Transcripts For CSPAN3 Hearing On Interagency Coordination On Coronavirus 20240713

Federal agencies are working in response to the coronaVirus Outbreak. Ken cuccinelli is acting deputy Homeland Security secretary, and dr. Robert kadlec is assistant health and Human Services secretary. They testified before a senate committee. Topics included supply chain management, sick pay support, and travel issues, specifically, how the coast guard is working with cruise lines. This is just over two hours. Good morning. This hearing will come to order. I want to thank the witnesses first and foremost for your efforts as theyre related to the current, i guess weve got to call it a pandemic at this point in time, right . With covid19, the coronavirus. I guess its important to put things in perspective and i ask to submit my Opening Statement to the record. But i think we oftentimes fail to recognize and put this in proper perspective, so let me just rattle off a couple figures here. Ebola. Total cases worldwide ended up being less than 29,000. Now, i remember in the midst of that crisis, we were talking about this thing spreading and could be a Million People, which obviously would have been a huge problem because ebola had a mortality rate of 40 . But in the end, because of really effective action on the part of the world health organization, the obama administration, we surged resources in there and prevented that from spreading, so less than 29,000 people actually contracted that. About 11,000 people died. Weve had other outbreaks of ebola, where were Getting Better at it. Weve developed i think some relatively effective vaccines that certainly help protect Health Workers and well talk a little bit about that, mr. Cuccinelli, in our Senate Briefings pointed out that thats a finite resource. The next deadliest virus weve been dealing with is the 2012 mers outbreak. Total cases were less than 2,500. 858 people died. So that had a mortality rate of 34 . 2003, we dealt with sars. 8,000 people affected, 774 people died, a mortality rate of 9. 6 . The average flu, you know, the seasonal flu these numbers are a wide dispersion of what happens. 9 to 49 Million People a year catch it. 140,000 to 810,000 people are hospitalized with it. Obviously anyone with Underlying Health conditions, the elderly are most affected by it, and we will lose there will be 12,000 to 60,000 fatalities per year with just seasonal flu. Another virus that certainly reached pandemic levels, sure sounded scary was the n 1 h 1 virus. The actual stats on that is about 60 million americans caught h1n1, over i think 200 million nationwide. Worldwide 150,000 to 175,000 people died from h1 globally, but the fatality rates were not that high. I mean, thousands died in the u. S. , but weve dealt with these things in the past. So, the current stats, as far as i have them, that we know about, 81,000 individuals have contracted and tested positive for covid19. Close to 3,000 deaths. The latest mortality rate is about 3. 4 , which is serious. I mean, the normal flu mortalitys about 0. 1 . So, this is definitely more virulent, a higher mortality rate, but i would caution everybody in terms of that mortality rate. This is just deaths from people we have tested. And we dont have the types of test kits or the numbers yet. Were developing them rapidly, thanks to, i think, reducing government regulatory burdens in terms of testing, getting the amount, and well talk a little bit about that. We definitely want to clarify that situation. But you know, my guess is the mortality rate, once its said and done, once we have a sense of how many people actually contract this or do not display symptoms or are very mild, particularly in young people, i think that mortality rate i would think would probably come down, but again, nobody knows. Theres an awful lot about this disease that nobody knows. So what im hoping we can accomplish in todays hearing is talk about this administrations response, which by the way, i think has been almost immediate. From what ive seen, my interaction, the accessibility of whether its acting secretary wolf, mr. Cuccinelli, members of the cdc, nih. Ive had access to them. Now, i have not abused that access, because i really want you working to mitigate this problem. But theyve been very accessible. I dont know how many briefings ive already attended. I appreciate we have two individuals here. You say, well, why dont we have like everybody representing every agency . Well, i want them to work. Theyve got a job to do, and i know theres been a lot of hearings, so youve been very accessible, that youve taken a wholeofgovernment approach. As ive said repeatedly, i certainly dont see the administration underresponding. In fact, youve taken unprecedented steps travel bans, quarantines for i think, is this correct, for the first time in 50 years . Unprecedented steps, so we have not underreacted. But i think this administration is fully aware of and cognizant of the cost of overreacting. So, the basic fact of the matter is, the chances of the administration getting it just right, reacting perfectly, is zero. It wont happen. But again, from my own knowledge, my own interaction, what weve seen in terms of the interaction with the senate and the house, this is an allgovernment approach, this is all hands on deck. This is not being ignored. I mean, you can just see the 8 billion response as opposed to the 2. 5 billion funding request. Funds are not going to be an issue. Congress will make sure the administration has the funds. In terms of priority of action, it is important that we are able to test so we know the extent of what the outbreak is. And i really want to talk about the regulatory issues, just the basic science issues. I was talking to dr. Kadlec in the front room. Theres a reason they call it medical practice. This doesnt just happen overnight. This is a whole new virus, just became known to mankind, what, three months ago, mr mr. Cuccinelli, you were saying . So it takes time to develop the tests to make sure the tests dont produce false positives. Then you have to manufacture them. So, im heartened by what im basically hearing, and i wont tell the figures now. I want to hear about those and we want to delve into those so we know what were really talking about in terms of what testing kits are available, how theyre going to be distributed throughout the nation, you know, kind of what the priority is for that distribution, so we really do get a sense by being able to test as many individuals as doctors want to test, because right now its been limited. Because theres limited number of tests, so theres pretty high criteria to test any patient. I want to talk about current travel restrictions. You know, obviously, this is Homeland Security committee. We want to talk about cbps role, tsas role, how youre cooperating with the cdc, what the screening measures are, what data were collecting. Mr. Cuccinelli, we talked about that, and youve reacted to our conversations. Were collecting more data so we can trace travelers that may have come in contact with people that are infected. So, we want to talk about all of those issues as relates to the department of Homeland Security. Again, testing is a top priority. But then, we also want to talk about the Current Issues with the supply chain, but also in the future. Once we have this all stabilized, we know where were at, you know, hopefully, this will prove to be somewhat seasonal, although there are indications it may not be. Once weve taken care of this and vaccines are developed and accessible to the public, which will be quite some time in the future, we really do need to take a look at the strategic stockpile, we need to take a look at the supply chains. We need to really ask ourselves, in a manufacturing process that is not laborintensive, why are so many of these precursor chemicals for drugs produced in india, which is now, according to a news report, blocking export of some of these chemicals as well . I see no reason for manufactured drugs approved by the fda for u. S. Use, that those things should be manufactured overseas. I just dont. And we have to learn from these types of situations and put in place either regulations or laws so were better prepared for the next pandemic, because there will be a next pandemic, because ive rattled off the ones weve already had to deal with. Again, i want to really thank the witnesses. Im hoping this is a really good discussion. Im hoping this is a clarifying discussion. This is about transparency, recognizing that you dont have all the answers because theres just things right now that are unknowable. But thank you again for your work in this. Thanks for appearing before our committee. With that, ill turn it over to our Ranking Member, senator peters. Thank you, mr. Chairman. And thank you to our witnesses for being here today. The top priority of this committee and of your agencies is quite simple, keep americans safe. To be clear, this coronaVirus Outbreak in the United States is not currently widespread, but nevertheless, it does pose a significant threat to our Public Health and our Homeland Security, and we have to take it seriously. And im grateful for the efforts of your agencies and Public Health officials across the country to limit the sprez of this contagious virus. While we have seen growing numbers of cases in the United States, we have, thankfully, not seen widespread outbreak yet in this country. It is the job of this administration to work with congress and our state and local governments to do everything we can to limit the spread of this virus. It is clear to me that we should also prepare for a worstcase scenario and widespread infections. Assessing clear information about coronavirus has been a significant challenge for the public to date. The American People have a lot of questions. They want accurate, reliable information about the virus spread and what the government is actually doing to protect their health and safety. As we have learned from past epidemics and pandemics, outbreaks like this require an aggressive, coordinated, and comprehensive response as well as timely and trusted useful guidance from Public Health officials as well as security officials. In the coming weeks and months, your agencies will play a Critical Role in containing the outbreak, educating americans about this virus and protecting Public Health. Whether your response is timely and effective will truly be a matter of life and death. With that in mind, i appreciate you joining us today. My constituents in michigan and the American People want clear answers to some of the most pressing questions that they have right now. I look forward to hearing what steps your departments are taking to ensure that we have the right plans and that you have adequate resources to actually execute those plans in order to stop the spread of this highly contagious disease. Thank you again for taking time to be with us today. Thank you, senator peters. Is it the tradition of this committee to swear in witnesses, so if youll both stand, raise your right hand. Do you swear that the testimony you will give before this kmem kme will be the truth, the whole truth, and nothing but the truth so help you god . I do. Please be seated. Our first witness is mr. Ken cuccinelli. Mr. Cuccinelli is the senior official performing the duties of the deputy secretary at the u. S. Department of Homeland Security. Mr. Cuccinelli recently served as acting director of the u. S. Citizenship and immigration services. He previously served as the attorney general of the commonwealth of virginia. Mr. Cuccinelli. Chairman johnson, Ranking Member peters, and distinguished members of the committee, its my honor to appear before you today to testify about the work of dphs and what were doing to respond to the outbreak of coronavirus disease 19, known officially as covid19. Let me first say i am proud of the work of the men and women of dhs and our partners in the department of health and Human Services and across the government are doing to contain the spread of the disease, slow the spread of the disease, and to prepare for a domestic response. The departments top priority is the safety and security of the American People, and were committed to an aggressive, proactive, and preemptive, wholeofgovernment response in fulfilling that mission. As required by congress in 2018, President Trump signed the First Ever National biodefense strategy to build upon our ability to rapidly respond to and limit the impacts of bio incidents like the one were facing now. Were seeing the strategy pay dividends as we implement a wholeofgovernment response to this disease. Dhs is taking action at airports of entry to support hhs in slowing the spread of the novel coronavirus. Dhs is working to decrease the workload of Public Health officials, expedite the processing of u. S. Citizens returning from china, and above all, ensure that resources are focused on the health and safety of the American People. Dhs, including Customs Border protection, transportation security administration, continue to work very closely with our partners at cdc to route all admissible persons who have been in Mainland China and iran in the previous 14 days to 1 of 11 designated airports of entry where the federal government has focused Public Health resourceresources. Any admissible person whos been in hubei province, china, the past ten days is subject to up to 14 days of mandatory quarantine where cdc has made arrangements with state and local authorities to ensure theyre provided proper medical care and Health Screening. Any admissible person whos been in the rest of Mainland China or iran within the previous 14 days undergoes Proactive Health screening at airports and if theyre asymptomatic, up to 14 days of monitoring to ensure they have not contracted the virus and dont pose a health threat. Dhs continues to facilitate enhanced Health Screening of travelers entering the United States who have recently been in china or iran. Travelers identified by cbp officers during their primary inspection are then referred to cwmd medical screeners. We have 500 of them, over 500 contracted and about 95 on duty at any given time. And for those that through medical screening are identified as particularly at risk, they are then referred to cdc personnel who are on site and have made arrangements with local Health Authorities. This has involved over 53,000 air travelers to date. We realize these actions could prolong travel times for some individuals. However, Public Health and Security Experts do agree these measures are necessary to contain the spread of the virus and protect the American People. To minimize disruptions, cbp and the air carriers are working to identify qualifying passengers before their scheduled flights. Dhs cwmd is supporting the enhanced screening efforts through agreements with state, local, and private ems, Public Health, and First Responder personnel. Thats where those 500 contractors come from. Cwmd established this capability in response to the ebola virus threat that was emerging last summer and these actions ensured a trained, vetted, and badged workforce was ready to rapidly deploy to support cdc with airport screening operations. Dhs was able to adapt this capability to quickly address the covid19 threat. Cwmd is also providing direct support to cdcs effort to collect passenger information at all 11 airports, allowing cdc to provide direct information to Public Health officials to facilitate Contact Tracing efforts. Cwmds efforts have significantly increased the accuracy of the data collected. Cbp and the u. S. Coast guard continue their work to recognize, detect, and assist individuals arriving through oyer land ports and waterways who may be carrying the virus, all in coordination with cdc. The coast guard continues to review all advanced notices of arrival. This is in a notice they get 96 hours before any ship comes to an american port. It gives a full accounting of the medical status of everyone on the ship. The captain of the port will communicate any concerns stemming from sick or deceased crew or passengers to their coast guard chain of command and the cognizant cdc quarantine station, who will coordinate with local Health Authorities to ensure continued facilitation of international trade, nonpassenger commercial vessels that have been in china or iran or embarked crew members who have been in china or iran within the previous 14 days with no sick crew members may be permitted to enter u. S. Waters and offload their cargo, reload, and depart the port. Since my time is up, ill go ahead and stop with the Opening Statement. We submitted it, covering a lot of this territory, and im happy to answer your questions. Thank you, mr. Cuccinelli. Our next witness is dr. Robert kadlec. Dr. Kadlec is the assistant secretary for preparedness and response for the u. S. Department of health and Human Services. Prior to joining the department in 2017, he served as staff director for the u. S. Senate select committee on intelligence and a special assistant to president george w. Bush for biodefense policy. Dr. Kadlec served in the u. S. Air force for over 20 years and was named u. S. Air force Flight Surgeon in the year 1986. A more expanded biography i wanted to read a little bit more. Dr. Kadlec was instrumental in drafting the pandemic and all hazard preparedness bill, which was signed into law to improve the nations Public Health and medical preparedness and response capabilities for emergencies, whether deliberate, accidental or natural. He served in the white house from 2002 to 2005 as director for biodefense on the Homeland Security council, where his haes responsible for conducting the biodefense endtoend assessment which culminated in drafting the National Defense policy for the 21st century and served as special adviser for counterproliferation policy at the office of secretary defense, with dod efforts to counter chemical, biological and radiological and Nuclear Threats after 9 11 in connection with the anthrax letter attacks. I thought it was important to point out how extensive your experience is in this, and as a result, what an appropriate witness you are for this particular hearing. Thank you, mr. Chairman. I appreciate it very much. Thats a very nice way of saying im a onetrick pony. Chairman johnson, Ranking Member peters and distinguished members of the committee, thank you for the opportunity to testify before you today on how hhs is supporting a wholeofhhs and government response to the 2019 coronaVirus Outbreak. This morning i want to take a few minutes to discuss how were addressing this issue from a point of strategic anticipation. Working with my colleagues at cdc, fda, chs and nih and across the u. S. Government supporting state and local authorities, were working hard to contain and mitigate this Virus Outbreak to save lives and protect americans. We have a fourpronged approach to manage and support domestic response. This includes medical countermeasure development, supporting the Health Care System incident management and direct support to state and local entities. In the area of medical countermeasure development, were rapidly establishing an interdepartmental medical Countermeasure Task force that includes partners across hhs, department of defense, and other federal agencies and the private sector to identify therapeutics, diagnostics and vaccines that could be rapidly brought through the pipeline to address the coronavirus threat. Specifically, were looking at pointofcare diagnostic stage, Public Health and rapid detection and guide treatment. Were also identifying potential therapeutics to aid and support the treatment of infected persons. Lastly, were also working very closely with nih, considering multiple potential vaccine candidates. Combined, all of our efforts are pushing platforms and candidates forward as fast as possible to aid the overall response. Turning to how we support the local Health System through the Hospital Preparedness Program and in coordination with cdcs Public Health and Emergency Preparedness program, we have improved coordination and collaboration between hospitals and the Public Health center and other entities like emergency medical services. Weve leveraged the National Ebola treatment network, which was an idea that was created by congress, and establishes a response as to the 2014 Ebola Outbreak to support the treatment of repatriated persons. As the Health Care Systems prepare for possible spread of the coronavirus, this network has and will continue to link technical experts with quarantine and isolation experienced aid transport and treatment levels at the state and local level. Shifting to the overall response level, since repatriation efforts began, weve been working with the federal Emergency Management agency, people was, to put in place an active Incident Management Network based on the National Response framework. This is the first time we have formally implemented this structure. Though we have practiced activating this structure during previous exercises, were doing it for real now, and it means we can leverage the capacities of fema and all of the Emergency Support functions that may be necessary to deploy responders to assist states and local authorities in responding to the coronaVirus Outbreak, if and when asked. I want to end with just a few brief updates how were providing direct support to state and local entities. First, i mentioned our repatriation aid earlier in my statement, where we successfully brought approximately 1,100 americans from wuhan and from the diamond princess cruise ship under very difficult circumstances. Currently, there are no additionally planned repatriation efforts at this time, but should the need be raised, were standing ready to support state department or any other authority. We have shifted our efforts to now to provide direct support and aid to states. In the state of washington, we have used the Strategic National stockpile to deploy personal protective equipment to protect Health Care Workers and a second shipment is arriving today to augment what weve already sent earlier this week, and were also planning to send 28 of our Commission Corps of Public Health Service Officers and our ndms team members to support them as well. Were concerned about Health Care Entities like longterm and elder care facilities, where we know the most vulnerable populations reside and are working proactively with cms, with cdc, to provide information on best practices. And when possible, help them shield our elder populations from the impact of the coronavirus. With that, i would like to be happy to yield the rest of my time and be happy to answer any questions you may have. Thank you, sir. Thank you, dr. Kadlec. Now, i do want to ask some questions. Normally, i yield and ask later, but i just want to get some clarity on a few things because i know this has been confusing. Lets talk about the test kits. My understanding is that 2,500 test kits will be distributed, they say the end of this week, which is, like, tomorrow. Each test kit can perform 500 tests. So, if you do the numbers on that, thats 1. 25 million individual tests. Senator was remarking yesterday that each patient, to be sure, should be tested twice. Thats about 600,000 americans. Is that an accurate assessment, or where are we at in terms of the test kits because its just yes, sir. So, thats so, whos manufacturing this . Is this privatesector manufacturer . Well, sir, cdc started initially manufacturing some of these test kits, and within a week or ten days of when the sequence for the virus was posted by the chinese, began to work on a preliminary chainreaction test, which is really a genetic test to look for the presence of dna or pardon me, rna, from this virus. So they were able to basically do a proof of concept, develop a prototype, and then began to produce that there at cdc, and then have shifted it to a commercial manufacturer called idt. Theyre the individuals that basically are making the 2,500 test kits, which include 500 tests per kit, to your point of 1. 2 million tests. And those would be going out to how many Different Centers . Theyll be going out to 190 places around the country. But quite frankly, the cdc has already distributed 75,000 tests already, of their tests, if you will. And so, the intent is by the intent of the secretary and the Vice President , its really to maximize the number of tests that can be performed. Now, to just kind of put some reasonable expectations behind this, these are test kits that are going to be sent out to labs around the country. Theyre going to have to basically validate these labs for their test procedures and train their personnel, so they wont become immediately available, but they will become increasingly available over the next week or two, to basically test americans, which is another part of this critical function, which is, there have been several things to do, to basically enhance our testing posture. One is make more test kits, distribute them, train the people who need to do that, but also ensure that theyre validated. But theres also been things that have been done to increase the use of these tests by indicating that people who fit the Case Definition for possible coronavirus can be relaxed so we can test more people, and that has been a significant will significantly enhance the ability of doctors and firstline primary care physicians and nurses to judge when their patients should get tested, if they suspect coronavirus. So, theres a lot of things that are in play here regulatory, definitional, as well as manufacturing and distribution. So, obviously, i think theres oftentimes unrealistic expectations. So, its a new virus. We just found out about this literally three months ago. It takes time to first develop the test. It takes time to validate it in the cdc, because you dont want false positives. And with the fda. Then it takes time to manufacture the first test kits. Then it takes time in the labs to validate the labs so the personnel they need to be trained. But youre thinking within a couple weeks, there will be a capability of testing about 1. 25 million tests. And then my guess is that manufacturing can ramp up pretty quick. Yes, sir. And in fact, i think theres an expectation for this particular company to expand their manufacturing, and theres also a parallel effort thats being done by bardd to engage laboratory testers to introduce the tests in their system, so that would proliferate it across the domain. I think the thing is, where theres been maybe a lack of test kits, there will be plenty of opportunity for testing. I think the key thing and what were focusing on is being able to do pointofcare diagnostics to support physicians on the front line in their offices and to basically test people in their offices to decide whether or not someone has coronavirus. What will happen at this point is its going to be hospitalbased, Public Health laboratorybased and then commercial laboratorybased. And were trying to push it out as fast and far as we can, but it will take some time, but were on the way. And again, as a former manufacturer, i realize, this takes time. You wish it wouldnt, but it does take a little bit of time. I think this has actually been proceeding pretty rapidly. But everybody recognizes how incredibly important this is, because we really cant really get a game plan until we really know the extent of the problem. Lets just quickly talk about the vaccine timing, because again, i want to have peoples expectations be reasonable. It sounds like we are developing developing a vaccine at pretty much a rapid pace. So, it will go into phase one, which is just the safety make sure the vaccine is safe when, approximately . So, i think dr. Faucis the best in the world in this, and he basically believes it can be done in a couple of months. And even then after that is done, there will be a period of time done to evaluate the safety data and then enter into the next phase so again, lets talk about the approximate period of times. No ones going to hold you to this yes, sir. But i want to create the expectation. So a couple months to develop one. Then were going to have to validate the safety. Right. Phase one study. And validate that. That will take another couple months. So were four, five months out. Then phase two. Is it effective . Thats the phase two study that will actually look at that. And that will take how many months . Another six months. So youre a year before we really have a vaccine that we think is safe and that will be effective. Then youve got to manufacture it, right . So, i think the reasonable expectation is between a year and 18 months. Host honestly. I think dr. Fauci talked about a year and a half to moderate expectations. Then a year and a half . So, lets say everything goes swimmingly well, and after a year, we actually have a vaccine that we know is safe and effective, but youre not going to be able to mass produce it yet, but will you be able to produce enough to provide to our firstline responders, to doctors, to nurses . I mean, i would think you would prioritize whos going to have access to this before the general population. Yes, sir. So thats quite an area that, quite frankly, i think is recognized in the supplemental, the generous funding that you all provided, is that our domestic manufacturing for a vaccine for this particular virus is limited. Typically and again, a lot of our plans were based on pandemic influenza, where we could use eggs, and much of our domestic capacity is eggbased production. And so, for these newer technologies like synthetic rna or recomidant genetic vaccines or subculture vaccines, we have a limited capacity. So we will be somewhat constrained to get a vaccine for everyone. But to your point, it would be prioritized to those who would need it most, Health Care Workers and First Responders. So we know this vaccine will use a more sophisticated technique as opposed to eggbased. So if youre talking about 18 months before you start getting to the general population, we will miss next years flu season and youre really not going to have a vaccine available until really the 2022 flu season, correct . Is that the right year . Thats conceivable. And again, thats why were putting a lot of emphasis on diagnostics and therapeutics to basically look at it. I didnt mention it in my Opening Statement, but screening existing fdaapproved drugs that may have activity to basically do that in the supplemental has helped us basically actualize that. And so, were looking at thousands of compounds that may be available that we could be using that could be, as well as the candidates that dr. Fauci has talked about, remdesivere and other drugs, an antihiv drug. But quite frankly, right now the only thing we have is kind of 18thcentury Public Health as well as things like n19 respirators. Okay. So again, the vaccines in the future is a solution. So now you really, again, turn to how do you mitigate this . And that will be, how do you screen, how do you get your arms around exactly where this is, quarantines. Well talk further about other contemplated actions, should this thing really spread and become a far more significant outbreak, but my times up. Senator peters. Thank you, mr. Chairman. Well, this informations very important that youre providing. And as i mentioned in my opening comments, its just so important for us to get this information out to the American People in a trusted source. One thing ive called for and gave the information to the Vice President yesterday, is as ive looked and our folks have looked to find out where information is for the public through the federal government, theres good information. Cdc has some information. But theres Additional Information the dhs needs to have. There is no one coordinated place were people can go to find out exactly what the governments doing with all of the agencies, the wholeofgovernment kind of approach Going Forward. So my suggestion is we have a dotgov website thats trusted by everybody that really talks about not just what the cdc puts out, but what travel restrictions are, what the Homeland Security departments doing, all of this where people can go to. Because right now, people are just actively searching, and i get this back home all the time. Theyre actively searching for information. Theres all sorts of websites that are not accurate. There are folks that are trying to peddle products and create fear in order to make money. I mean, theres a lot of stuff happening right now. Weve got to tamp that down. And to me, to have one coordinated site makes sense. Does that make sense to both of you gentlemen, that we have a place where all of the agencies, and its trusted, a dotgov site . Mr. Cuccinelli . Yes. Obviously, at dhs, we have used our websites for each agency and at the departmental level to describe what were doing, but this is, as dr. Kadlec described it, is a wholeofgovernment approach. Its a complicated interaction at the government level. I would also note, and well talk more about it, im sure, the preponderant role that state and local officials play in this response and then coordinating between Different Levels of government as well. So, yes. And i saw your letter, senator. Was glad to see it. And i believe that it makes an awful lot of sense, particularly in a circumstance like this where, while dr. Kadlec, for instance, has the lead federal agency, there is an awful lot of us working on this subject, which is why the president convened the task force and so forth. So, its definitely something, we heard you loud and clear in your letter and were taking back to the task force to talk about. I appreciate it. And ill just say, we just saw another incident. Im looking at the cdc website, putting out facts about the disease. I know last night the president was being interviewed and some of the comments that he made has caused some confusion, so i want to take an opportunity at this hearing. It says here, if you are sick, to keep from spreading respiratory illness, you should stay at home when sick. Is that accurate . You should stay at home when sick . I know theres some confusion now yes, sir. Which is why its important we have one trusted source. Yes, sir. That is part of the best thing itself, isolation, if you have respiratory illness and youre not sure what it is. If its flu, good reason to stay home. If its coronavirus, better reason to stay home. But its a good practice. Right, right. Thank you. Mr. Cuccinelli, there are some reports that some foreign nationals have traveled that have traveled to china in the past 14 days are actually coming in to canada, which doesnt have those same restrictions, and theyre crossing the land port of entry from our northern border. Obviously, michigan has a very active northern border, but all across the northern border. Are you aware of these reports . And is cdp conducting any screening at the northern border to try to intercept folks who may be using canada as a port of entry and then using a land port to come to the United States . Yes, senator. So, to broaden the context even further, it has not been uncommon for chinese nationals to fly to tijuana or vancouver or montreal. Thats not the limit, but by way of example. And then cross into the United States. The three largest land ports of entry for chinese nationals are blaine, washington, buffalo, new york, and san ysidro in california. As you know, of course, with detroit, they are not the only ones. Right. And at those three ports, the numbers are sufficiently high that we staged in cooperation with hhs medical personnel there, much like we have at the airport. It wasnt widely advertised, necessarily. I would note that the 212f proclamation applies at land as well as airports, and we have excluded over 300 foreign nationals. Some people may find it ironic, but the largest excluded group are canadians. And it is canadians who had traveled to china in the previous two weeks. The next Largest Group were chinese nationals. And then it drops substantially from there. I want to say 90 chinese nationals. So, the challenge you pose is real. We have been very aware of it and confronting it head on and turning those folks back, frankly. So, do you screen passengers in vehicles . Because its a different screening process, clearly, when youre coming across the land border. Easier at an airport as youre walking by cbp folks. Right. How do you deal with passengers who are in a vehicle and have an opportunity to really screen them . So, the first screen and the most important screen that cbp is best at is a travel screening. So for instance, i described turnaways, people who are not allowed in the u. S. Because of their travel history. So, cbp does have some access to this at the border, depending on how the individual or family, perhaps, in front of them came to be there. If they came through air travel recently, that is a fairly straightforward determination, but they are also doing interviews, essentially, of people at the ports of entry in addition. So, if you think of the airport arena, the cbp folks do a travel interview. Where have you been . Who do you encounter . Et cetera. Then the next layer, you get more of a medical interview. But that first one, its the location where theyve been that is the first and biggest flag. And predating this virus situation, cbp has always had direct access to cdc when people present in front of them with the appearance of illness. Now, of course, the danger here is you can be asymptomatic with this particular virus, but that process has been vigorously engaged in on both borders, north and south. But youre talking about airports. It is even more complicated when someones coming across in a vehicle. Yes. Address that. Youre coming across in a vehicle, across we have the two two of the three busiest border crossings in north america are in michigan. Yes. Lots of vehicle traffic. How are you doing that . So, the main screen that is our first filter and our biggest filter is the travel screen. Even so, were using the data systems we have available to our officers and that interview, which while they were always doing it, theres obviously a heightened focus on china, on iran, but also korea, italy, jan, et cetera. There is not a proclamation barring those, but if you get a yes answer to those areas of the world, youre still going to pay closer attention and these are not medically trained individuals but if theres anything they suspect, then those individuals will be pulled to secondary screening. Contact will be made with cdc, and it essentially becomes a consultation at that point with genuinely medically trained folks but who are not physically present. Right. Thank you so much. Yes, sir. Bottom line is, its far from a foolproof system. Right. And again, just the nature of the beast. Thats go ahead. Yeah, if i could thats a really important point, mr. Chairman. This has never been, from day one, intended to be a hermedically sealed process. We are trying to reduce and delay the biggest peak in the virus wave hit on the United States of america. And all of these steps reduce and delay, they do not stop the virus. And weve never suggested we were capable of doing that. And viruses dont care about boundaries, right . So, its an obvious point for us to try to provide extra safety to the American People, but it is by no means foolproof. Again, this is my comments not a criticism. Its just trying to create realistic expectations, okay . Because if it was hermedically sealed, we would not have trade at the border. Again, overreacting here would be unbelievably costly. And the idea is to slow it down, to buy time, to have more testing kits out there, to be able to mitigate it. And youre buying us time at the border, so thank you for doing that. Which again, is what dr. Fauci said in our private briefing. The travel ban definitely delayed this, definitely helped mitigate this, reduced and it was contrary to the models, so it was not necessarily predicted to work that way. Our analysis on the task force, we came to a different conclusion, and now we can monday morning quarterback ourselves. That has clearly been effective. It doesnt mean perfectly, as you pointed out, mr. Chairman, but it bought us time. It bought us time. Senator carper. Thanks, mr. Chairman. Welcome. Thank you for joining us today and for your testimony and for your work. Dr. Kadlec, given the potential for a fairly rapid spread of this virus, we cant afford for patients to delay screening because of concerns of affordability due to insurance dedu deductibles and copays. Recently, the news documented one shortterm Health Insurance plan in florida, i believe, billing a patient more than 3,000 for his coronavirus screening and flu test, 3,000. What are you and your staff doing to ensure that coronavirus screenings and treatment are lowcost and affordable . Have you asked Health Insurers and employers to lower or remove financial barriers to coronavirus screenings . Well, sir, that was appreciated, and that is why sima verma, dr. Sima verma is now a member, who is part of the cms, is part of the task force, is to focus in on that part of the problem. One is about the accessibility of people who might have the coronavirus and how that is being covered as well as affordability issues. Shes been engaging with Insurance Companies and its not surprising that someone may be taking advantage of this, but shes not someone to be fooled with, and i clearly have confidence that shes going to engage on this fully. But we can certainly have her available for a briefing for members, if that would be helpful, to talk more about what cms is doing in address that concern, accessibility and affordability. I think that would be well received. Thank you. Theres a Bipartisan Commission ondefense. I think dr. Kadlec, you might have been the founding staff director yes, sir. For that. I think its cochaired now by tom ridge, former governor, former secretary, and Joe Lieberman was once the chairman of the committee, as you may recall. In 2015 that group issued a report, i think that report included 33 recommendations to improve our nations preparedness for intentional or naturally occurring biological threats. Pleased to know that the president has filled one of those recommendations thats by centralizing response efforts at the highest level of government, in this case with the Vice President. Many of the recommendations however remain unfulfilled. As the founding staff director of that commission, can you just speak for a minute or so about the recommendations that still remain to be completed . And what stands in our way for completing them . Thank you, sir. I think just broadly there was a second one that was completed, that was the National Bio Defense strategy, which was the foundational document or effort to understand what is the whole of government we need to do. There is a lot of great Work Congress did with the administration back in 2005 and 2006, and quite frankly thats unfinished business. I think that was the intent of that study panel to evaluate what needs to be done. Broad strokes in the Health Care System, we have a Health Care System about 95 privatized running on limited margins, in terms of profitability, and the surge, lack of Surge Capacity is going to be tested to the limit here. Thats one area in terms of hospital Health Care System preparedness is a major v vulnerabili vulnerability. The other is the Critical Health infrastructure at the state and local level. Theres serious issues there in terms of the numbers of people willing to get involved in that business. I call it the Rodney Dangerfield of medicine, they get no respect. When they do everything right nothing happens. It is a circumstance there i think does require a little more nuanced effort to promote and incentivize that. The third is infrastructure, say infrastructure for countermeasure development. We talked about the Domestic Production of vaccines. Thats a good thing. If we can expand that, making sure we have the right vaccines, and great jobs for americans in many parts of the country and advance innovation in health care, thats the fourth element. Were doing some of that to address some of the issues related to supply chain that have to be addressed, such as active pharmaceutical ingredients, much of it is overseas and a great v vulnerability. So there are four things that i would suggest that that study panel has done to raise our awareness and focus our efforts to do that. You may have answered. Just to take another minute talk to us about steps that additional additional steps that the administration has taken to fill other recommendations. You mentioned four that have been fulfilled. But the other 30some that maybe have not been. Ill put it in broad strokes. One thing was executive order on pandemic influenza which talks about relative to this issue how do we manage a potential pandemic, a flu, a lot of that is really about speed. Speed of action. Which i think is a fundamental issue in thissan event. The virus is moving faster than sometimes we can think and act. And the second thing is really about domestic capacities and supplies. Things like the Strategic National stock pile that have to be maintained over time. Ill point out one of the findings out of the biodefense strategy was we invest about 8 billion in this kind of activity each year. Sounds like a lot of money but when you consider an Aircraft Carrier is about 12 billion and we have 17 of them, that gives you an idea of the what we want to invest in our National Health security. As you know, pharmaceutical companies that exist, maybe they were founded and operate exclusively in this country, ov oftentimes partner with other countries around the world in order to try to solve alzheimers disease, ms, parkinsons disease. What should be done to address this problem . We have an international con sourceup that involves a welcome trust, gates foundation, several european governments are involved to focus on major disease areas, coronavirus is one of them, quite frankly, as well as marberg virus, and i think those initiatives are valuable because they can, if you will, consolidate small resources and give bigger opportunities. And again tap into the wealth of innovative thinking around the world to address some of the hardest problems and understand that in many of these cases the underdeveloped world is probably the greatest at risk. So to make it affordable and more accessible. Those models are helpful. The Global Health agenda was created in the obama administration, per pep chaited in the Trump Administration so countries could be better position to help themselves. That was the success with the Ebola Outbreak where money helped build the infrastructure and the vaccine. Those are some examples ill use, sir. Thank you. Senator hassen. Thanks to our chair and both of our witnesses not only for your presence this morning but to you and your teams. Please take our thanks back to everybody on the front lines. Dr. Kadlec i wanted to start with following up on senator johnsons line of questioning about what we can be communicating to our constituents about the timing of increased testing availability. You went through, weve got tests at Public Health labs, now were surging up on the commercial side. We talked about a million plus test capacity, but part of the process here is going to be, once the commercial labs get these testing kits, theyve got to validate them, right . So how long does the validation process take . Im trying to get to a time line so people understand when this surge will really be making a difference in their experience. I think the key thing is based on whats the availability of the tests now, in terms of delivery. Theyre being delivered now. In the Public Health labs by the end of next week probably see very high capacity and capability. So about a week. And then you can imagine the commercial lab torys will be lagging about a week behind them. How long does the validation process . Several days, a couple days to do that. For each kit . No. Its the machine and validating the test itself on the machine and the people who have to work the machines and the test kits. So i think it would be helpful, i want to move on to other questions, i dont want to belabor this, but if the administration would put down a time line so people could see in writing on a website when do you dont have to promise an exact date but when it would be reasonable to expect commercial labs to be able to perform this testing if your doctor suggests you get it. I think that would be very helpful. I wanted to move on to another issue. As you know, dr. Kadlec, the National Disaster medical system and other programs play a Critical Role in ensuring that uninsured and under insured patients can receive care by helping to reimburse hospitals. I know you mentioned this issue was under discussion with the administration, can you provide an update on the conversations and what the administration is doing to help ensure that under insured and uninsured patients can receive the Emergency Care they need . Im probably not the best one to answer that. I think dr. Verma may be. But i know theres moneys to support that, i think its about a billion dollars, you were generous in that allocation. I think that will be money used for that purpose to ensure we can take care of everyone whos afflicted with this. Ill follow up to be sure but its answer important issue and if we need more resources to make sure people are not only getting the care they need but getting the test they need so they will not be infecting other people. Earlier this week, dr. Kadlec, i met with new hampshires Public Health officials. They have in state stock piles of protective equipment such as masks but they recognize the stock piles may be used up, weve already had one case in new hampshire. Public officials have attempted to order more supplies but theyre told such supplies are on back order until may. Based on your testimony earlier this week, i am concerned that the National Strategic stock pile wont be sufficient to meet the demand. Whats the time line for getting the equipment in the field and how will you advise people to protect themselves in the interim . Weve taken a multiprong strategy to address your point. Unless you have it on hand immediately youre going to face challenges. One is we have a stock pile a limited stock pile right now of masks when i say masks, surgical masks and were in the midst of procuring more, meaning tens of millions and have introduced or released as of yesterday a request for proposals for 500 million respirators to be provided over the next 6 to 12 months. The splupplemental provides funding for that so the manufacturers know theyll get paid. Yes, maam. Do you have a plan in place to make sure First Responders are prioritized for receiving the equipment . Theyre making allocations on their own, but realize in the course of lets say these n95 masks, in a given year only 10 is used by the Health Care Professionals and lump in the First Responders, so much of it is used by construction, mining, and manufacturers. So fda has given an emergency use authorization to allow nonmedical masks to be used by a broader population, First Responders included. Were going to try to work to see if we can get an allocation to make sure those First Responders are covered. That is helpful to know. In addition to states needing these supplies, its going to be important to provide training to any responders or providers tasked with treating or assisting coronavirus patients what efforts are under way to ensure that responders and providers can Access Training on the use of personal protective equipment . One of the critical things again and a product of Congress Work has been the network cre e created post the 2014 ebola event. With that there was more generous moneys to address 10 regional centers, three National Centers of excellence. But weve also, like in the new england area, started a Regional Disaster Health Response network with mass General Hospital thats working with your area to basically train and prepare people. That will be one mechanism we can get training out and specific information how to manage the coronavirus experts. Actually we used some of the people from mass general and repatriation of the people from diamond princess. Something i asked secretary wolf about too because in the proposed dhs budgets theres cuts to train First Responders in this kind of work so i want to make sure were focussed on that. I am just about out of time so i thank you both and mr. Chair. Senator rosen. Thank you for being here. We know youve been in a lot of hearings we appreciate your round the clock work. As no surprise to anyone the virus is moving fast. Nevada just reported its first case of the virus today, ive been in close contact with the state officials, Governors Office and i want to emphasize, stress the importance like the other senators have here, how important it is to keep the clear lines of communication open with really good data they can respond there boots on the ground. I want to address federal assistance to those quarantines. What plans are in place to provide relief to americans who may be dealing with government imposed quarantine. Many folks live paycheck to paycheck. This could lead to people losing their homes, not being able to afford food or other essentials. If we have disaster like situations on the ground, what can fema do to alleviate this in the short term, what do you need to address that . Fema has been in place with hhs for almost a month now. And assisting them and bringing the expertise fema brings to Disaster Response to this effort. Still with asper as the lead federal Agency People look to the stafford act and this is a disaster of sorts, but the response mechanisms are not the same. It is not currently anticipated that you would see a stafford act declaration. The intensity of the problem will be different in nevada than it will be in virginia, for instance. And so there is the base fund that where governors can make requests when elements of their systems are overwhelmed for funding. There is a 5 million cap that is waivable for that. And this is not the Disaster Relief fund. The 34 billion disaster. This is a base fund that has about 640 million or so in it. Would they be able to use this . We know around the country some places are reporting school closures, we could anticipate maybe closures of Senior Centers. We have many kids across the country, many in my state kids on free, reduced lunch, free breakfast, we have Senior Centers where those seniors are reliant on those meals every day. How do we ramp up and give the ability if theres a school closure, Senior Center closure, to use meals on wheels and brown bags to these kids and their families, can you speak to that . I believe secretary azar has some authority to expand aid, welfare programs under these circumstances. But fema nor dhs do not have dollars available that would legally fit the description of the relief youre describing, senator. So thats something that i believe is being covered and addressed in the supplemental. And that is the appropriate vehicle. And i would just note, more generally, that dr. Kadlec referred to the Planning Efforts that have gone before this all arose, and we operate off the pan cap 2018 plan. And in that plan it was envisioned that the financial vehicle to deal with an outbreak of this nature was via supplemental. So we are sticking with that plan. As was said six weeks ago, if we need dollars well come to congress. Were here now of course. That discussion is going on. It is including the things youre describing . Our governors would be able to request this and funnel it to communities that need it, is that what youre saying . No, i think youre mixing two things. If the supplemental includes moneys to address the financial short comes youre describing then the answer would be yes. Theres nothing currently legally in place that fema has available that would fulfill the needs youre describing. We may have to look to that in the future and see what we have to do to take care of those vulnerable populations . Yes, maam. The next thing id like to ask you is about immigrants seeking care. Nevadas diversity is its strength with about one in five born outside the United States, many more living in households with immigrants, some of whom are undocumented. As we work to contain the coronavirus, we have to ensure that theres timely access to medical care for everyone who needs it, regardless of their status. This is a Public Health and safety issue. Anything less puts all of our communities at risk. So mr. Cuccinelli, no one should be afraid to seek care as the coronavirus spreads, placing our communities at risk. Will the department refrain from apprehending individuals based solely on their immigration status while theyre in the process of seeking care. Much like the cdc cbp relationship existed, i. C. E. Already has an agreement in place, they do not do health care apprehensions. So theres no reason anyone should expect would they refrain from potential intimidation factors such as placing vans outside of Community Centers or Health Centers where people may go to seek the tests. That would be consistent with the policy, senator. Thank you, i yield back. Mr. Cuccinelli, quickly, senator portman brought this up yesterday he had a chance to look at the supplemental. Zero dollars for dhs. We talking about this in the cloakroom. Can you describe what the thinking of congress is on that and how dhs is going to get the funding to do the things you need to do . The easy point is the starting point, with dr. Kadlec assisting hhs, that is fitnessed by hhs, so theres interagency agreements in place, so dollars that flow to hhs to address the virus challenge, the source of the lead federal agency, do flow to dhs when were providing those sorts of supportive efforts from any of our agencies or components, the most obvious one day to day being fema at the moment. Youre not concerned when you look at the supplemental, wheres our support . Where are our resources . Youll get those through hhs, and again, administration requested 2. 5 billion, were going to give 8. Resourcing should not be a problem. Thats how this will work Going Forward as it has the last month or so. Senator holly. Thank you, mr. Chairman. Thanks to both of you being here. Thanks for the work youre doing to address the outbreak. Its very concerning. Im concerned about the spread of the virus nationwide. I i think this exposes our supply chains. You mentioned it a moment ago, the fact for medical devices are manufactured in whole or in part, china in particular and weve seen reports about potential drug shortages because of chinese closures. We need to make sure were not caught with severe medical shortages in key drugs, antibiotics, antivirals but also Going Forward we take necessary action. Mr. Kadlec let me start with you. Can you describe what actions youve taken to ensure our Health Care Providers have uninterrupted access to masks and gloves . Weve been working with the key manufacturers, all the manufacturers in the United States and the distributors, and again its a delegate balance to ensure that what is made available is available into the stock pile and not only our stock pile but to distributors so they can provide for Health Care Workers and institutions. Many statements have a limited supply, a limited stock pile and our intent is to basically provide, support the states by providing them commercially in an emergency of this nature. You wrote about the National Stock pile working hand in hand with supply chain partners to monitor shortages, can you elaborate on that. Again, if not daily, weekly conversations. With the major suppliers, to basically understand what their allocations are to the private sector and what are the needs for the federal government as well. And there are many departments and agencies that have needs as well and were monitoring that so we can moderate what is perceived needs versus actual needs to ensure we have enough in the pipeline for the private sector to meet their first line needs. Its my understanding that the fda is working with manufacturers to monitor potential short falls for drugs and devices. To what extent are manufacturers complying with requests from the fda in this regard . The fda does it in a confidential business arrangement with nethem, so i d not know what the particulars are. Dr. Hahn would be an excellent source to brief you on what theyre doing. At this point, however, theres only one prescribed drug that has been identified as being potentially at a short fall. There are alternative products available in the u. S. Market that could be substituted. So the impact of that limitation doesnt seem to be great. But hes monitoring that like a hawk with his team to ensure they cannot only identify near term but longerterm risks to our medical pipeline. We need to give the fda more authority to look under the hood and find out where our drugs and medical devices come from and give them the authority to back fill by speeding up approval of ali alternative devices or drugs. Ive entered legislation to do that. Do we need to look at expanded travel restrictions, how do you evaluate that . The short answer is yes, its yes because weve been considering them on a daily basis. And the driving factors would include, and they very how they weigh in each country. First the transparency of the nation under consideration, you compare say chinas transparency to korea, its a rather dramatic difference. The ability of their own Health Care System to respond to the outbreak in their country and the capacity remaining after they do so. So, for instance, ill give you an example, the state departments warnings early on about china were not just because chinas because of the outbreak. They were also directed to keeping all of our u. S. Employees safe, because if you got in a car accident, completely unrelated to the coronavirus in hubei province, there wasnt a doctor to take care of you. So their systems in parts of their countries were, and are, overwhelmed. So that is another consideration. Now china on the other hand would be a very different consideration than, say, their neighbor mongolia. Which you compare the Health Care Systems, mongolia closed their border very fast. Part of the rationale was they do not have the ability to respond. Were talking in this committee about our strengths and weaknesses and what we could do better in the future. But they have no ability. So those sorts of factors weigh in on those other countries. Your testimony is youre reevaluating this on a daily basis. Daily basis. Is that an interagency process . It is an interagency process. Were using two scales to warn americans. Both the state departments travel advisory scale, which is a 1 to 4, and the cdc health scale which is alert to 3. And their numbers, naturally are off by one as we go down, so 4 and 3 are the tops respectively. We have found as steve begin would tell you for sure, they i dont think have ever seen such responsiveness to their travel advisories. Weve never seen such consumption by the American Public much like the cdc had 500,000 downloads of their business guidance in the last 24 48 hours. So that is all having a real meaningful effect without government mandates. Of course theres a 212 proclamation with china. The tsa issued directives with respect to korea and italy. Dr. Kadlec, let me come back to you before i before my time completely expires. Im sure that youre aware of news reports of other countries like south korea is performing over 10,000 diagnostic tests per day and they set up drive through tests where citizens can go and be tested. Why are we not at scale to do Something Like that . Can you explain the precise reason for the defective kits we saw earlier . I cant describe the exact reasons for the defective kits. We need cdc to brief you on that. In terms of the scaling, were scaling up now by commercialization of not only test kits that can be used in Public Health laboratories, but engaging the private health sector, labs that can do testing. Weve been rolling off the line expanding the opportunity to do testing in Public Health labs, hospitals and clinics and doctors offices that use these commercial laboratories. We may not get to drive through swapping, if you wanted to call it that, but also i want to comment on that point alone. You have to do it with some precision how you take those swabs and so the risk is you can swab somebody, if youre not careful and get a false negative. It does take a little bit of training. I wouldnt think jack in the box will be swabbing here in the United States any time soon. Senator scott . Dr. Kadlec, weve got a lot of information out of nih and d cdc, i havent seen anyone talk about the risk for pregnant women. Is there any increased risk, any precautions to take . Theres Little Information on that at the time. Thats a particularly vulnerable population for a variety of reasons, two lives, and the effects of the pregnancy on the women and the baby. Thats an issue. The earliest coronavirus report, or a case in a newborn in china, but thats the only thing, thats an anecdotal case. Certainly thats a major issue or concern. Nothing out of south korea or japan . No. Were getting high level statistical data but not reports vital for this purpose. Mr. Cuccinelli, from florida we have 150 million plus passengers through the airports and the millions of people that go through our cruise ships. What advice are you giving to our airports and sea ports to deal with . We have so many people coming from all over the world we know the countries have coronavirus. What advice are you giving them and what precautions are you putting in place . A few things, the coast guard, tsa in particular have regular communication with the cruise lines and airlines. In fact, ive been doing that as well. You will have noticed that for the first time ever, were talking about travel advisories with senator holly, we issued a travel advisory, the department of state, related to cruise ships not a country, a location but to cruise ships because they have proven to be such a risky venture from a health standpoint. And that was unique. It was effective. In terms of the responses that is not economically good for the cruise ship industry. But the diamond princess was a viral disaster. And avoiding a repeat of that series of mistakes that really are going to take a long time to even understand completely has driven a lot of that response. And the airline front, we are seeing pointtopoint declines in traffic. I have data on some of that if youd like. Needless to say chinas flights have gone through the floor. And korea has declined. But maybe by half. Japan by about 25 . Just by way of example. And there are good reasons for that. The cruiseships themselves, in my discussions with some of the representatives, are themselves trying to avoid bringing on passengers from these hot zones. And to avoid a repeat of the result of essentially quarantining a ship. And as it works in the ports, and you do have many of those in florida, the captain of the port, the coast guard person in command of that port is in absolute control of that port. And we hold ships offshore when needed. And we have done that throughout this entire time. That has primarily been associated with cargo shipping because we tried very hard to some of the discussion about supply chain to keep the cargo flowing, not for dollar reasons but because of the interconnected nature of our supply chains. Weve taken special steps for instance keeping ship crews off ships. In a passenger context, that is much much difficult and we continue to contend with these. Youre sitting next to senator harris. Were dealing with one coming in San Francisco and literally as we speak that is being dealt with directly. And the captain of the port will work directly with the regional cdc head to address these on a case by case basis in terms of how to deal with passengers. As you might imagine, having been governor of florida, you can appreciate if we were to try to use the Health Care Facilities in one port to deal with an entire cruise ship, we would immediately swamp the Health Care System locally. So thats our counter balancing challenge that we rely on cdc to make those state, local arrangements, though theyre conversations the coast guard has at a time. We are handling them one at a time, but its with an eye to not bringing ashore virus spread. That is the priority and its part of why weve warned americans not to go on them in the first place. Airports we have a lot of International Flights in. Florida. Whats it going to take for you to do the same thing you did, restricting travel out of china . What will you have to have . Of course that step was taken in literally the worlds epicenter there in the hubei province, still the largest number of cases in the world. We dont see anything like that developing to that scale though korea and italy are kicking case numbers up very fast. Its important to remember when you take a snapshot of todays cases, that is a week, twoweek, threeweek lagging indicator of what was already there. So were operating on this dealing with this virus that hasnt been known to exist in humans for three months yet. Lots of areas we lack knowledge. So were trying to err on the side of conservativism. If youre in the travel business thats going to hurt you, we dont know for how long but our challenge is to keep america safe. I dont trust any of the information coming out of china, i dont believe theres any transparency. Do you have any inclination to open travel to china any time soon . Thats not on the discussion table. Were not talking about it right now. I think clearly it would be important for my state. But on the cruise industry, do you think youll get to the point youre going to Start Testing everybody thats going to come off . Again, that would be a case by case. We wont be able to for a few weeks at least. However, we are right now literally as we speak flying test kits out to a cruise ship off San Francisco, off california, i should say, its moving up San Francisco, with coast guard hilos and pjs basically dropping onto the ship and bringing kits. Were going to test if not everybody, a large number of individuals relative to the ship. So that we have full information when the captain of that port in San Francisco is talking to their local cdc authority and they have already been working as an action group with the cruise line themselves. So this is not popping on us, weve been working it for days. Thanks, both of you. Just quick on the cruise industry. I would think in terms of availability, testing kits because its a unique situation that would be a priority in terms of getting test kits, so thats a capability. Senator harris . Thank you, mr. Chairman. As you know my state is home to 40 Million People, we have the largest number of cases, 62 yesterday our governor declared a state of emergency for the entire state. The coronavirus, i think, presents an interesting convergence between Public Health concerns and pay equity concerns. Two theirs of low income workers in the United States do not have paid sick leave. As you know, we have been encouraging people who are sick to say at home. Often people in that pay category are in the service industry, they work in restaurants, they work in hotels, they work in child care, they have contact with a lot of people. For them to stay at home in the interest of Public Safety means they may not be able to put food on their table. So my question is, understanding this is a very real issue. What is the Administration Planning to do to encourage employers to provide paid sick leave for sick employees so they will stay at home and not have to face that awful decision about whether they stay at home in the interest of Public Safety or dont put food on the table of their family . So i will speak first to the communications weve had with people across the private sector. In addition to our accelerated communications with local and state level officials weve always been talking to nonhealth care private enterprises and encouraging them in this direction as well. Re recognizing that the burden of asking an employee poses both on the business and employee. You recognize where its important for everyone else for that person to stay home. If youre serving food and like a fast food worker. Yes. Dont want you to come to work. So what can we do to support you talking with the private sector about providing paid family leave during this concern . So sisa has already standing sector consortiums this is a sector they already talked to them about, supporting employees asked to stay home. Were obviously asking businesses in those lines of work where its possible to make the tele work arrangement so people can keep working and getting paid. My concern is for the majority of low income workers, who do not have paid sick leave, they are in the service industry, so tele working is not an option for them. Perhaps we can followup to find out ways to support ways to make sure these employees dont have to make a decision between paying their rent or contributing to what we know is a there is more money available. And i would defer to dr. Kadlec because thats out of hhs. One other area. Secretary mnuchin, mr. Kudlow and the Economic Council are involved in this. Theyre looking at ways, the conversation has been about small businesses, a critical part of supporting individuals and how they can do that. Im sure they will welcome the opportunity to work with congress to figure out ways to support individuals facing this problem, who are challenged. Thank you. Federal employees. So we have many federal employees who, again, their job does not allow them to tele commute, tsa, postal workers, what is the administrations plan for those workers in terms of what is and also what is soon to be enumerators for the 2020 census, what is the administrations plan for dealing with those federal workers who do not have the ability to tele work and do their jobs . One of the subgroups in the task force is dealing with the federal workforce, to use the department of Homeland Security as an example, we have a building in Washington State where we had an employee test positive. Thats an Office Building setting, one setting that dhs operates, different than a Border Patrol situation or tsa where people are going by you in close proximity. For those folks the example of the tsa, we have made ppp available to them. The medical guidance on how to use it, it does require appropriate training to use correctly in a way that is advantageous to the wearer. Ive been out to the dulls airport myself when china flights were coming and i observed a difference in employees who when i arrived at the airport with no flights had their uniform on, otherwise looked like you and me. And when the china flights were arriving, gloves and masks were on. Thats great. And that is available to all of our employees, and that is true for the front line folks across the federal government. But that is being closely studied. Were doing things like pulling down unnecessary travel, other things where we dont create risks for our employees or the general public. Thank you. In followup to senator rosens question about immigrants and undocumented immigrants. The reality is we have many undocumented immigrants who are in americas workforce. And we also recently had an announcement from i. C. E. They were going to increase enforcement. So it is a legitimate and real concern that undocumented immigrants and their family members are in fear of and discouraged from going to Public Health facilities to receive treatment if they are sick. I heard what you said about the policy. Would you be willing, mr. Cuccinelli, to issue a public sta statement that during the crisis were facing around the coronavirus, there will not be i. C. E. Enforcement at these medical facilities . We actually issued a statement yesterday in response to similar inquiries. Obviously our statement was based off the existing policy but we did restate that publicly just yesterday. Thats great. For both witnesses, there has been a lot of discrimination against asianamericans and asian immigrants. And Public Health experts agree that the coronavirus does not focus on or target any group by race or ethnicity. Yet we are seeing many, many reports and hearing many reports of intimidation, of provifiling and threats in particular to our asianamerican community and friends. So what is the administration prepared to do in terms of committing to actively dispelling misinformation about this issue, because it is very real. We have enough fear about the Public Health crisis already but to compound that that our friends and relatives and neighbors would have fear about being profiled is something very real. Obviously were trying to convey, calmly, lots of different information about a virus, about which much is unknown. And we have woven into remarks really at every level of government, the very same concern youve just voiced. Because periodically, we typically do it candidly when we have instances brought to our attention so that in our our now is the department of Homeland Security and the same would apply in other places. In our soon thereafter public statements is when we try to knock that back. Thats when we talk about that. We want to be very clear as you said, ill say it clearly, the task force, theres without question no difference that this virus shows whether youre black, white, asian, hispanic, anything else. And the dangers are to the same people regardless of race, ethnicity, et cetera. And our responses should be irregardless of peoples skin color or ethnicity. Obviously thats how the federal government and were responding to it. At the same time, you know, i use the northern border with the china 212f proclamation. More canadians have been bored on the northern border than chinese, 113 to 90 because of that proclamation. It was travel based. Its not that youre chinese, its youre in the hot zone in the past 14 days. Well continue to operate that way and continue to knock down story lines or narratives that say different than that. Thank you. Thank you chairman and Ranking Member peters and our witnesses for participating in our important hearing. I represent arizona. Id like to acknowledge the Arizona Health services, state lab and Arizona State university for their swift actions to care for those individuals and to mitigate potential exposure to those in the community. We need to see the same level of corporation on the federal level. I have constituents quarantined at lack lund air force base who received little to know information about when they would be able to go home after another individual who had been released later tested positive for the coronavirus. While many are on their way home to their loved ones, many are still in quarantine. Our constituents deserve straight answer from the government on quarantine guidelines and efforts to develop a vaccine and treatments. These must be driven by evidencebased Public Health expertise. My first question is actually directed to both of you. Innovated Companies Large and small are working to develop vaccines, theorapeutics and are lending expertise from other pandemics. Newer innovators like arizonas own phoenix bio metrics has submitted information to the cdc to evaluate the Bio Sensor Technology to detect viruses. Once a vaccine is approved what will the strategy be for deployment, specifically targeting older populations and those with preexisting Health Conditions and workers at the ports of entry, and our service line workers hit hard in other countries. Maam, ill take the first shot at this, we have been reaching out to companies and we actually have met with over 1500 engaged 1,500 commercial entities, universities and the like. Wed be delighted to receive any suggestions from your from your folks on this, and ill be happy to provide that information as well. And i think the key thing here is were looking across the doma domain, barta yesterday put out, my director is still behind me, if im right. Basically they put out a broad area announcement to look for innovative ideas across the spectrum. So there is a way to do it physically and electronically engage in that area. Subject to the issue of the vaccine. Clearly thats not an imminent possibility from earlier conversations, 12 months to more like 18 months we would have something. And the scale of that availability will be dependent on the kind of vaccine that will be developed. Right now there are primarily three candidates considered, maduro is one, johnson and johnson another, and santa fe as well as the third. So much of what will be available will be determined on the prioritization you identify. Clearly theres a National Security component in this, what we need to protect forces and t how do we protect people on the front lines like Health Care Workers and as you highlighted the vulnerable populations, which are significant in our country. That all has to be factored into that. Those are answers yet to be determined based on, like you said, the best evidence and Scientific Answers we can come up in the time that we have. With respect to the prioritization, you can expect to see when we reach that point, what id call a traditional prioritization. You mentioned it yourself, high risk categories, the mortality rate if youre over 60 and have a secondary condition is much higher than if you are under 50. So limited supply will be funneled to the priority c categories as typically happens already. We are also going to have to work through exactly the kind of challenges you described, the force protection, as well as Front Line Law enforcement and First Responders. The people who come facetoface and Health Care Workers. Im sure youre familiar with the sort of the the first doctor in china to speak publically about this has now passed away and he was an otherwise healthy 34yearold. But Health Care Workers are a limited resource in this the sense that we nothing any of us are going to do here will make more Health Care Workers to fight this battle. So they get priority to care for them, because we need them to care for everyone else. And that priority will go forward and itll be similar for First Responders. So you can fully expect to see that play out in your state, as a border state, that will include Border Patrol agents and so forth who man those posts and deal with people who dont come in with documentation, with medical histories and we have to be very, very cautious in those circumstances. And frankly one or two people in a facility like that can wipe that facility out for utility purposes. Thank you. Yes, maam. My second question is, the fda announced it will allow more types of respirators to be used by Health Care Workers to address concerns. This week we introduced the work protection act and addresses liability concerns by amending the Emergency Preparedness act certified by the institution for Occupational Safety and health. Can you talk about the efforts your office is making to ensure adequate supplies of equipment, including incentivizing manufacturers to increase production. Thank you for that question. Thats a critical industry that needs to be addressed. I was on the committee at the time when the prep act was originally considered and enacted. So i have firsthand experience. One thing we didnt consider at that time, quite frankly is the situation we have here now. Which is then we thought a pandemic of influenza would be the threat we had to face. And with that we needed countermeasures necessary to protect our front line workers, vaccines, diagnostics and the likes. With that, the prep act was focussed on those particular things and did not include respirato respirators. That was 15 years ago, a little bit of an oversight but has significant implications today. I want to thank for introducing that bill with senator fisher and acknowledged in the house theres a companion bill. And i would hope that congress would makea on it. We tried to make an event to have it included in the supplemental language and were unable to. This is vital for the producers of the products who the food and Drug Department gave permission to use respirators used by Health Care Workers. Depending on how big this outbreak is we have an order for a billion n95 respirators, theres no way we can do that with the respirators, but we can use other ones used by industry which are not splash resistant that can be used in other Health Care Settings that would expand our ability to protect front line Health Care Workers. Right now the only thing we have is the personal protective equipment to protect the front line Health Care Workers and First Responders. Thank you. Thank you. Thank you, mr. Chairman. Senator hassan has a couple extra questions. I appreciate this very much, mr. Chair and i appreciate our witnesses stamina. I know you started at 8 00 this morning. I wanted to circle back, mr. Cuccinelli, to something you had talked about on the cruise ship issue. We learned lessons from the diamond princess, first positive test was february 1st, took several days before a quarantine was immaterial policemplemented. 700 people out of 3,500 tested positive, six deaths. We determined it wasnt a good result if if theres a positive result on that cruise ship to keep everybody on the cruise ship together. Now apparently according to news reports and what you said, that theres a news ship off california, which is 40 Million People, lots of military bases, hospitals, health care and Public Health care facilities and yet we dont seem to have a patr protocol to get those folks off the ship in a way that would minimize spread of infection. Im curious and concerned that given the example of the diamond princess and what we learned we dont seem to have a protocol in place right now that is clear. First of all, lets be clear about what we learned. That was a bad quarantine. That was not a successful quarantine situation, and not just because the virus spread. That was a secondary effect of a bad quarantine. So its the lessons we learned there were negative lessons, im sure that doesnt surprise you. No. Thats my point. It is sounding, from news reports, that what happened on the diamond princess is being repeated on the ship off the coast of california. So the initial assessment, with the diamond princess before the spread accelerated, was that the safest thing for all the passengers was to hunker down. It was to isolate in place. And because the quarantine wasnt maintained effectively, that did not hold. Had it been done well, it would have been the right course. And so, we dont want to obviously use one bad example to set the rule for everything else. Thats why weve flown test kits out to the ship literally as were speaking. Thats going out so we have greater clarity on what were contending with. You may remember the cruise ship that went out of bay on new jersey, seems like a long time ago now, when that one came back, we basically investigated the circumstances on the ship and designed an offload strategy for that ship, under those circumstances. And this was the captain of the board working very smoothly with the regional head for cdc there. And then, last but not least brought those who were suspected of infection off the ship separately to prearranged local Health Care Facilities. Now we could do that because it was four people. If you start putting zeros on that number with heavy suspicion theyre positive, you can overwhelm local health care capacity. Understood and i dont want to belabor the point except to say this, its not as if we have to take all the people who have tested positive on a cruise ship off and send them to one Health Care Facility were the United States we have lots of them. Some states are hit more than others. I think its important that we have protocols in place. I understand the importance of, you know, factual case based determines. Sure. But it seems like theres some confusion going on here. So thats just an observation. I appreciate the response. But we have the whole country available to us, and we dont have to worry about overwhelming a single point. If i just could, we dont. There is a misconception about the capacity we could put together for quarantining. And frankly, dr. Cadlec is better positioned than i. But this is an important misconception that i think would be helpful. Why dont you address that, dr. Kadlec, because if we dont have the capacity knowing now for at least a couple of months that highly contagious virus, not as lethal as some, but a highly contagious virus, was heading our way in all likelihood, what is our quarantine capacity then and what do we need to do to increase it . I, you know, know in my state we have the capacity on a state level to quarantine when we need to. So why dont you address that . Maam, we dont have the quarantine or isolation capabilities or treatment cape anlts to manage these. Even those weve made investments for ebola, its been on the singledigit kind of events. We had that capacity as modest as that is where we had only a couple of dozen isolation beds we could use for ebolalike disease we could use here. We maxed out that capacity particularly at university of nebraska where they have 12 beds and they expanded it to 16 beds for us to basically help take care of most seriously atrisk personnel from the diamond princess. So i think theres another area for i think congress to consider is, how do we do this in the future, given the nature of what we experienced . And to the chairmans point, this aint the last one. There will be another one behind it. And how do we ramp up now if we need to is the other thing . Because again, this were americans. We know how to do things. And we are we do hard things, and we can ramp up capacity. We have a lot of resources, and we have a lot of smart people and we are good people who want to take care of each other. Lets figure this out. One other question to follow up on something senator harris was touching on. As we know, a lot of people who should stay home if they get sick, to senator harris point, cant stay home and still feed their families and pay the rent. I wanted to follow up with you on a question i posed earlier this week. Sometimes the federal government invokes authorities to help those in need during a Natural Disaster by for instance providing snap benefits and temporary assistance for needy families to go beyond those typically eligible. Since we know many of our citizens cant afford to miss work and face real financial burdens, have you considered providing similar support during a public emergency . Maam, hhs and secretary azar is exploring all these options to ensure those who need care or assistance can receive it. Assuming funding, there are potentially through a supplemental, hhs has authorities to do some things. When are we going to have a determination about whether youre going to do it . Because again, we have a virus spreading in our country. If people know they could get s. N. A. P. Benefits or tani if they need to stay home, theyre more likely right now to selfquarantine. When is the answer going to come . Ill have to get you a firm answer on that. Ill take the question back. Its a question thats been asked already this week. Its a question that needs an answer. They sent you here to us today. Id appreciate it as quickly as possible. Yes. Thank you. Thank you. Before i turn it over to senator peters, i want to go back to the definition of quarantine capacity. My guess is were talking about something pretty strictly defined in terms of its capabilities, medical facility for very sick people, that type of thing. If we have to, i mean, again if this thing becomes more and more significant, there are things we can do. It may not be perfectly defined quarantined facility but we can still do things. Can you define, when you say we have limited capacity, im not denike that. In what way is it limited . For institutional, d. O. D. Was vital instrumental to accommodate individuals and disrupt some of their activities, training and otherwise. You know institutional quarantine. What does that mean . Having dorm rooms or place todays keep people. Probably the best place is in their homes. In the cases of wu hand the diamond princess, that was not necessarily feesible when youre trying to move a large group of people who are representative across the nation and realize they are at risk and potentially could be at risk to society, you have to put them in one place at one time and monitor them over time. I think if you talk about a distributed approach, the best place to do it, cdc has been working with state and local authorities to do this, is for people who are particularly being identified in travel screenings at airports, is try to get them to maybe their home of record and have them selfquarantined or isolate, so they can be in familiar settings and not put a burden on everyone else. This discussion all dependent on this thing ramping up to a level of snins where wed start this. One of the issues of home dwaurnteen, will people do it . Some kid went out to a party, should have been in selfquarantine, here he is out in a place where a lot of people are coming in contact with him. Mr. Cuccinelli, did you have an issue . In the ebola, what experts told us they used this tactic, smaller numbers, but it was over 98 effective. And i just want to give you a sense of scale. Im sorry to senator left. If you just look at the number of people who have been referred by the medical screeners at the 11 funneling airports and thats it for home quarantining, thats over 32,000 people in only 11 communities. Theyre all big cities, but they are not unlimited in their health care capacity. And the logistics of just getting that person safely and that means the people getting them to the next point must remain safe from point a to point b, are very substantial. I mean, you just look at the repatriation flights. They were enormously expensive. They were enormous logistical undertakings. And just moving a single perp from point a to b becomes a challenge. And you get local authorities who say dont move them through here because of the fear factor. Thats just the beginning of this event. So that would contemplate, if you really the only solution might be selfquarantining. I guess there would have to be some kind of pinlts at least threatened. Is that something the congress would have to pass . It is really suming something becomes far more significant. Yes. You noted earlier, mr. Chairman, that we used federal quarantine here in a scale not used in over 50 years. The last time was small pox in 1969. Remember small pox . Its been that long. The Real Authority and daytoday expectation is that local and state authorities are going to make these sorts of decisions, because they have the most knowledge about their communities. Now, i will say the legal authorities vary rather dramatically from state to state and with home rule states locality to locality. But that is where we expect those to take place. Ill give you an example one of your colleagues has talked to me about. Its an an airport. And wonders about the economic exceptions, cargo pilots and so forth going into town. Will that their equivalent of secretary azar, the state equivalent, i talked to their attorney general, has the Legal Authority to keep them in the plane and to force that Company Effectively to use two crews and fly in, turn it around, fly out, like were doing with the coast guard with ships frequently. And that is a state authority, and they have the sensitivity to make that decision in the case of their community. Because it also has economic impacts, all these other impacts, that we would rather not impose at the federal level, being federalist respecters, on local authorities. But we obviously want them to be engaged. We want them to make those wellinformed decisions. We stand with them shoulder to shoulder in talking to these. Thats why we were talking to the attorney general and health commissioner. The federal governments role will be robust in this. But so lo the state and local governments role. Well be providing resources. Well be advising, providing information accumulating all that information. But in some of these cases, this will really be dependent on local and state authorities to okay. Thats helpful. Senator peters. Question regarding the air travel and tracking folks that are traveling. Just both to mr. Cuccinelli and dr. Kadlec. Airlines dont have the requisite information the cdc needs to help trace the spread. Because passengers only provide a phone number or email when they purchase tickets. Its difficult to track. My question to both of you, are you aware of the holes in the data between what is provided by travelers when they purchase tickets and what the cbp and airlines provide to the cdc . And should we be looking at that . So, yes, and i think we both have elements to sneak to on this. Theres been a 15year battle going on with the cdc and the airlines, with cdc trying to get a regulation in place to get what they would say are the five key pieces of data they need to effectively do Contact Tracing, if the need arises. And the airlines have successfully fought it off for 15 years. The task force dealt with an interim final rule that cdc in fact has issued directing the airlines to provide these pieces of information. There is now a logistical gap between right here as we sit here together and when they can have the systems in place to actually do this. Because it has to happen at the point of ticket purchase. And of course many people will have already bought tickets already. I would also note that airlines arent the only ones that sell us our tickets. Well go to owebits or travelosty and so forth. They provide even less information to the airline than you or i would if we went to their website or called their sales folks. So its very widely varying. When this broke out cbp went through the databases, pulled manifest information going back two weeks from the then previously existing wuhan flights. Were talking about 7,000 passengers over the course of two weeks, roughly. And it took cdc time to process through using that information to try to contact those individuals. And what they found is they could only actually ultimately reach about 25 of them. And when i say they, their partners in this were the local and state Public Health officials. We mentioned how important they are. This is one of the roles they play as the investigation. So what has happened is we evolved and senator johnson and i were talking in the midst of the changes we were making only as a practical matter, not legal, where away used that secondary screening, brought on more contractors, and got cdc to give us, meaning the dhs personnel there, their commuters. And we started just manually entereding this information one person at a time. Straight into their system. Now, since that time, they have been able to contact well over 95 of the people theyve been trying to contact. Again, they in this situation is heavily weighted to local and state Public Health authorities. Thats who gets this information. Cdc works with them. But theyre the ones really with pulling the oars on this work. So that has changed dramatically. You can expect when the ifr is in place, when the airlines are checking and delivering this information immediately, we should maintain that level of performance, above 95 contact rates. Let me quick interject, this is one of the prime examples of how responsive the administration has been. In some of our briefings i was not getting satisfactory answers from the cdc. Im talking to ken and really in a very rapid period of time again youre already on the case, you changed that procedure so you can capture that information. Again, thats what im saying from my own personal experience, this administration has been on top of these issues, grappling with gaps, and then try and correct them as rapidly as they can correct these issues. So anyway, senators peters. As we were talking about, the cooperation between industry and government sharing that information, its also critical were doing that in the supply chains weve talked about here in the hearing throughout the day. Weve got to have data as to where things are in the chain. So dr. K addlec, information chairing is important and my question is, are you receiving the information you need from interagency counterparts such as data from manufacturers collected by the fda to adequately assess supply Chain Security and where those vul neshlgtsz are and if not what we should be doing . Since the fda has the authority, i look to dr. Han to basically provide me his analysis of what is necessary. And not getting into the detail. He is part of our team. Fda is embedded in what were doing. They have the inside authorities to to do that work. We look to them to provide the guidance as well as awareness as to anything that may be awry or at risk. My understanding is the pandemic plan did not formally address Drug Delivery devices such as needings and syringes which which be important for max vaccines. What steps is hhs taking to ensure these supplies are available to respond to this outbreak . There are a couple of ways. You can do the Old Fashioned way and buy it. However a lot of that material is kind of just in time. So the ability to provide for example for a pandemic influenza, you may need 600 million or more, more like 800 million needles and syringes to do that. Thats a lot, right. Right. So whether or not that can be stockpiled, weve been looking to innovate around that. Weve worked with very Innovative Companies called lab eject that is looking to just in time mass manufacture of a very simplified one dose nonreuseable needle and ser ij. Its quite elegant and something that can be used not only here domestically during a pandemic, used around the world particularly in developing countries. Were looking at that as a joint Public Private partnership to address that. With the benefit of the supplemental monies, we intend to actually kind of work to build some capacity to do that, ustion that kind of innovative approach, as well as other innovative approach, like trans dermal application or administration of vaccines. Dr. Bright who leads barta here has been successful in their endeavors. 53 . 54. 54. Weve probably got 54. My apologies. But the point is really getting trying to look at innovation to basically help solve some of these very difficult supply chain issues. We dont just have to do it the old way. We can find new ways to do it for effectively and likely cheaper as well. Final question, mr. Cuccinelli. Is the department now considering issuing an Emergency Declaration under stafford act, given what happened . Maybe you could walk me through that. To issue an Emergency Declaration that would allow the government to deploy disaster medical teams, mobile hospitals or transportation support . Weve done that in the past with west nile virus and ebola, et cetera. Walk me through that in your thinking . The answer to the first part of the question is no, but that does not foreclose the use for instance of the imat. Just to give you the idea of the work weve been doing with the time we bought with the strategies weve been using, youre familiar with our imat teams, theyre sizable, numbers of people. We have reshuffled them down to four and fiveperson teams who we provided some additional training to deal with a virus situation versus say hurricane tornado in tennessee were dealing with right now. And the reason we did that is so because the impact of a virus, unlike a weather event, can be everywhere at once, in worstcase scenario, we created enough standalone teams that we could help all 50 states in smaller degree with the kind of support that fema brings in terms of experience and so forth. So again not sitting idly, those are the kinds of changes weve been making to our structure so were responsive to whats out there today. But on the stafford act doesnt envision a circumstance like this. I mentioned earlier the availability of the base fund, not the Disaster Relief fund, that really i think you have to go back to the 90s, and it was i think it was west nile. It was a a new york and new jersey, if memory serves, made request of the base fund, to get ahead of, alleviate. The easier example is a forest fire. If you help us now we can keep this from getting bigger. Its a wavable cap and is designed to avoid rolling damage to a system. In this circumstance youre probably looking at when a community or state has sits Health Care System threatened to be overwhelmed because theyre getting hit harder than other parts of the country. So there is some money available for that purpose. I would say the stafford act is not really designed for this. And not surprising to you, we have analyzed it for these purposes sort of backwards and forwards. So you are seeing, even those imat teams would typically be deployed alongside hhs. And in support of them hhs would reimburse us for the deployment just for the fema team thats supporting them. Thanks. I really need to close it out here pretty quick. But dr. Kadlec, who is in control of the strategic stockpile . Operational control and the secretary is the overall if you will, i wont say Incident Manager but hes the person at charge at hhs so manage this event. How many items are inventoried . Its about an 80 billion 8 or 80 . 8 billion. How many items . Hundreds of vaccines, therapeutics, all kinds of supplies, masks. So who and how is are the inventory levels set . We have requirements set based on a requirements process. Some of it has been fix youated on the basis, what can we afford to buy as much as what we need. How close are we to actually having the required levels in inventory now . Sir, id have to give you a detailed answer back on that. Okay. Again it is something we have a multiyear budget that looks at what we would need to do it. I think you can look back over the last five years as what should be those levels of funding that reflect many of those requirements. So again, the point wasnt to get the answer my questions, but to raise the issue. From my standpoint in terms of supply chain and what we need to the stockpile, we have the shortterm situation, about what we need now and how are we going to procure it . So that if this thing continues to get worse and worse, weve got the supplies. And recognizing again not to create unrealistic expectations, it takes time to manufacture things. If its not in stockpile right now, those are going to be some issues. Again, really appreciate your pointing out that our first strategic spock pooil is the number of doctors and nurses and Health Care Professionals and thats finite. We need to protect them first. Longterm, we do need to take a look at how we fill that stockpile. Do we, based on our experience how this all ends up, what inventory levels should be there . What things should be inventoried . How much money should we spend . Again, i think some of you pointed out the Aircraft Carrier, 8 billion versus 17 billion. Hopefully we learn from this. I want to use this committee, and id imagine youre the person to deal with, in terms of what we need to pass legislatively to make sure we are better prepared next time. Learn the lessons from this episode and be better prepared. I will also say to me its riddick lois, im a manufacturer. Im all for Global Supply chains. But when we have an fda approving drugs for use in america, the fact that weve wreef put ourselves in a position, i think its about 77 of the api comes from india, correct. Yes, sir, a lot from overseas. A lot from china, but thats not a labor intensive manufacturing process. So theres no reason, i dont believe, that the fda, approved drug here, needs to be manufactured here. We do need to take a look at these things and be smart about this. The way you do it in industry, we need to do the same thing from a standpoint of government as well. Really want to work with you. When the dust settles on this, by this event, weve got to prepare better. I think its going to require legislation and appropriation. But its going to require thoughtful analysis. So to close this out, i want to thank all the Committee Members not here but hopefully theyre hear it, for their respectful questions, for their attendance. And i want to thank you. I hope the press, i hope the American People, are listening to the thoughtful responses. It would give them a fair amount of confidence. This is uncertain. We dont know where this will go. From my standpoint having dealt directly with members of administration and people throughout this industry, first of all, thank the men and women of your agencies. But this is being carefully considered. We are thoughtfully working our way through this process in a very uncertain situation. So again, thank you. Thank the men and women in your agencies. Again, i really do appreciate the members of this committee being very respectful and thoughtful in their questions as well. The hearing record remain open for 15 days until march 20th at 5 00 p. M. For the submitting of questions and statements. This hearing is adjourned. Tonight on the communicates, former fcc commissioner susan nest talks about ways to reduce hate speech and extremism online. Companies when they find terrorist content, they will tag, so that others dont copy it. And theres now much greater cooperation than we had even two years ago. But there still is a tremendous amount that needs to be done, the pressure needs to be there. Watch the communicates, tonight at 8 eastern on cspan2. Comes out to be a campaign in which we have one candidate who is standing up for the working class and the middle class. Were going to win that election. For those have been knocked down, kouchted out, left behind, this is your campaign. The president ial primaries and caucuses continue tuesday, for six states, including idaho, michigan, mississippi, missouri, north dakota, and washington. Watch our campaign 2020 coverage of the candidates speeches and results tuesday evening live on cspan, cspan. Org, or listen wherever you are on the free cspan radio app. Next, a hearing on the Airline Passenger experience. A house transportation subcommittee heard from representatives from the Government Accountability office, consumer reports, paralyzed veterans of america, the Airline Passenger experience association, and spirit airlines. Subcommitte