population of one state if other states arent holding up their end of the bargain. So, a federal response is needed to truly protect the public. I dont understand why cdc isnt taking a leadership role in establishing testing benchmarks for each state to meet. Thank you very much, chairwoman, for your question. And also, thank you for the recent resources that you provided to hhs, of which 10,250 million came to cdc and has all right been distributed to the states to do just that. Weve worked with each of the states to develop their independent plan and benchmarks, and those plans are now under review. They were due on the 31st of may through june, and then on june 15th, theyre due for the rest of the year, from july to december. Its really going to be important. I will say that youre blessed with the Wadsworth Lab and one of the best state labs in the nation. As i talked about core capabilities, the number two was laboratory resilience. Im personally saddened that theres a handful of state labs that have the capability to do what needs to be done. Again, as part of this core capability investment, i want all state labs to be able to do that. I got to work with Harold Zucker very early as new york state labs stepped up to develop their own test, as you know, and they were the first to develop the test not on what i call the slow platform that we have for flu, but they put it on a rapid throughput platform and really led the way. So, i agree with you. Were in the process of doing those plans with each of the states because of the resources from you all and congress, but i would add that i think its a critical time for us now to invest heavily in state labs so that they have the resilience to do exactly what your colleagues in new york have been able to do. We could do that in each of the 50 states of this nation. Well, thank you very much. And i just have a little time left. And i want to say that this committee had the benefit of being briefed early on by dr. Nancy mesengie, director of the National Center for immunization and respiratory disease at cdc. And on february 26th, she said, ultimately, we expect we will see Community Spread in this country. Its not so much a question of this will happen anymore, but rather, more a question of exactly when this will happen and how many people in this country will have severe illness. Was the doctors explanation correct . Yes. I mean, i just also want to add that dr. Messingier is one of the outstanding lead scientists at cdc. She continues to run our center for immunization and respiratory diseases. And as you know, she was the first leader of our im response to this outbreak when it was grounded in her center. Now, i just want to comment in the limited time i have left. Was she sidelined for telling the truth . Its been widely reported that President Trump wanted to fire her after her comments, fire her for telling the truth because of the impact on the stock market. Instead, he removed her from any publicfacing role. What does this say to the Public Health professionals at cdc who may be fearful of retribution for doing their jobs. I just want to stress that dr. Messinger remains one of our outstanding leaders. She continues to run our center for immunization and respiratory disease. Shes a great scientific ally of mine and other leaders. In addition, i want to point out shes our lead on the project warp speed in developing the vaccine and taking the leadership for cdc on that task force, so she has not been sidelined, and she continues to use her expertise to lead one of the most important agencies that we have at cdc. I want to thank you, dr. Redfield. Weve known each other a long time, and im glad that youre there, and im glad that dr. Messingier continues to be a key part of this project. Thank you very much, madam chair. Thank you. Thank you, chairwoman. Thank you. Congressman harris. Thank you very much. And thank you, dr. Redfield, for being here. First off, i want to draw the distinction between march and june. In march because the chairman brought up, well, it doesnt make any sense, we had very few cases in march. We have a lot of cases now. But in fact, china had a lot of cases by then. And we really didnt know a lot about the disease by then. We know much more about it now. And i would suggest that if we really want scientifically based actions, we should actually use data. And we have a lot more data now. For instance, i remember sitting at a hearing in this committee where the death rate was speculated to be 3 to 4 . And last month, the death rate, i think the cdc, quote, best estimate is 0. 26 . So a lot has changed in the past time, and to say this is politics is ridiculous. This is actually science. Its actually looking at data and dealing with science. Now, dr. Redfield, i dont have a lot of time, but you are well aware of the effect of unemployment on health, i hope. The landmark study in 2009, quarterly journal of economics looking at the Unemployment Rate following the oil crisis of pennsylvania in the 1980s showed that the death rate among men unemployed doubled in the year following their unemployment, and when they tracked it for 20 years, there was an effect that lasted 20 years with an average loss of longevity of 1 to 1 1 2 years for unemployed people. Thats a pretty Serious Health effect. So im going to ask, because were in the midst of reopening in maryland, and one of the things that in my district is very important is the Tourism Industry and the restaurant industry. And our governor has decided in accordance with cdc guidelines, because i mean, we have the phasing document. Our governors decided we are ready for phase two. I look at the document that cdc has about scaling up operations for restaurants and bars. It is step two where you have Indoor Dining. And our governors decided, for some reason, you can do outdoor dining, you cant do Indoor Dining in restaurants. So im going to ask you a simple question. In fact, since our governor decided phase two gating is already criteria, theyve already been satisfied, is there anything in cdc guidance that would say Indoor Seating is not appropriate, maintaining social distancing . I mean, could the governor say, well, the cdc guidance is holding me back . Once phase two gating has been exceeded. No. You wouldnt find that in there. Again, as you pointed out, the critical thing is to have these things cdc, were not an opinion organization. Its got to be sciencebased. And i think the principle of the science that we have right now on social distancing is that six feet, twometer distancing, and thats the key. Should be adequate. Thank you very much. Thats what i thought. And again, you know, you want to talk about things based on politics. Some of these delayed reopenings are based purely on politics because theyre, as you suggest, there really isnt a whole lot of Scientific Evidence that at this point would delay some of these reopenings, consistent with cdc guidelines of social distancing. Now, i do have a question about masks, because you know, there is now a cult of masks. Thats what ill refer to it as. Because you know, we get criticized, oh, my gosh, im afraid to get a picture taken of me without a mask somewhere because someone will say, how can you possibly youre a doctor, how can you not wear a mask . But in fact, we dont know a whole lot about whether a mask is better or worse than a cloth Face Covering or is better or worse than a face shield. But im going to ask you something very specific about restaurant opening guidance, because the cdc document says that restaurant workers should wear cloth masks and not surgical masks. I mean, it specifically says wear a cloth mask, not surgical masks. But my understanding is a surgical mask is probably a little bit more protective of the other person in the room than a cloth mask. So, is there evidence behind that . I mean, is it just that we want to reserve surgical masks for other situations . But is there Science Behind that saying a cloth mask is better than a face mask . And face shields arent even mentioned in the guidance. Yeah, not in terms of lfay clearly, there is Science Behind the potential benefit, if i am infected, of wearing a Face Covering in changing the amount of infectious virus that can go across a sixfoot space or a threefoot space. And we have good data to show that. But i think you hit the answer yourself, is the real issue is to preserve the medical, the surgical masks for the medicalsurgical First Responder community. Thats the intent there, not that theres any evidence its one better than the other. Thats what i imagined. And again, you know, getting back to science, because theres a lot of critique when, you know, first people were told dont wear a face mask, then theyre told wear a face mask. We have a big discussion, surgical mask, face mask, face shields, what is it . I mean, the bottom line is you should protect the other person that youre coming near. Thats right. In case you are asymptomatic or presymptomatic carry. Exactly. Thats the purpose. Thank you very much. I yield back, madam chair. Congresswoman roybalallard. Thank you, madam chair. And dr. Redfield, thank you for being with us today. Id like to follow up on the issue of masks. In early april, the cdc reversed its initial guidance for masks being optional to advising the public to wear cloth masks in public spaces at all times. In spite of this advisory, u. S. Culture has continued to be a barrier to a universal acceptance of these recommendations. Maskwearing, unfortunately, has become very politicized, and those who oppose their use argue that mandating masks is interfering with individual freedoms. A recent study by a group of Cornell University scientists showed that when quarantines are lifted, if 80 of the population wears a mask with social distancing, the virus could be eliminated. Unfortunately, to date, only 15 states require the wearing of masks in communal places as our president continues to flaunt his opposition to this Public Health recommendation. Based on the science, why did you initially recommend the mask as optional . And what fears do you now have regarding the spread of the virus, if states and individuals cant be incentivized to wear masks in public, including during these massive protests that we have recently witnessed throughout our country . Thank you very much. I think fundamental to this was the recognition of the importance of asymptomatic infection or presymptomatic infection. When this outbreak originally happened, cdc had the original 12 cases in the first january february. We did about 800 contacts through our contact followup. Two of those individuals were confirmed to be positive, both symptomatic and both spouses. So, we had the view from our chinese colleagues in their experience and our early experience that this was a symptomatic disease, like most respiratory viral diseases were. But what we rapidly started to learn is theres significant asymptomatic infection or what we would call presymptomatic infection. Asymptomatic or presymptomatically affected if they were wearing a Face Covering, that they would have less ability to transmit to others. And thats why we embrace this important Public Health tool. And i will say that we continue to see this as a critical Public Health tool. As i said in my Opening Statement, that we ask the American Public to be vigilant about utilizing, particularly as a major mechanism that we have to protect the vulnerable. And can you also elaborate on what your concerns are, then, when you see these mass protests, when you see as things are opening, when you see people on the beaches and in Public Places who are not wearing masks, what is your concern of what the possible outcome of that will be in terms of the spread of the disease . Yeah. Obviously, were very concerned that our Public Health message isnt resonating. We continue to try to figure out how to penetrate the message with different groups. The pictures that the chairwoman showed me are great examples of serious problems, you know, and i can say that we will continue to try to message as well we can. Were going to encourage people that have the ability to request or require a mask when theyre in their environment, to continue to do that. We do think this is an important Public Health tool, and were going to continue to try to figure out how to get more and more people to embrace it. I was just remarking when i would go home in the baltimore area, i dont see anybody without a mask, but a lot of times when i walk through washington, d. C. , i see a lot of people without a mask. So theres different cultural approach to it, but we think its an important Public Health message and were going to continue to stress it. I think its going to be key. These social distancing strategies that weve learned are something we need to perfect because were going to need them to be our major defense again in october, november and december. Well, i hope that you can start with convincing our president to be a champion of advocating for masks to prevent the further spread of the virus. I yield back. Thank you. Congressman moolenaar . Hi. Can you unmute, and then start from the outset here. Okay. Thank you, madam chair. I appreciate the opportunity. And dr. Redfield, we appreciate your presence with us today and want to thank you, the 5,000 members of your team that are helping during this health crisis, and also just for the sacrifice that they and their families are making to help protect the vulnerable. And i wanted to talk with you. One of the areas that you brought up as a concern was the i. T. Infrastructure. One of my priorities on this committee has been to provide funding for the cdcs Public Health data Modernization Initiative. And i think this pandemic has really demonstrated the importance of that. In fact, some of the early reporting said that the cdcs response was hampered by an antiquated data system and a fractured Public Health reporting system across the United States. And i wondered if you could speak to the early response as well as what youve done since that time, and as we go forward, what do we need to do to really invest in this data modernization . Thank you. And again, i want to thank the chair and this committee. You, i think, heard those discussions that i had i think in the first weeks of my directorship, and we talked about the core capabilities. The one that i said was the most, most, most important was data. We need data. We need it in real time. We need it actionable. And i mentioned that i had had a briefing the first month that i was on with the opioid tests, and when they finished, this was in april of 2018 when they finished, i asked my cdc experts what the data was through, and they said march 2015. And i said, is that the most recent data we have . And they said yes. I said i didnt know i was becoming a medical historian. And i shared that comment with the chair and the cochair and others, and were appreciative. We have a long way to go, though. Its not just the data system at cdc. Its the data system throughout this nation. And in some states, they have decentralized Public Health Data Collection. I have states that are still collecting data on pen and pencil. And so, this data modernization that you all started, i do believe to get us over the goal line, its going to require substantial enhancement of that investment. Were talking about building a comprehensive data system for the Public Health system of this nation. But when that is accomplished, its going to be a gold mine. You know, were able to do some surveillance now, and that twoyear lag that i had, threeyear lag i had for opioid tests, we now can solve in 48 hours. We saw it with the evoli syndrome we had with the ecigarettes, how rapidly we were able to detect that because of the surveillance. I want to encourage you to continue to accelerate the ability for us to modernize this nations system and get it done once and for all. Its going to have Enormous Health Benefits for us across the nation, to be able to respond to that which we dont know were going to respond to. Even during my short time, weve had evoli, weve had hemorrhagic deaths from marijuana, weve now had this. All of these things. We had the acute plax paralysis in children. All of these things would be enhanced so much if we had a realtime actionable data system across this nation. Thank you, doctor. You know, i want to also follow up with you along the lines of the Data Collection and talk to you about the Skilled Nursing facilities. Its no secret that Nursing Homes and longterm care facilities have been among the hardest hit during this pandemic, and data from cms suggests that 26,000 nursing home residents have died from covid19 and more than 60,000 have fallen ill. However, only 80 of Nursing Homes have reported data to the cdc. So, these numbers are only going to increase. Two questions. How has the cdc been working with cms to ensure greater compliance on reporting of infections and deaths at Nursing Homes . And then also, when did you expect that we could get this data reporting as close as possible to 100 . Thank you, congressman. This is a major priority. Cms and ourselves, our group are working very closely together. This is really one of the key priorities to successfully combat the impact of this pandemic on Nursing Homes. And as you mentioned, we have the ability now to have these Nursing Homes required to report all of their infections to us, and deaths, and for us to get those into cms and for cms to face them forward so the American Public knows what Nursing Homes are doing well and what Nursing Homes arent doing well. And we know which ones we need to go in and help them even more with infection control. Im hopeful that well have this completed over the weeks ahead. This is a priority. Its a requirement now by cms that these Nursing Homes do report. You know, it was just a couple weeks ago, we were under 20 . Then recently 60 and now 80 . And i think, actually, i heard numbers today that it might be 90 . So i think were going to get this done, hopefully before the beginning of july. Its a priority, get it done this month. Thank you, and i yield back. Congresswoman lee. It is very, very timely. First let me just say, you know, and i think everyone recognizes, we have a pandemic upon a pandemic in the Africanamerican Community. And so today i just want to take a moment to offer my condolences to the floyd family as we mourn and grieve his loss and hope that justice is served in his memory. And that goes right into the disproportionate rates of africanamericans and people of color who are dying from covid19. Now, dr. Redfield, the ppp and Health Care Enhancement act, which became law april 25th, mandated that the cdc provide us with a report on covid19 data based on race, ethnicity, socioeconomic data, within 15 days. Now, within 21 days, excuse me. We received this report on may 15th. And of course, you signed this report. It was 2 1 2 pages long. It contained no new insights. And what it did was just link to websites of data that was outdated, and it was very limited on testing and demographics. In short, the cdc and the Trump Administration did not complete the assignment at all. And so, dr. Frieden, first of all, whats your plan for how youre going to target resources and a federal response to black and brown communities, which are disproportionately being hit . And as you said, the impact is greater disproportionately with people of color. How are you going to target a federal response if you dont have the data . You said that you would provide this. I actually called on may 18th to some of your deputies and asked for some of this data as relates to where africanamericans are being disproportionately hit, and i was told the cdc did not have the data to illustrate these disparities and must make assumptions. So i want to know, how are we going to get the actual data and the report quickly so we can target the federal response . And then secondly, i cochair the asiapacific american caucus task force, and im concerned that the data as it relates to the Aapi Community is not disaggregated, which makes it challenging to properly allocate resources and to ensure positive Health Outcomes. Actually, in one of your reports, you had the Aapi Community designated as other. And so, what are you going to do in terms of collecting data as it relates to the Aapi Community, as it relates to cases and mortality, and how are you going to make sure we get the report, your next report, which i think is due on june 14th, that tells us where we need to target these resources based on race, ethnicity, and socioeconomic status . Congresswoman lee, i want to thank you for your question. And first, i personally want to apologize for the inadequacy of our response. It wasnt intentional. Unfortunately, its just reflective of what i tried to say, is that we didnt have the data that we needed to be able to answer that in a responsive way. That data comes into us, obviously, from the state and local tribal Health Departments, but that response was not adequate, and i apologize. And unfortunately, it was under my signature, so i take responsibility. But we are correcting it. I think there is going to be an announcement today that because of what you all have done with the c. A. R. E. S. Act, its now going to be a requirement for all Laboratory Tests to be reported to cdc to include the type of test, the zip code of the test, the ethnic and racial demographics, the age and the sex. Its, as i said before in my opening speech, the data is the roadmap. Its fundamentally the key first step that we need to do to address the Health Disparities that youve so correctly highlighted. And i think many of you know i spent 22 years practicing medicine in urban baltimore. I understand firsthand disparities of health care in this nation. This is why congressman cummings and i became close friends. I have every intent to get that data so that we can begin to understand. Clearly, increasing the access to knowledge of infection in vulnerable communities is critical, getting testing more available in there. I do think so, dr. Redfield, so what report are you going to release today so that we can have so we know in advance what we can expect . Yeah, its not a report, congressman. Its a requirement that the reporting to cdc now is going to include ethnic, race, age and demographics and zip code. So were going to be able to generate exactly what you have been requesting very specifically, so we will know exactly where this virus is occurring dr. Redfield, okay, so the next report to congress is june 15th. Will we have that data based on the c. A. R. E. S. Act requirement . All i know is that whatever data i have, and im pushing to get it in the way that meets yours and my goal. Im not going to be able to promise its going to be perfect on the 14th, but its going to be a lot further along than it was in the last one, and i think were going to get this solved, if not by the 14th, by the next one. So, youre going to and i know my time is up, but just let me ask you, about the aapi data be disaggregated . We need that, because otherwise, we wont have a true picture of where to target resources. Yeah, were going to try to make sure this datas forwardfacing down to the zip code level, congresswoman. By no, im asking you the disaggregation of data based on the aapi, the Asian American Pacific Islander community. For example, are you going to say, in the chineseAmerican Community, this is the data. In the filipino community, this is the data. In the japaneseAmerican Community, this is the data. In the you know, disaggregating the Asian Pacific okay, that i will have to look into, but i will take your concern and recommendation that we work to see how to accomplish that. Thank you very much. Thank you, madam chair. Congresswoman herrera beutler. Thank you, madam chair, and thank you, dr. Redfield, for being here. I have a difficult question for you, but i think its really important to really understand what we can do to not be in this place again. And i value so much your work and your many sleepless nights and the work of your agency, because i know they have been on the front lines. I was reading an article theres i saw an article from the wall street journal, i think in april, and i saw one from the times today about cdc and testing. One of the things that was quoted said, former officials in the cdc said the cdcs culture locked some of the agencies in play into a fixed way of thinking, helping its failure in the crisis, inability early on to provide state laboratories around the country effective diagnostic tests. And then if i kind of fastforward over to where and im not trying to say whos its not im not trying to take a figure down, despite what everybodys probably thinking. I want to understand this. I understand that when the Public Health emergency was declared on january 31st, it meant that state labs any lab had to get permission then to get approval to do our own testing. Basically, it was about a month later before tests started really flowing. We know early on kind of the control of the situation was aggregated. They wanted whoever made the decision that it was aggregated and cdc was going to produce the first test and send them out to the states. What we now know is those tests didnt work. They were sent to washington state. Washington state had to send them back. And ultimately, what i feel like happened was, you know, we have to have diagnostic testing ability, and we had to ramp that up quickly in order to stop infection. Now were at the place of limiting new infections for reopening. And weve broken through some of the barriers. Thank goodness the private companies were able to step up. We broke down some of that bureaucracy and they were able to step in and fill in holes. I know in my community in southwest washington, my local health i mean, ive spent months trying to get testing capability for private labs. I know that because of relationships, for example, within the vancouver clinic in southwest washington, they were able to use their relationships to get their testing capability going. Everybody was it was kind of like everybody was doing their own thing to make it move forward and we were trying to break down the bureaucracy. The wall street journal says this was back in april that an fda official flew to the cdc headquarters in atlanta, visited the lab that had prepared the tests and the lab was, quote, a mess, and it became clear that the tests had likely been contaminated, said one person familiar with the matter. The cdc then disputed that the lab was a mess and pulled back its test, and theres been an investigation. We havent i havent seen the investigation results yet. I know that your heart and your soul is to protect and to promote the Public Health of the people in this country. Theres no question about it. You have a long and distinguished career, which we are grateful for. In recognizing these problems, my question is and i keep hearing, we just need to put more money into Public Health, we just need and i agree, i want a realtime active data system, but this committee in a bipartisan fashion has increased funding for cdc, Strategic National stockpile, weve instituted a National Response team. We say yes to Public Health requests. We really have. And yet, here, when it all counted, some people in some places made decisions that all this was going to be kind of constricted by the federal government. The federal government was going to be the one that innovated and then distributed it. And i dont know if all the money in the world can fix what some have called a culture where, quote, again, the New York Times, the culture at the cdc is riskaverse, perfectionist and ill suited to improvising in a quickly evolving crisis. So, when i read that, i dont think ill of the cdc. I think you guys are doing what youre doing in your lane. But wouldnt this better be wouldnt we all better be served if the doors of collaboration opened at the very beginning, and it wasnt Public Health or private, you know, or private labs, because weve got my challenges with how private labs have done things with regard to qwest and labcorps, but if we had thrown open the doors and said, together were going to move forward. And i would ask you, would you consider i know your want your legacy to be building a robust Public Health system, but could your legacy also include fixing what seems like a siloed approach within the cdc and thats going to require you to fight upwards, i realize, not just downwards but is that something youd be open to consider in terms of righting the ship so that the next time were in this place and i pray god its not in the fall, but it could be but is that something you would consider and speak to that . I prescient yoappreciate you. A couple of things. First of all, i do believe, just to level the field here, is that the cdc developed within ten days a test from the time the sequence was published, and that test is not a flawed test. It works perfectly. It was available in midjanuary, to diagnose the original cases in washington, as you know, and its only limitation was in order to get that test, you had to send the blood to the cdc. And there was never a moment in this nation when any Health Department couldnt get the test. They just had that limitation. Theres no question there were shortcomings at cdc when we i have to push back on that one. My Public Health departments could not get that test. Well, im saying if they chose to send it to cdc, they could get the test. Thats what i was saying, congresswoman. We always had that capacity. The shortcoming is then we tried to manufacture the test so that each Health Department would have their own, all right . I dont think youre going to see cdc in the manufacturing position anymore. It will be contracted out. And in that time, there was a shortcoming. There was a contamination. Its being theres an inquiry into it to figure out what was there and why it happened. But i will say, within five weeks, it was corrected. And so, for me, within five weeks of the sequence, we had the testing now available in the Public Health labs, which some people may think is a delay, you know. As a virologist, from the time of a new pathogen to having a test available in public labs around the country, i think thats still an accomplishment. Let me add in there, though, that six weeks madam chair, i beg your indulgence that six weeks was the six weeks that we had to get ahead of this virus. That six weeks six you said five weeks on january five to six. On january 29th to february 29th, thats when we shut down. And now we are digging our Small Businesses were digging everybody out. That i know as a virologist, thats good, but we have to get into the 21st century. We have to change the culture at the organization, because that was the five weeks we had. That was our lead time. If i could just make one last comment on this. Please, madam chair. Thank you. I beg your thank you so much. I know can i make one comment . Yeah. I know the times up. I wont go through the other comments because we can talk offline on that, but the issue that really has to happen and that one thing we have to correct is the day cdc got in the lane to make a Public Health test, the private sector had to be in the lane to make a test for the rest of america. It wasnt cdc. Cdc makes the Public Health lane. It took, unfortunately, you know, weeks and weeks and weeks before the private sector stepped up, all right, and developed what we now have. As you know, weve now done over 17 million tests. The private sectors in the game. The Public Health is a small part of it. But i think that has to change, too. Thank you. Thank you, madam chair. Congressman pocan. Thank you very much, madam chair. Thank you, dr. Redfield, for being with us. Dr. Redfield, i have a lot of questions, so if you can be as concise as possible, i would certainly appreciate that. It was inferred earlier by our Ranking Member that and i think you answered the question, but that we dont have the worst amount of cases, the highest amount per capita on the planet. Is that correct . Yeah, thats correct. However, according to your data, cdc data, weve had over 1. 8 million cases of coronavirus. Thats nearly a third of all the cases on the planet. And by far the most of any country. Is that also correct . Of those that have been reported, yes. Yeah, and also, weve had 106,000 deaths, by far the most in the world. Is that correct . Again, of those that have been reported, yes. And our death rate is like 320 per 1 million, which is six times the reported global average . Is that correct . I would have to doublecheck that. I dont have that figure in my head. But i have confidence that you have data there, but id be glad to check that and get back to you. Sure, thank you. In fact, theres only eight countries out of 195 or so countries that exist on the planet that have a worst ratio per capita qatar, san marino, endura, behind ran, kuwait, luxembourg, singapore, and chile. Altogether, their populations are 33. 5 million people, about a tenth of the United States. So its not exactly impressive to say that we dont have the worst, but for almost every other country, we have the worst amount of cases that are out there. Do you have to agree, dr. Redfield, that countries like germany, with a rate of 220 out of 100,000, new zealand, 31 out of 100,000, and south korea, 22 out of 1 00,000, have been more successful than the u. S. In controlling the spread of the coronavirus . Based on the reported cases that we have, that would be correct. Right. So, i think one of the problems that we have in the United States, unfortunately, dr. Redfield, is back in midapril, your agency was putting together detailed, stepbystep recommendations for businesses, child care facilities, restaurants and others to reopen, and that got sidelined for a month. In fact, i think it finally was on may 20th you released those guidelines, and on may 14th, you put out decision trees. Who made the decision to delay the release of the reopening guidelines . Again, all of these guidelines that we have developed, and as i mentioned well, the question specifically is who made the decision to delay . Right, and i was just trying to answer, sir, that these guidelines, forming them was a reiterative process. So it wasnt a question of delaying the guidelines it was a question of completing the process to make sure the guidelines had the input of the different groups. Who made the decision specifically that they would be released on may 20th, rather than any time sooner . It would have been me, sir. Okay. And were you at all in consultation with anyone at the white house, and if so, who . No, we were working again through the interagency group. So again, that has multiple agencies that have input when these guidelines cross over. As i mentioned, its a collaborative inter yeah, i can tell you, that release, though, dr. Redfield, states like wisconsin, where our state Supreme Court forced us open and other states were opening, came after all that happened, and it created a lot of chaos and we had a spike in cases after that. Let me ask you another question. So, we know that chemical agents that are similar to tear garks and tear gas itself can cause people to cough, which can spread covid19, is that correct . Definitely coughing can spread respiratory viruses, including covid19. And do you agree that tear gas and chemical agents like tear gas can cause people to cough . Thats been my experience. Have you made any advice to the president or to any Police Agencies or the military to not use tear gas or chemical agents with the recent protesters because, obviously, that could cause an increase in covid19 due to the coughing . I think you raise an important point. We have advocated strongly the ability to have Face Coverings and masks available to protesters so that they can at least have those coverings, but you do raise an important question. Would you make that recommendation to the president . Ill pass on this comment to the next task force meeting, yes. Okay. I appreciate that. And with six seconds left, i will yield back. I thank the gentleman. Congresswoman clark. Thank you, madam chairwoman, and thank you, dr. Redfield. As you acknowledged in your opening comments, you come before us today in a time of national anguish and turmoil. This pandemic did not create inequities, disparities, or racism, but it has magnified the lethal effects of all of those. So true. We will only emerge through this Public Health crisis, this economic crisis, and this moral crisis, if we demand that our american ideal of equity truly applies to each and every one of us. Dr. Redfield, the cdc website contains pages of information on disparate Health Outcomes for people of color higher rates of asthma, heart disease, diabetes, to name a few. I understand from your answers to congresswoman lees questions that tomorrow you will have an announcement or today, later today, about mandatory demographic reporting. But wasnt it eminently predictable that covid19 would disproportionately impact black latinx and indigenous communities . You know, congresswoman, i dont know, but its clear, once we understood that individuals with certain medical conditions were at greater risk, once we stepped back and understood certain social factors in Living Conditions would be critical, i think it became rapidly selfevident. Well, i can tell you, it played out very, very quickly and evidently in my district, and i think that is true across this country. And we have to do better. This plan that youre putting forth, is it a written plan that you will be sharing with us with specific benchmarks on how you are going to collect this data . Again, the announcement thats coming is actually coming from the secretary of health. Its not cdc, but its cdc thats going to be getting this. But you highlight such an important area. And those of you who have been able to visit cdc, the whole area of health disparity, the whole area of health, making purposeful, meaningful progress in this, not just for covid, but for, you know, for the Health Outcomes that we have i did mean what i said when i said the time is now to get a purposeful program to address these inequiti inequities. I have visited cdc, and i appreciate your commitment to that, but in this particular case, with this pandemic reaction, there were public outcry and outcry from members of congress and pressure to have this information. Im interested in who wrote this plan that is going to be released today . Was that the cdc or someone within hhs . Its in responsiveness, as i understand, the c. A. R. E. S. Act and hhs will be announcing it. Do you know who wrote it . Its really just a meeting the criteria. Its not a plan in how to respond. Okay. Well, what i would request is that we get a plan i agree with you. So that we can make sure that we actually collect this data. Yep. Going back to the other point, weve seen native, hawaiians and island Pacific Islanders have the highest covid rates of any race group in california, and in many states, Asian Americans have a case fatality rate significantly higher than the overall population. I hope you will do more than look into the disaggregating of aapi information but that you will make it happen. I also hope that you will add the lgbtq community. June is pride month. This is a great time to add them to your forms, your surveillance forms, in particular, the person under investigation form. Your website also states that a lack of Health Insurance is one of the reasons that communities of color face systemic Health Disparities, and in tlparticula have been hard hit by covid19. Isnt your professional opinion then that dismantling the aca and the administrations proposed budget cuts of 1. 6 trillion to medicare and medicaid could actually harm people, and in particular, people of color in this country . You know, congresswoman, the way i can answer this is that, you know, i share with you the deep commitment to all americans get access to highquality health care and that we effectively address access issues. I do know do you think there is a way to address the disparities of health care in this country without expanding, rather than reducing access to quality, affordable Health Insurance . I think we clearly have to make sure that all americans, and expand the ability to get access to highquality health care. The manner in which we do that, you know, i am not really here to comment on it, but im not asking you to comment on the manner. Im just saying, is there any way, in your professional opinion, to address these disparities, if we do not expand, rather than contract access to health care in this country . And as i said, im firmly with you that we need to continue to expand access to highquality health care in this country for everybody. Thank you. I yield back. Congresswoman frankel. Yes, thank you, madam chair. Thank you. I want to thank your staff, lori i hope i said her name right, but she really set us up well for this, and im finding this meeting actually very enjoyable, and im sitting at home. That makes it even better. I didnt have to get on one of those planes. So, thank you, dr. Redfield, for your service to our country. I want to i have a few questions. First of all, dr. Redfield, do you agree that the cdc might have learned more about the virus and the necessary response, had we had a greater Global Presence in the days and months leading up to the covid outbreak . You know, congressman, i think we would have benefited enormously from having a greater presence, particularly in our cdc office in beijing. Thank you for that. In your written testimony, you say that Contact Tracing is a core infectious Disease Control strategy and involves case and contact investigation followed by implementation of intervention. Youve also i know you testified at the senate that Contact Tracing is going to be the difference from succeeding in containing this outbreak. So, first of all, i just have a few questions in regards to Contact Tracing. One of your former predecessors, tom frieden, has suggested a workforce of at least 300,000 people in the country to effectively contact trace. Id like you to comment on that. And then a few other things. How should a community determine the right number of contact tracers they need to respond to the pandemic . Thank you very much. You know, ive spoken to tom about this. I know his number. He estimated 300,000. I mentioned that ive estimated between 30 and 100,000. It is sizable. I think we wont really know until we work state by state. We have met with all 50 states and jurisdictions, and some of the metropolitan areas or cities that we have also, and to work with them to figure that out. Im happy that many of the states have started to really expand. A number of them have already added 1,000, 1,500 contact tracers. Were working with them. Cdc has made available through our foundation the ability for states. We will allow them to hire people to help augment the e epidemiologists and the Leadership Group that they need. And then were looking at them with the resources we gave them. Were hopeful that the americorp will be another source, but we really have to get this built and we have to get it built between now and september and get these Public Health workforces up. And in some states, it may be 500. In other states, it may be 5,000. Were in the process of doing that state by state by state to help them understand, what is that workforce they need. What exactly are you doing to build the Contact Tracing, the workforce . So, what were doing is really a couple things. We have over 600 cdc people now embedded throughout the country, but weve, through our foundation, our cdc foundation, is there to hire for the states additional personnel. And we can augment that substantially. That process is ongoing. In addition, obviously, weve dispersed the resources that you all have given us to the states to encourage them. And some states have already, i know, hired on their own over 1,000 individuals that are being trained as contact tracers, to work under the supervision of the people that they hired through our foundation. And were going to continue to do that. And lastly, im hopeful that americorp will also in each of the states be having a Public Health workforce that will provide more longterm7v augmentation of this Public Health workforce. So, were working state by state by state by state to see them augment. And as i mentioned, some states have already augmented over 1,000. You know, finding that magic number, i dont know. I do think in some states its going to be over 5,000 people, maybe 10,000. In other states, its going to be 300 to 500 people that they need. But it is fundamental that we have a fully operational Contact Tracing workforce that can every single case, every single cluster, can do comprehensive Contact Tracing within 24 to 36 hours, 48 hours at the latest, get it completed, get it isolated, so that we can stay in containment mode as we get into the fall and winter much 2020. Thank you. Madam chair, if i may just follow up with one more thought on this, on Contact Tracing. You know, were watching all these peaceful demonstrations. And i know a lot of people are very close together. So i just would like your what are you advising the states, if the number of cases overwhelm Contact Tracing abilities . Yeah, i think the first thing i would like to see is those individuals that have partaken in these peaceful protests or been out protesting, particularly if theyre in metropolitan areas that really havent controlled the outbreak to the extent we want. Minneapolis happens to be one whos still having significant transmission. D. C. s another one. We really want those individuals to highly consider being evaluated and get tested, and obviously, go from there, because i do think there is a potential, unfortunately, for this to be a seeding event. And the way to minimize that is to have each individual to recognize its to the advantage of them to protect their loved ones. Hey, i was out, i need to go get tested, you know, in three, five, seven days, go get tested, make sure youre not infected. All right, well, i dont think you answered that question, but you know, the question is what are you advising the states if theyre overwhelmed and they dont have the contact tracers . Yeah, i want to work with the states so they dont get to that pace. I agree with tom frieden, we need to build that workforce and they need to work with us now to make sure theyre overprepared. This is not an area that you need to skimp and be underprepared. This is a time to be overprepared. And if you hire extra contact tracers, then you can use them to help with our hiv Elimination Program or vaccination programs, our Maternal Child Health program. But this is not a time to be understaffed. Thank you, madam chair. I yield back. Congresswoman bustos. Hello. Everybody. Thank you very much, dr. Redfield. Appreciate your time today. And thank you, madam chair, for putting this together. My entire screen disappeared when i went to gone on mute. I think this were learning this together. Like many of my colleagues i know congresswoman clark brought this up. Congresswoman lee did also. I am very concerned by how covid19 is impacting our communities of color. I would like to start there with my line of questioning with you. Im from the state of illinois. Africanamericans represent roughly about 15 of the population but nearly 30 of the covid19 deaths. Hispanics represent about 17 of the population in illinois and 31 of the people diagnosed with covid19. That puts it in perspective. Im going to drill down to my Congressional District. I want to look at specific to my district. The farthest northeast county in my Congressional District, africanamericans make up 13 of the population there and 25 of the covid19 cases. In the farthest southeast part of my district, africanamericans make up 18 of the population and 36 of the covid19 cases. Where i live, where im sitting right now, the Mississippi River is to my left, hispanics make up 13 of the population and 22 of the covid19 cases. Dr. Redfield, given these facts, i want to ask you how social determinants can influence this. I heard a story of a resident who literally would have to stop at 16 stops while riding the bus to get to a grocery store. Thats the only way that that person had access to fresh produce. My question is this, dr. Redfield, can limited access to healthy food increase poor Health Outcomes and lead to issues like diabetes and obesity . Do such conditions put people at higher risk if they contract covid19 . Thank you very much, congresswoman. You have hit on a critical issue, something i would love to work with congress. The social determinants of health i shrug my shoulders and say, i dont know if thats relevant. But obviously, data is the key. I happen to be data driven. I have seen compelling data to show it do determine longterm Health Outcomes. I would like to work with congress to develop the mechanism for this nation to understand longterm which are the most important. Ive talked about trying to set up a study over the next 20 years that allow us to nail down firmly, is it the grocery store, is it the fresh area, is it violence in the home . What are the critical social determinants of health . Theres no question as pertain to quality food have enormous impact on Public Health outcome. Lets drill down. Part of my line of questioning, dr. Redfield, is i want to make a point i think were on the same page here. I hope my colleagues are as well. Theres a 2018 report that says two out of five black residents are below the 100 federal Poverty Level in the rockford region. Thats the farthest northeast region of my district. Can you talk about how poverty can lead to negative Health Outcomes . Can Poverty Levels put a person at greater risk of contracting covid19 . I dont think theres any question. What i would like us to not me, but hopefully my grandchildren or maybe in the next five years, ten years, i would like us to understand exactly which social determinants of health are the most influential. We dont have to wait for an answer to start correcting them. Some are intuitive. I do think this is one of the critical Public Health issues of our time. Thank you, dr. Redfield. In my five remaining seconds, what i would like to point out is i have a bill called the social determinants act. Also, dr. Redfield, im hoping this is something that not only will have a debate around it but also pass it this congressional session. Thank you very much. I yield back. Congresswoman watsoncoleman. Thank you, madam chair. Thank you very much for this hearing. Thank you, dr. Redfield, for all of your testimony thus far. I want to follow up on a couple of questions that have been posed to you. With regard to the report thats going to come out thats supposed to break down the demographics of where the disease is, how it hit and how its affecting certain populations, will that information that is coming out in the report on the 15th include the number of positive cases by race, ethnicity . The number of hospitalizations by race, ethnicity . The number of and percentage of deaths under those categories . Will it be broken down to that finite degree . Just to clarify, again, congresswoman, this is the beginning of finally getting the data that we really need to do all that you just asked. There is now thats a no . Thats a no . Its not a no. Im saying, this is the beginning to the data to get the report in the manner you ask. The first step is to get the data. Thats really what the announcement is later today, that that data is coming to us. That gives us, enables us to give those reports in that detail you request. Will that be in the report thats coming out on the 15th . We will wait for a later report . Just want to know. Im going to give you all the data that i have at that time. Youre not answering the question. Im going to give you the data i have. Thats all i can do. Thank you. Reclaiming my time, doctor. When will testing be available to anyone who wants it and thinks they need it . Do you have any idea . I think the key on this testing is for it to be a decision between the individual and their Health Provider to get the testing. Im simply asking, is there any impediment to anybody getting tested who wants to be tested if they have a doctor and the doctor says yes . Is there Testing Capacity that exists to meet that need . There should not be an impediment. If you are if you dont have a relationship with a doctor and you are just an uninsured individual, how do you get tested . Theres a variety of testing sites that have been set up. I know i think over twothirds have been set up in areas that are considered socially disadvantaged. Those sites are available for the American Public. If were going to consider reopening up our economy, is there any science that informs us as to what percentage of a population needs to be tested and their information traced, if necessary, before we know that were really in a healthy mode as opposed to a leveling off of a curve simply because of the few numbers that were testing . Is there a percentage of the population . I know each state will be different in terms of the number. Is there a percentage of the population . Its an excellent question. What we have is estimates from the w. H. O. And others that the threshold of being adequate in your testing is when one out of every ten tests that you do is positive. When okay. But thats how many based on how many you are testing. Im asking you, what is the percentage of the population that should be testing . I dont know the answer to that question at this moment in time. Okay. Are there people in the Science Field who think they have a handle on that . If so, would you find out for us and share that information with us . Yes, congresswoman. Thank you. Earlier on in response to a question, you made a comment that if this were a Global Health threat. Is this not a Global Health threat, this pandemic . Yes, its a Global Health threat. You must have misunderstood. Thank you. Then should we not be connected to the World Health Organization . Have you any position on that . Have you given the president your wisdom, your advice on that . The w. H. O. Continues to be a close colleague of ours in the Public Health efforts. Were working on a number of outbreaks around the world, polio, ebola. We continue to have a close collaboration with the w. H. O. It doesnt seem to be a priority of the president s. Im going to ask you about the ozarks, the wonderful time they had on memorial day and the launching of the space shuttle. Even though those states may not have asked for your help, because of the possibilities of additional infection or higher rate of infection because those people were so densely integrated into whatever they were doing, is there a role for the cdc to be proactive in reaching out to them to see if we can get a handle on what possibly could be a problem before it becomes a big problem . If so, what would that be . I agree with you, congresswoman. We routinely reach out to state Health Officials and offer our assistance. In those circumstances, i have 3018s out assisting different states and territories with the different outbreaks, particularly in the area you mentioned, Contact Tracing. We will continue to emphasize that, obviously, to our colleagues in missouri and florida that were prepared to provide the assistance if they would request us to come in and help. Thank you. Chairman, one last thought. Given your vast experience and your interest in this area, was it not obvious to the cdc that the Africanamerican Community would be disproportionately negatively impacted by this covid from the very beginning . Again, congresswoman, i think we have worked and will continue to work to try to identify and help respond to develop interventions that can minimize the impact of this in the Africanamerican Community. And we have. The challenge that we had that we have acknowledged is we havent gotten the data that we needed so that we could give the American Public the analysis. Again, were going to continue to commit to get that data so we can do that. Thank you, dr. Redfield. I guess you have to go where the action is. Thank you. I yield back. Thank you. Were going to begin a second round. It can be only two minutes. Dr. Redfield has a hard stop at 1 30. I want to accommodate people. We can only go two minutes. Try to be as lenient as i can because its a critical, critical hearing. People have excellent questions that they need to get answered. With that, let me start. What i want to do is talk about vaccinations. Influenza vaccine campaign. Dr. Redfield, you said that in april, the need for an enhanced vaccination effort this fall for seasonal flu. As you noted, we were going to have were going to have a flu epidemic and the coronavirus epidemic at the same time, which will put tremendous strain on the hospital system. Yes or no, do you still stand by your april 21st questions . Or answer. Yes. I think were going to have a difficult time. Given that, we have to be prepared to deal with that effort. We are going to be having companies around the world racing for a vaccine. Theres funding that needs for infrastructure, medical supplies, work force and a bunch of unknowns which have to do with storage requirements, cold chain supply. Explain that aspect of massive vaccination campaign. Whats already in the work ss . Whats the funding capabilities . If you cant deal with the funding, i want a budget. It willi ismpact our negotiatio when we are dealing with the senate on the heroes bill. Is that in influenza or covid . I want to know about vaccine but i wanted you to answer the question on influenza and what we need to do with regard to that. The covid vaccination, run by the secretary of defense and secretary of health, thats moving rapidly. Its moving quickly. Its my expectation we will have one or more vaccine available before the end of the year for covid. Which will be a great the infrastructure for putting this together. And a budget for putting this together. We need it now. We will be able work with hhs and get that back to you. I do want to emphasize the importance of flu vaccine. To really get our nation accelerated. As you know, only 47 of the American Public take advantage of flu vaccine. Were hoping that the American Public will see that the flu vaccine is one major way they can help this nation get through this fall. Thats going to be a further strain on the system with this virus. Congressman cole. Thank you very much. My friend from wisconsin had questions about my numbers. Let me add some. Death rate in the United States, 333. 9 per million. United kingdom, 597. 5. Italy, 556. France, 433. Spain, 580. Belgium, 835. 9. Netherlan netherlands, 347. 6. Sweden, 446. Ireland, 341. 8. Thats are advanced countries with first rate health care. Frankly, likely to produce numbers we can trust. Personally, for the record, i dont trust numbers coming out of russia, china or iraq. I think a lot of the rest of the world doesnt have the infrastructure to give us. I will say theres real stars that i do trust. Japan, 7. 1. New zealand, 4. 5. Taiwan,. 3. Hong kong,. 5. I say that to say their places have done this better than us. We have lessons to learn. I want to be clear that were not the worst in the world. This data is very interesting to compare, because its not the same data from the same source. Theres a lot of apples and oranges comparison. Let me more to something near and dear to my heart. Recent data from the university of california said tribal nations were states, the five with the highest infection rates in the country would be tribal nations. On a per capita basis, five tribes have more coronavirus cases than new york. Given that challenge in that community, can you tell us some of the things i know you are working on this hard that you are doing to help tribal nations deal with this . Its really important, congressman. Clearly, the native American Community has been hit. We have been able to award, as you know from what you have granted cdc, almost 60 million to the tribes with the total hopefully to be 205 million, to Indian Country to help give them financial support. I think more importantly, we have also provided a number of Rapid Response teams into Indian Country to basically provide Technical Assistance. They have had some of the more significant outbreaks, as you know. Help them with Contract Tracing and Community Mitigation as well as some of the challenges they have had in dealing with particularly water security. We will continue to augment the ability of the Indian Health service to support the tribal nations in terms of providing Technical Assistance and resources. They are disproportionately affected. Congresswoman, can you unmute . Yes. Can you hear me now . We can hear you now. Dr. Redfield, first of all, let me acknowledge under the leadership of both congresswoman delora and congressman cole has been mentioned efforts have been made to address the serious sho shortfall in cdc funding. Nevertheless, there remains deficits in local and state Health Department resources as well as cdc still has an antiquated infrastructure. Theres been discussion that you have received billions of dollars to address the covid19 and also its anticipated you will be seeking more money under the heroes act. Can you explain to this committee, what is the difference between what this supplemental funding pays for and the base funding that you actually need to address the shortcomings in cdcs infrastructure and core capabilities . Then quickly, after you answer that, if you could just please give your opinion with regard to what your predecessor tom friedman said about the need to create a Health Defense operation budget designation that would exempt several Health Security budget lines from the spending caps so we dont have the same situation where cdc gets money through supplemental during a Public Health crisis and then we go back to the erosion of funding cdc. Thank you very much, congresswoman. A majority of the funds that we have received from the supplemental we have really pushed out to the state, local, tribal and territory Health Departments to give them the Immediate Response capability. At cdc to support the more than 5,000 people that we have now moved out to help support this response. Its really been directed at Immediate Response activities. As well as building that capacity in the states we mentioned for rapid ready testing, Contract Tracing and isolation and quarantine. The issue is many states dont have the capability to effectively isolate people that dont have adequate housing. This has to be built. The real challenge, as has been alluded to by the chair and congressman cole as well as yourself is, how do we get this into the longt hlongterm base . I will say that i dont know the best way to accomplish that. Its going to be very, very important. I think the comment also that you have worked with the Emergency Response fund, the ability to have emergency funding when things happen around the world is important. Thank you. Thank you very much. If im correct, despite reopening and greatly increasing number of tests so you can confirm more cases, were down about 40 from our peak, is that right . Its 32,000, now its down to 20,000 . Yeah. We average 20,000 new cases a day. Were down about 40 , again, despite reopening and despite more testing. So thats evidence that i guess that we are on a decline and now is the time to think about reopening, because we cant really stay shut down forever. You brought up a point in response to a previous question. If cdc is expected to be the foremost Public Health authority in the world, it needs cooperation from other Health Authorities in the world. Can you describe the cooperation between chinese authorities and the cdc in january when we really needed information about this epidemic that was going to become a pandemic . As you know, congressman, we have a cdc office in beijing. Its limited in its staffing. I had augmented it. I had been in regular discussions with my counterpart who is the chinese cdc director over the new year. We did have discussions about what was then an unidentified pulmonary illness. We did request the invitation to come in and assist them directly. After the coronavirus, we reiterated that, formally requested at the levels above limb to grant that request. Unfortunately, we havent been able to have that scientific interaction that we requested. Is that because you think they also consider cdc the worlds leading expert in Public Health . Was it for political reasons . I know, you cant it was a rhetorical question. I assume the release, for instance, of the Genetic Information on the virus was held back until it was reported outside public channels. You cant do your job if we dont get cooperation. We didnt get cooperation from the chinese. I yield back. Thank the gentleman very much. Congresswoman lee. Thank you for meeting next week with the black, hispanic, naive american members of congress. Its going to be a very important meeting. We thank you for that. Let me just say one thing as it relates to what was talked about as it relates to social determinants. We have a road map, the National Medical association, i know all of the africanamerican doctors, the asia pacific american, Hispanic Community in terms of the medical profession, we have the road map how to deal with that. The Surgeon General back in the day came forward with that. I was surprised and disappointed that your response it takes political will of this administration to address it. We need to discuss that with you further. We cant wait. We know what the social determi determinants are. We have a road map on how to address that. Let me ask you about contact tracers. Because of the sensitive nature of this work, we want to make sure that contact tracers are from the community, trained and provide the very sensitive type of work. Can you comment on a protocol or the importance of having not people coming into our community doing this in minority communities but the trust of messengers, how they would be trained to provide this type of work . Thank you. I will be quick. Im familiar with the thatcher report. I have high regard for it. I think it was a critical turning point. I was trying to raise the idea of getting scientific proof for which ones influence but not waiting. I look forward to working with you on that. On the Contract Tracing, i couldnt agree with you more. Its the same thing you and i discu discussed. We need to build trusted members of the community to be the workers to get this work done. We dont need outsiders coming into communities to do this work. We do have a significant training program. I do think these need to be we have to expand the community base. I have trusted individuals in the community to do this work. I couldnt agree more. Thank you very much. Thank you, madam chair. Thank you very much, madam chair. Let me ask you, dr. Redfield, a question about supplies. We have had a problem in wisconsin getting supplies from the federal government. Fema originally months ago said they would get us reagents that i think around april 8th said we would get them from cdc, from irr. In april, we got less than 1 of the reacts we requested as a state. Last month, of all the information we requested, we got less than 18 . I find it confusing that of all the ppe and other supplies that were supposed to be getting, fema gets us some of it. One out of every five items we need. We have to go to another agency to get reagents. From cdc, we can only get for public labs, which are a couple in the state. We have 60 doing covid tests. We need more reagents. We need them for hospitals and clinics. Were not able to get them from fema and from the cdc. Clearly, the cdc and irr, which is longstanding that we support our Public Health labs is that mechanism for the Public Health labs. Congressman, i need to look to see. I know we have been transigi g transitioning to the public sector. Let me look directly into your request and see if i can get better clarity and get back to you and your staff. I appreciate that. In the 30 seconds i have left, mr. Harris said that cases are going down. However, scott got lelieb said expacting the number of cases according to a report. Thats part of because theres still this no consistent standard for people reopening. Can you address, what did we do wrong that we are ninth worst in the country only behind qatar and bahrain . I do believe we have enhanced our response. As i mentioned, i think we have tested almost 17 million people. I dont want to get into the number of the tests. Its how testing is used and the consequence. We have, after the slow start that we had in getting the pry vase s its not to say were at the end of the day. We need to expand access across this nation. Its not where it ultimately needs to be. I will say that each day, each week, we continue to make progress for that expansion. We will continue to do that. I will look into the specifics of your question related to where Additional Laboratory reagents are coming from for your state. Thank you. I yield. I yield to congressman graves and since congressman graves did not get his five minutes in the first round, he is recognized for five minutes. Thank you, madam chair. Thank you, dr. Redfield. I come to from you georgia. Thank you for your service ina [ inaudible ] i wanted to change a little bit to Antibody Testing. If you could share [ inaudible ] if there are approvals of testing kits. If you can give us feedback or insight into that. Thank you very much. There are a series of antibody tests that initially the fda allowed to come out and tests got on the market and they had to show they really were valid. A number have been pulled back. There are a series of antiibiliantibody tests that are really quality test. The real issue is what does antibody mean. Right now, we dont really know exactly what antibody means. If you have a valid antibody, it means that you have been infected at one point in time with the virus. We dont flow how long that antibody will last. We dont know the critical question. When does the test mean you are immune to the virus . Thats what we are trying to find. It does help us at cdc to understand the full extent of the infection in our nation. Our current estimate is 5 of the American Public got infected during this initial experience. That does mean that about 95 are still susceptible, for us to understand what might be coming. Some cities, its different, like new york, obviously and the new york metropolitan area. Thats the key. Right now, its a surveillance tool we have. Whether it has clinical implications or not, we dont know. Thank you. It seems like theres a lot of potential for fraud. Im sorry maybe you could share with us, how do you think what about the accuracy and reliability of the testing . I think your point is critical. I can have my staff get you the actual list of the testing that we know we do not recommend and that the fda is asking to get off the market. Then theres another group that have really performed well. I can make sure you get that. Ortho is one of the main ones that we have been using for Antibody Testing. I can get you that and make sure your office has it. Great. Thank you. As we are talking about testing and the covid19 testing and the testing sites, is there any value to at the same time testing for antibodies. A lot of individuals get tests because they are concerned they may have the virus. Is there value in testing for both simultaneously and on top of that if do you believe its something that should be paid for by the government as we have as the covid19 testing is . The challenge that i have there is just trying to understand what the Clinical Utility of Antibody Testing is. Cms they will pay for it if its for a specific clinical indication. My understanding is they pay for it with the clinical indication being that you have been previously infected by this virus. Thats the one part. I was going to Say Something else, but im having an adult moment. The first part of your question . Should the antibody tests be conducted simultaneously with the covid19 test . I think the one area that it has a major clinical relevance is in children. You have seen about this hyperinflammatory syndrome we see in children. Luckily, its very rare. It occurs post a covid infection. It does help understand that thats really the causation. We do use Antibody Testing in trying to define the Case Definition of children that have this new rare inflammatory system. I think the answer to your question, just to be honest and transparent is, i dont know. Thank you. To sum up on Antibody Testing, we dont know what it means right now . Somebody tests positive. It sounds like we dont know how long might it last. Those results will be determined. Thats correct. It is one of the critical things i think were going to learn between now and january. Great. Thank you. Thank you, madam chair, for letting me jump in late today. Thank you so much. I want to go back for one minute to the disparities and outcomes and ask if the cdc has made any effort to ensure public test sites are installed in communities of color. Is that going to be a focus . That was orchestrated by the assistant secretary of health. I dont have the exact number. I can tell you that 60 to 70 of them were put into areas that had were basically in areas that had social distance advantaged sites. I can get you the exact number. There was a direct intent to open these sites when the federal government opened these testing sites that you know. In the last couple days, i was telling the chair woman before this hearing, unfortunately, we have a new ebola outbreak. We jumped on to begin to confront that. If this administration completely severed our ties and demanded you did as well, are you worried about our impact to develop our access of vaccination . You know, i dont want to get hypothetical. I feel theres i feel confident that the Public Health partnership we have, although it may be modified in some way and a political level, i dont think its going to be modified in terms of our Public Health efforts. Thank you. Congresswoman frankel. Thank you, madam chair. Dr. Redfield, i have a softball question for you. Older adults represent a High Risk Group for covid19 as higher with a higher hospitalization, mortality rate. Cdc correctly is telling them to stay home. We also now see that this isolation is exacerbating Mental Health challenges, making it difficult to obtain food, fill prescriptions. My question to you is, would cdc benefit from an increased collaboration across agencies during the pandemic as well as the pandemic, beyond the pandemic to meet the Public Health needs of Older Americans . I think you raise critical, critical questions. As you said, many Older Americans who have stayed at home have then also had negative consequences of isolation, lack of human connectedness, obviously other issues into maintaining the critical activities of life. They have necessarily maybe not gotten the preventative medical care for chronic illnesses they need. Were committed to continue to work and figure out how to mag niez just to remind you, i know we talked about this. We filed a Bipartisan Legislation that we established a national covid19 Resource Center for Older Americans within hhs and established a Healthy Aging Grant Program at the cdc. I thank you. I yield back. Thank you. Congresswoman boostos. Thank you, madam chair. Dr. Redfield, there have been large outbreaks of covid19. Our communities, our prison staff, our inmates are put at risk because the bureau of prisons continues to transfer inmates without first testing them for covid19. This is in part because the cdc guidelines do not recommend testing inmates before they are transferred, even from facilities with covid19 cases. Your guidance this is a quote. If a transfer is absolutely necessary, perform verbal screening and a temperature check. End quote. As a result of this, a few weeks ago, the bureau of prisons transferred 19 inmates from the chicago prison where there are cases of covid19 to the thompson prison in my Congressional District where there were zero cases. They did this without first testing all inmates. Now two of those inmates have tested positive for covid19 at our prison in thompson, illinois, which by the way, there are no hospitals in the county where that is located. Those inmates that have tested positive for covid19, we got that. For weeks, because of all of this going around, i have been pushing the bureau of prisons to test all inmates before they are transferred. What they have told my office is that they cannot test inmates before transfers because they dont have adequate testing supplies. A couple questions, what is the cdc doing to increase Testing Capacity at the br raw ureau o n prisons . Should inmates be tested before they are transferred . Im hoping you will end this by saying you will update your guidance. Thank you. You raise a very, very important critical issue. I think we know that we are learning as we go along. One of the areas we prioritized for surveillance and when we talked about the 10 billion to go out for each of the states to come out with their testing strategy, the priorities that we have given them is a comprehensive surveillance strategy. All nursing home residents to be tested. Weekly testing for the workers in the nursing home. To develop their prison guidelines. Thats being debated back and forth. I think theres a strong sense of getting everybody tested in the prison. New people coming in. I cant tell you where thats going to land. We are discussing that now. Obviously, encouraging states to use these new testing resources to accomplish that. Obviously, the same goes for homeless and shelters and homeless settings. These are critical areas that in Certain Industries like meat packing plants where we have this. Were on board with you that we need expanded testing, particularly high we have to wrap up. Okay. I yield back. I would love to know more. We can talk offline. Thank you. Dr. Redfield, i want to explain something to you what my concern is about our opening up our various states. I asked you that question about whats the safest percentage of people that immediate to be tested as a function of the population. Some states may be testing more than other states. Some states may have morree relevant data as to what the situation is because theyre testing more. The state next to you may be testing only a fraction of the people that it needs to test. Is there not any kind of guidance what percentage of the population needs to be tested to make sure that were at optimum opportunity to open up . I think you raise an important point. I know the first threshold was at least 2 . I know we have some states that are over 10 . I think you have raised this earlier and you raised it again. This is an area we will have our subject Matter Experts discuss, because its clear that we would benefit from this guidance. Thank you. Lastly, i want to point out that when the aca was passed ten years ago, there was a section under 4302 where you were the there was a form to collect information and have the requirements that we have asked for. Its not really creating something new. Its something that really already has been in operation. Does that mean your form is out of compliance with the requirements of the aca and the law passed ten years ago . No. Our form that we do for case reporting has that information. Where the challenge has been is the reporting of the actual Laboratory Test results. Historically, thats not something that was necessarily independently reported to cdc. We would get case report forms and that data we do have good racial ethnics and sex distribution. We know where its coming from. Were getting reporting of all the test results. Its a test result. They come in without that information nonname linked. Every positive test result, every negative test result is going to have those fields that we discussed. I think its going to be very helpful for us to get even additional sets of information based on testing. Thank you. I yield back. Thank you. Let me yield to congressman cole for closing remarks. Thank you for holding this hearing. Its very informative. I want to thank all the members on both sides. The participation and questions were good. Dr. Redfield, i want to thank you for being here. You have one of the most important jobs in of the United States, but probably one of the toughest. I appreciate you giving our committee this much time. I want to thank the president s chief of staff who helped make that possible. I know our chair talk ed with hm directly. He couldnt have been more helpful in making it possible. We are grateful for that. We covered a lot of ground today. I thought it was very good. I think appropriately so, a lot of the focus is clearly driven by coronavirus, clearly on massive supplementals where we have devoted much more money to this than your normal entire budget would be. We have entrusted a lot of money there. You have done a tremendous job moving this through the chain at cdc and getting it out into the country and to your state and local and tribal partners to deploy these resources really well. I want to thank you for that. Acknowledge the hard work on your staff. I want to close by saying, while im confident the congress will continue to work on these supplementals, like i suspect the chairman, im worried about the longterm funding here and capacity. You have talked about that in your opening remarks and in your testimony. I dont want to lose sight of that. This committee and frankly the congress are dealing with a budget agreement that, again, was done in good faith. Im not critical of anybody for it. It doesnt apply now. Just as i told somebody the other day, the Defense Budget was one thing on december 1, 1941. It was something very different in january 1, 1942. Theres an intervening event called pearl harbor. This is a biomedical pearl harbor. We need to recognize that and not just deal with this thing but build the capacity. A phrase i used is not popular with some of my friends, but i think its right. Its a smart thing to spend billions to save trillions. We know what the cost of this event has been to our economy and our country. We need i hope our leadership on both sides i will work with my friend the chairman on this. We need to have the adequate, permanent investment. Ebola and some others have taught up, the supplementals can be helpful. The capacity erodes when the supplemental money runs out. We need the longterm thinking. We know we will be dealing with this in the fall and for the foreseeable future. We also just got one heck of a lesson from the biosphere about how dangerous it is and how when we think we have done pretty well, it wasnt nearly good enough. I pledge to my friend the chair, we will be working with you to try to make sure that you have the resources and that this committee has the resources to invest, to give the American People the protection that they deserve and they require and to work with our friends around the world. When we do this for ourselves, frankly, we also work with others and appropriately so. This is a global pandemic. There are no isolated countries. We will need to Work Together. I thank you for your leadership in that area, dr. Redfield. You have been a visionary on this for a long time. We talked about this many times before we were dealing with this crisis. Thanks for being ahead of the curve on that. Madam chair, thank you for the hearing. I thank the gentleman. The gentleman is my friend. Its good to partner with you on these efforts. Thank you, dr. Revealed fdfield being here today. I know represent harris said we have been successful in reducing our cases by 40 from a peak of 32,000 a day to 20,000 per day. We are ready to reopen. I just reiterate that it wasnt what we talked about in march and we declared a National Emergency when we had 556 cases. Virtually all other developed countries have cut their cases by 90 or more before they reopened. The federal position seems to be our governments position is we cant do what other countries do. So we just have to live with 20,000 new cases per day. That puts us all in danger in my view. I agree with my colleague, congressman cole, that we need to have longterm funding and capacity. But i will say this to you, dr. Redfield. You made a comment that it was dr. Messenea. It was grounded in your center at the cdc. That is no longer the case. You are no longer at the center. The point of the speer on this issue. It really has gone to fema. It has gone to the white house. I will be very honest with you. I want to build your capacity. I want to get you the data. I want you to be science driven. By god, i do not want your science and your Health Experts challenged by people who do not know and understand either science or Public Health. I might just add that we have talked about this, your guidance changes, delays, duplication. We didnt get to that. National Health Care Safety network, by hhs shows a message from this administration in my view that cdc is being undermined. The administration violates every rule in your 450page manual. All of the time. Talk about lysol. Talk about lysol. We need credible messages. We need credible guidance. We need to hear more directly from cdcs experts. The cdc media briefings, i hope you will just one more comment from you and one more thing to say. Your briefings stopped. You had daily briefings. And they stopped. Those briefings need to continue. I hope let me say this to you. Will you continue those daily briefings . Its a yes or no answer. We had them weekly. We did our weekly briefings. We do have our briefings back. I did one last friday. Right now they were going to be every other week. Im working to get them every week. We need to have those briefings back online. I want to comment on yesterday. Nature published a study that analyzed the Economic Impact of lockdown and reopening. The conclusion was that to protect our economy, we need to focus on Public Health. We are not doing that. I make a reference to these photographs. I showed earlier on. We are not doing it. Reopening before the virus is under control will put our economic recovery at risk. Until we get that and its loud and clear from the science community, from the Public Health community, we are not going to succeed economically in my view. You talked about testing. The number of tests every day and knowing that and the public knowing that is important. Because we need to know who is testing, where they are being tested and where they are not. I just say, i am in awe of science, dr. Redfield. I dont have scientific knowledge. Dr. Harris does and there are others. But most of us do not. What we do here is to provide the resources that allow you and your colleagues at the cdc to do what you do. We are reliant on that science. Let me just say to you, dont be afraid. Stand up. Talk about what your scientists do and give us that direction. I will tell you that we will provide the resources that you need to do your job. Without that and without driven, there will be a great reluctance i will speak for myself on my part to go further if its not a partnership in Going Forward. Thank you for your service. Thank you for what you do. As i said domestically and internationally. I know that is where your heart and soul lies in the science. Let us hear from all of you on that. Thank you. This hearing is over, closed, whatever the word is for it. Its adjourned. Thank you. Today at 2 00 p. M. Eastern, nancy pelosi will speak about the protests taking place across the nation following the death of george floyd, an africanamerican man who died in police custody. Watch her briefing live here at 2 00 p. M. Eastern. P. M. Eastern. Today at 3 30 p. M. Eastern, secretary of state mike pompeo will hold a news conference, well have that for you live here on cspan3. Tonight on American History tv, a look at the american revolution. Beginning at 8 00 p. M. Eastern with historian park ranger and author Philip Greenwald on bostons role on the origins of the revolutionary war. Thats followed by a discussion of revolutionary war clothing and how it impacted the error and the origins of the american revolution. A number of historians offer their thoughts on how it started. Watch American History tv tonight and over the weekend on