Good. The steering will come to order. I want to thank you witnesses for your efforts as they are wed to the current have to call it a pandemic at this point with covid19 karate coronavirus. I think it is important we put ever in perspective. I asked my Committee Members to include my Opening Statement in the record. Fail towe often recognize and put this in proper perspective. Let me battle off a couple figures. Worldwideal cases ended up being less than 29,000. In the mist of that crisis, we were talking about this spreading and it could be a Million People. Which would have been a huge problem because ebola had a mortality rate of already percent. In the end, because of effective action on the part of the world health organization, Obama Organization administration, we prevented that from spreading. Less than 29,000 people contracted that. We have had other topics of ebola where we are Getting Better at it. We have developed effective vaccines that helped protect Health Workers and we will talk about that. That is a finite resource. We have deadliest virus been dealing with is the 2012 outbreak. Total cases were less than 2500. 850 people died, a mortality rate of 34 . 2003, sars. 8000 people affected, 774 died. Talley rate of 9. 6 . Flu,verage flu, seasonal these numbers are a wide dispersion of what happens, 45 Million People a year catch it. Anybody with Underlying Health conditions, elderly are most affected by it. We will lose there will be 60,000 fatalities a year with just seasonal flu. Virus that reached pandemic levels, it sounded scary, was the and one h one virus. Stats on that is about 60 million americans caught h1n1. Million. , over 200 worldwide, hundred 75,000 people died globally. Fatality rates were not that high. Thousands died in the u. S. But we dealt with these things in the past. That we knowtats about, 81,000 individuals have contracted and tested positive for covid19. Close to 3000 deaths. The latest mortality rate is about 3. 4 . Which is serious. The normal flu is about 0. 1 . A higher mortality rate. I would caution everybody, this is just deaths from people we have tested. The types of test kits or numbers yet, we are developing them rapidly they still reducing government we will talk about that. We want to clarify that situation. Rate,ss is the mortality what we have a sense how many people contract this, where they dont display symptoms or they are mild, i think the mortality rate would come down. Nobody knows. There is a lot about this disease that nobody knows. What i am hoping we can our compass in todays hearing is talk about the administrations response, which i think has been almost immediate. From what i have seen, the accessibility of whether it is acting secretary both, mr. Cuccinelli, members of the cdc, and i ate, i had access to them. I have not abused that access because i want you working to mitigate this problem. They have been accessible. I dont know how many briefings i have attended. We have two individuals here. Why dont we have every agency . I want them to work. They have a job to do. There has been a lot of hearings so you have been accessible. Yet taken a whole of government approach. The have said, i dont see administration under responding. We have taken unprecedented steps. Travel bands, quarantines is this correct . The first time in 50 years . On positive steps. We have not under reacted. But i think this administration is aware of the costs of overreacting. Is fact of the matter chances of the administration getting it just right, reacting perfectly, is zero. It will not happen. Knowledge, interaction, what we have seen in terms of the interaction with the house, this is an all government approach, all hands on deck, this is not being ignored. You can see the billiondollar response you can see the 8 billiondollar response. Congress will make sure the administration has the funds. In terms of priority of action, is important that we are able to test so we know the extent of what the outbreak is. I want to talk about the regulatory issues, the basic issues, the basic signs issues. There is a reason they call it medical practice. This does not happen overnight. This is a new virus that just became known three month ago. It takes time to develop the test to make sure the tests do not produce false positives and you have to manufacture them. I am heartened by what i am hearing. I want to tell the figures now, i want to delve into those so we know what we are talking about in terms of what testing kits are available, how they will be distributed. What he priority is without distribution so we get a sense by being able to test as many individuals as doctors want to. Livid number of tests, there is high criteria to test any patient. Currento talk about travel restrictions. This was Homeland Security committee. We want to talk about cbps role, tsas will, how you are cooperated with cdc, with the screening measures are, what data we are collecting. If we talked about that at you reacted to our conversations, collecting more data so we can trace travelers that may have come in contact with people that are infected. I want to talk about all those issues as it relates to the department of Homeland Security. Testing is a top priority. We want to talk about the Current Issues with the supply chain but also in the future. Once we have this stabilized, hopefully this will prove to be seasonal, although there are indicators it may not be. What we have taken care of this and vaccines are valid and accessible, which will be sometime in the future, we need to take a look at the strategic stockpile, look at the supply , why are sourselves many of these precursor chemicals produced in india . Which is now blocking exports to some of these chemicals. I see no reason for manufactured drugs approved by the fda or u. S. Use that those should be manufactured overseas. We have to learn from these situations and put in place regulations or laws so we are better prepared for the next pandemic because there will be a next pandemic. I rattled off the ones we already had to deal with. I want to thank the witnesses. I hope this is a good discussion. I hope it is a clarifying discussion. This is about transparency. You dont have all the answers because there are things that are unknowable. Thank you for your work. Thanks for up your in before our committee. I will turn it over to our ranking member. Thank you to our witnesses for being here. The top priority of this committee and your agencies is simple. Keep americans safe. The coronaVirus Outbreak is not currently widespread, but it does pose a significant threat to our Public Health and Homeland Security and we have to take it seriously. I am grateful for the efforts of your agencies and officials across the country to limit the spread of this 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 local governments to limit the spread of this virus. It is clear that we should prepare for a worstcase scenario and widespread infection. Assessing clear information about coronavirus has been a significant challenge for the public. The American People have a lot of questions. Informationliable about the virus spread and what the government is doing to protect their health and safety. Academicsn from past past pandemics, it requires a comprehensive response as well as timely and trusted, useful guidance from Public Health officials as well as security officials. In the coming weeks, your agencies will play a Critical Role in containing the outbreak, educating americans about the virus, and protecting Public Health. Whether your response is effective will be a matter of life and death. I appreciate you joining us today. By constituents in michigan at the American People want clear answers to some of the most pressing questions that they have. I look forward to hearing what steps your departments are taking to wet sure we have the right plans and that you have adequate resources to execute those plans to stop the spread of this contagious disease. Thank you for taking time to be with us today. Is the tradition to swear in witnesses. If you will stand and raise her right hand. Do you swear the testimony you will give will bill will be the whole truth . Please be seated. Our first witness is ken cuccinelli, the senior official performing the duties of the home security. Director ofthe immigration services. He previously served as attorney general from virginia. Mappers of thed committee, it is my honor to a peer before you to testify about the work of dhs at what we are doing to respond to the outbreak of coronavirus, known as covid19. I am proud of the work of the andand women of dhs department of health and Human Services are doing to contain the spread of the disease, slowly spread, and prepare for a domestic response. The Department Top priority is the safety and security of the American People and we are committed to a proactive and preemptive response in fulfilling that mission. As required by congress in 2018, President Trump side of the first bio Defense Strategy to build upon our ability to respond to and limit the impacts of the by coincidence like the one we are facing now by bio incidents like the one we are facing now. Airportsking action at to support hhs in slowing the spread of the coronavirus. Dhs is working to decrease the workload of Public Health officials, expedite the processing of u. S. Citizens returning from china, and ensure resources are focused on the health and safety of the American People. Customs border protection, Transportation Security Administration to work closely with our partners at cdc to route admissible persons who had been in china and iran in the previous 40 days to one of 11 designated airport of entry where the federal government has focused Public Health resources. Its antiadmissible person who was been in the Hubei Province of china is subject to 14 days of mandatory quarantine cdc has made arrangements with local authorities to ensure they are provided medical care and Health Screening any admissible person and the rest of china or iran within 14 days undergoes Health Screening at one of the airports and if they are a some thematic, 14 days of selfmonitoring to make sure they have not contracted the virus and do not pose a health threat. Dhs continues to facilitate and hold screenings of travelers entering the United States who had recently been in china or iran. Travelers identified by cbp officers during their primary inspection are then referred to see wmd medical screamers. We have 500 contracted and 95 on duty at any given time. For those who through medical screening are identified as particularly at risk, they are referred to cdc personnel who are onsite and have made arrangements with local health authorities. Involved 53,000 air travelers to date. We realize these actions could prolong travel times for some individuals, however experts do agree these measures are necessary to contain the spread of the virus and protect the American People. To minimize disruption, the air carriers are working to identify qualifying passengers before their scheduled flights. Dhs is supporting the enhanced screening efforts through ems publicwith health at a First Responder personnel. That is where those 500 contractors come from. See wmd establish this capability and response to the anda threat last summer make sure a workforce was ready to deploy to support cdc with airport screening operations. Dhs was able to adapt this capability to address the covid19 threat. Support toing collect passenger information at all 11 airports allowed cdc to provide information to facilitate contact freezing effort. See wmds efforts have increased the accuracy of the data collected. The u. S. Coast guard continued their work to recognize and attack individuals are vibrate through our land ports and waterways who may be carrying the virus. All in coordination with cdc. The coast guard continues to review advanced notice of arrival. This is a notice they get before a ship comes to an american port. It gives a full accounting of the medical status of everyone on the ship. The captain will communicate concerns stemming from sick or deceased crew or passengers to their postcard chain of command and the cognizant quarantine station who will coordinate with health authorities. To ensure continued facilitation of international trade, nonpassenger commercial vessels that have been in china or iran in the previous 40 with no sick groomers may be permitted to enter u. S. Waters and offload cargo, reload, and depart the board. My time is up. I will stop with the Opening Statement we submitted, covering this territory and i am happy to answer your questions. Thank you. Our next witness is dr. Kadlec, the assistant secretary for preparedness and response for the u. S. Department of health and Human Services. He served as staff director for the u. S. Senate select committee on intelligence and special assistant to president george w. Bush for bio defense policy. He served in the air force for 20 years and was named Flight Surgeon in 86 1986. I want to read more. He was instrumental in drafting the pandemic and hazard. Bill to he served in the white house as a director for bio defense on the Homeland Security council where he is responsible for conducting assessment which culminated in drafting the bio defense policy for the 21st century and served as special advisor for policy at the office of secretary of defense, efforts to counter radiological, Nuclear Threats in the wake of 9 11 and contributed to fbi anthrax letter attacks. What an appropriate witness you are for this hearing. I appreciate it. That is a nice way of saying im a one trick pony. Chairman, ranking member, thank you for the opportunity to testify before do on how hhs is supporting the whole of hhs and u. S. Government response to the 2019 coronaVirus Outbreak. This morning, i want to take a few minutes to discuss how we are addressing this issue from a point of strategic anticipation. Working with my colleagues at cdc, cms, and across the government must supporting authorities, we are working to contain this Virus Outbreak to save lives and protect americans. There is a four pronged approach to domestic response. This includes development, supporting Health Care System, incident management, and direct support to local entities. In the area of cutter development, we are establishing a task force that includes partners across hhs, department of defense, and other agencies and private sector to identify therapeutics, diagnostics, and vaccines that can be brought to the pipeline to address the coronavirus threat. We are looking at point of care diagnostics, Public Health in rapid detection and guide treatment. Your identifying therapeutics to support the treatment of infected persons. We are working with nih, multiple potential vaccine candidates. All our efforts are pushing platforms and candidates forward as fast as possible to aid the overall response. Turning to have we supported Public Health system, and coordination with the Public Health emergency program, we have improved coordination between hospitals and Public Health sector and other entities. Leverage the ebola treatment network, an idea that was created by congress, and establishes a response to the 2014 Ebola Outbreak to support the treatment of repatriated persons. As the Health Care Systems prepare for the coronavirus, this network has and will continue to link experts with quarantine and isolation experiences, treatment efforts at the state and local level. Shifting to overall response instructor, since repatriation efforts began, we had been managementh the agency to put in place a Management Network that is based on the National Response framework. This is the first type we have formally implemented the structure. Thisacticed activating instructor during previous exercises, we are doing it for real now. We can leverage the capacities of female and Emergency Support functions that may be necessary to deploy responders to assist states and local authorities. Few briefend with a updates how we are providing support to state and local entities. Our repatriation efforts, we had 1100 americans from wuhan and the diamond princess cruise ship on your difficult circumstances. There are no additionally planned repatriation efforts at this time, but should the need to be raised, we are Planning State Department or other authorities. We shifted our efforts to now to provide support and aid states. In washington, we use the stockpile to provide protective equipment. A second shipment is arriving today. 28are planning to send Public Health Service Officers and and the mst members to support them as well. We are concerned about Health Care Entities like elder care facilities where the most vulnerable populations reside and are working with dms, cdc to provide information on best practices and when possible, help them shield our elder populations. I would like to be happy to yield the rest of my time and answer questions you may have. Thank you. I want to ask some questions. Normally i yelled and asked later. On a fewme clarity things. Lets talk about test kits. My understanding is 2500 test kits will be distributed by the end of this week, which is tomorrow. Each test kit can perform 500 tests. If you do the numbers, that is 1. 2 5 million individual tests. , to be sure, should be tested twice. Is that an accurate assessment . Where are we at . Who is manufacturing this echo the cdc started manufacturing test kits and within a week or 10 days up when the sequence for the virus was posted by the chinese began to work on a Chain Reaction test, which is a genetic test to look for the presence of dna rna from this virus. They are able to do a proof of concept prototype and begin to produce that as cdc and have shifted to commercial manufacturer, the individuals who are making the 2500 test kits, which include 500 tests per kit. Those will be going out how many Different Centers . They would go out to 190 places around the country. It cdc has already disturbed 75,000 tests of their tests. By the intent of secretary and president , it is to maximize the number of tests that can be performed. Two put some reasonable expectations behind this, these will be sent out to labs around the country, they will have to validate these labs for the test procedures at train personnel. They will not become immediately available but increasingly available over the next week or two to test americans, which is part of this function, which is there have been things to enhance our testing posture. One is make more test kits, distribute them, train people who need to do that, but ensure they are validated. There are things that had 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. That has been that has and the ability of doctors and primary care physicians and nurses to judge whether their patients should get tested if they suspect coronavirus. There is a lot of things at play. Regulatory, definitional, manufacturing, and distributing. Times k there are there are at times unrealistic expectation. It is a new virus we found out about three month ago. It takes time to further develop the tests. It takes time to validate it. You dont want falsepositive. Tot it takes time manufacture the first test kits, then time to validate the labs so personnel need to be trained. Ui thinking within a couple weeks, there will be a capability of taking a test, 1. 2 5 million tests, my guess is that manufacturing can ramp up great. Expectationhere is for this company to expand manufacturing and a parallel being done to engage commercial laboratory testers to introduce the tests and their systems so that would proliferate across the domain. The thing is, where there has been a lack of test kit, there will be plenty of opportunity for testing. The key thing, but we are focusing on, to do pointofcare diagnostics to support andicians in their offices test people and their offices to decide whether someone has coronavirus. What will happen is it will be Public Health laboratorybased and commercial laboratorybased, we are trying to push it out as far as we can. It will take some time but we are on the way. This takes time. You wish it would not, but it does take time. I think this has been proceeding rapidly. Everybody recognizes how important this is because we cannot get a game plan until we know the extent of the problem. Lets talk about the vaccine timing. I want to have peoples expectations be reasonable. It sounds like we are developing a vaccine at a rapid pace. One to go into phase make sure the vaccine is safe when . The doctor believes it can be done in a couple of months and after that is done, there will be a period of time to evaluate safety data. Lets talk about the approximate period of time. I want to create the expectation. Couple months to develop one. Then have to validate the safety. That will take . Another couple months. We or four or five months out. That is it effective . That is phase two. That will take how many month . Another sixmonth. You are a year before we have a vaccine that we think is safe and will be effective, then you have to manufacture it, bite . The reasonable expectation is between a year at 18 months. The doctor set up to a year and a half to moderate expectations. Lets say everything goes well and after a year, we have a vaccine that is safe and effective. But you will not be able to massproduce it yet. Will you be able to produce enough to provide to our first line responders, doctors, nurses . I would think you prioritize you have access that is an area that is recognized in the supplemental funding you provided, our domestic manufacturing for a vaccine for this virus is limited. Onot of our plans were based pandemic influenza where we can use eggs and our capacity is eggbased production. For these newer technologies like synthetic rna or genetic vaccines, we have a limited capacity. We will be constrained to get a vaccine for everyone. It would be prioritized to those who need it most. Health workers and First Responders. This vaccine will use one of those sophisticated techniques echo if you talk about 18 months before you start your manufacture, we will miss next years flu season, and we will not have a vaccine available until the 2022 flu season . That is conceivable. We put a lot of emphasis on diagnostics and therapeutics. I did not mention in my Opening Statement, but screening existing fda approved drugs and activity to do that in the to actualize that. We are looking at compounds that may be available that we could be using, as well as candidate the doctor has talked about, some other drugs, antihiv drug. Right now, the only thing we have is 18thcentury Public Health as well as things like 1995 respirators. Vaccines in the future as the solutions. You turn to, how do you mitigate this . How do you screen, get your arms about where this is . Quarantines . We will talk about other actions should this thing really spread and become more significant. My time is up. This information is important. My opening comments, it is important to get this information out in a trusted source. , as iing i called for for looked and folks looked information to the federal government, there is good information, cdc has information, but there is information dhs these two have. There is no coordinated plays where people can go to find out exactly what the government is doing with all the agencies. My suggestion is we have a. Gov website that is trusted that talks about not just what the cdc puts out, but travel restrictions, Homeland Security department, where people can go to. Right now, people are searching. They are searching for information, there are websites that are not accurate, there are folks trying to peddle product and create fear to make money. There is a lot of stuff right now. We have to tamp that down. To have one coordinated site make sense. Does that make sense where we have all the agencies and it is trusted . Have used our websites for each agency and at the departmental level to describe what we are doing. But this is a whole of government approach. It is a complicated interaction at the government level. I would note and well talk more role it, the preponderant that local and state officials play in this response and coordinating between Different Levels of government. I saw your letter, was glad to see it. I believe it makes sense. Particularly in a circumstance like this. There is a lot of us working on the subject. Which is why the president convened a task force. Is something we have heard and we are taking back to the task force to talk about. The cdclooking at website putting out facts about the disease. Last night, the president was being interviewed and some of the comments he made caused confusion. I want to take an opportunity at this hearing, it says if you are sick, keep from spreading illness, you should stay at home when sick. Is that accurate . Stayathome website . There is some confusion. We have one trusted source. That is part of the best thing, self isolated if you have a respiratory illness and you are not sure what it is. If it is coronavirus, better reason to stay home. It is a good practice. Thank you. There are reports that some or nationals have traveled that travel to china in the past 14 days are coming into canada, which does not have same restrictions. They are crossing the land point of entry from our northern border. Reports . Ware of these is there screening at the northern border to intercept folks who may be using canada as a port of entry and using a land port to come to the United States . Context, itn the has not been uncommon for chinese nationals to fly to tijuana or vancouver or montreal , by way of example, and cross into the United States. The largest land point of entry for chinese nationals are andalo, new york, california. They are not the only ones. At those ports, the numbers are sufficiently high that we stage in cooperation with hhs medical personnel, like we have at the airport. It was not widely advertised. Applies at land and airports and we have excluded 300 foreign nationals. Some might find it ironic, but the largest excluded group are canadians. It is canadians who traveled to china in the previous two weeks. The next Largest Group was chinese nationals. That dropped from there. I want to say 90 chinese nationals. The county poses real. The challenge you pose is real. Do you screen passengers and vehicles . It is a different process when youre coming across the land border. How do you deal with passengers in a vehicle and have an opportunity to screen them . The first screen and most important screen that cdp is best at is a travel screening. I described turn always, people are not allowed in the u. S. Because of their travel history. This at thess to border depending on how the individual or family 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 of people at the port of entry. If you think of the airport arena, be cbp folks to a travel interview. Where have you been . Who did you encounter . The next layer, you get a medical interview. Locationt one, is the where they had been that is the biggest flag and predating this had directhas always access to cdc when people present in front of them with the appearance of illness. The danger is you can be a symptom eric with this virus can be a symptom eric virus. Matic with this we have two other three busiest border crossings in north america in michigan. The main screen that is our first filter and biggest filter is the travel screen. Data systems we have available to our officers and that interview, while they were always doing it, there is a heightened focus on china, iran, but also korea, italy, japan. There is not a proclamation barring those but if you get a yes, you will pay closer attention and these are not medically trained individuals, what if there is anything they suspect, those individuals will be pulled to secondary screening, contact made with cdc and it becomes a consultation with medically trained folks who are not physically present. Thank you so much. Go ahead. That is an important point. This has never been, from day one, intended to be a skilled process. A sealed process. We are trying to delay the largest peak in the virus wave hit on the United States. All these steps reduce and delay, they do not stop the virus. We have never suggested we break capable of doing that we were capable of doing that. Viruses do not care about boundaries. It is a point for us to try to provide extra safety, but it is by no means foolproof. My, it is not a criticism, it is trying to create realistic expectations. Sealed, weetically would not have trade at the border. It would be costly. The idea is just to buy time, have more testing kits out there, mitigate it. You are buying us time at the border. Thank you for doing that. Which is what the doctor sat in a private briefing. The travel ban delayed this. Helped mitigate this. And it was contrary to the models. It was not necessarily predictive to work that way. Our analysis, we came to a different conclusion. Now her back ourselves. That has been effective. Effectively, but it bought us time. Thank you for joining us today and for their testimony and your work. Potential for a rapid spread, we cannot afford for patients to delay screening because of hasntly the media documented one shortterm Health Insurance plan billing a patient 3000 for his coronavirus screening. What is your staff doing to ensure coronavirus screenings are low cost and affordable, asking insurers to remove barriers to coronavirus screenings . We could have a briefing to talk about what we are doing to address that concern. That would be well received. Thank you. Commissionbipartisan on bio defense. You might have been the staff director for that . Yes, sir. In 2015, that group issued a report that included 33 recommendations to improve preparedness for biological threats. Know thesed to president has fulfilled one of those obligations. Remaincommendations unfulfilled. Could you speak for a minute or so about the recommendations that remain to be implemented . The second window was created , which was the effort to understand what we need to do. I think that was the intent of the study panel to evaluate what needs to be done. System 95 ealth care surge, and limited that will be tested. Critical infrastructure, Public Health infrastructure that helps people at the state and local level. The third is a different kind of structure, the infrastructure for medical countermeasure development. We talked about vaccines. Haveve to make sure we vaccines and jobs and made parts of the country that enhance health care. There are supplychain issues that have to be addressed. There are four quick things that i would suggest the panel has done to raise our awareness and focus our efforts to do that. Us about additional steps the administration is doing to fill other recommendations. I will put it in broad strokes. Relevant to this issue quite frankly how do we manage of potential endemic, a flu . A lot of that is about speed of action, which is a fundamental issue. The virus is moving faster than sometimes we can think and act, and the second thing is about domestic capacities, supplies, the Strategic National stockpile that have to be maintained over time. We part of the strategy is invested 8 billion in this kind of activity each year. Money,ds like a lot of but was an Aircraft Carrier cost 70 billion, that gives you some kind of idea what we invest in our National Health security. Thank you. Pharmaceuticalomise Companies Often partner with other pharmaceutical companies. O solve diseases what kind of collaborations are being and should be encouraged to develop a vaccine to address this virus. There is an International Consortium that involves multiple entities. They focus on major disease areas, coronavirus is one of them. Those kinds of issues are valuable because if you consolidate small resources and get bigger opportunities and tap into the wealth of innovative thinking around the world, you also understand that the underdeveloped world is the greatest at risk to make it more affordable. Other things address how we can build capacity in countries so they can position to help themselves. The success with the western outbreak of ebola, small amounts of money helped to build infrastructure and an effective vaccine. Those are some of the examples. Thank you. Thank you to our witnesses for your presence here this morning, but to you and your teams, thank you for your service. Please take our thanks back to everybody on the front lines. I want to followup up on senator johnsons question about what we can be communicating to our constituents about the timing of increased testing availability. We have tests at Public Health labs. Now we are searching on the commercial side. Weve talked about one million plus text capacity test capacity. Get the commercial labs these testing kits, they have to validate them, so how long does the validation process take. Get to theying to point where people will understand where this surge is making a difference in their experience. These tests are being delivered now. Next week, you will see high capacity and capability. The commercial laboratories will be lagging a week behind them. It takes a couple of days to do that. It is basically the machine and validating the test itself, and the people who have to work the machines in the test kits. Administration would put down a timeline so that people could see in writing on a website. , not an exact date, but when it expecte reasonable to commercial labs to perform this testing if dr. Suggest you get it. I want to move on to another issue. National disaster medical system and other programs play a Critical Role that patients receive care during emergencies. Issue you mentioned this was under discussion within the administration. Can you provide an update on what the administration is doing underinsurede patients can receive the Emergency Care they need. I do know there are moneys to support that that would expand that. I think it is about 1 billion. I think that would be money used for that purpose to ensure we can take care of everyone who is afflicted with this. We need more resources to make sure people are getting the care they need, the tests they need, so they will not be ther people. New hampshire has instate stockpiles of protective equipment, but recognized the stockpiles could be used up. We have had one confirmed case. Public Health Officials have attempted to order more surprised, but were told they are on backorder until may. Testimony, im concerned the National Strategic stockpile will be sufficient to meet the demand. What is the timeline for getting equipment in the field and how would you advise people to protect themselves in the interim . Youre strategy to address point, you will have to face some challenges. Limitede have a stockpile of masks, surgical ks, respirators, and we are acquaintance of mains more. For 500 million overrators to be provided the next six to 12 months. The supplemental provides funding for that so the manufacturers know they will get paid . Sureou have a plan to make First Responders are appropriately prioritized . We met with manufacturers yesterday. They are making allocations on their own, but in the course of these masks, in a given year, only 10 is used by Health Care Professionals in First Responders, so much that it is used by construction, mining, and manufacturers. We will try to work to see if we can get an application to make sure First Responders are covered. That is helpful to know. In addition to states needing these supplies, it will be important to provide training to responders and providers who will be tasked with assisting coronavirus patients. What efforts are underway to ensure responders and providers can Access Training on the use of personal protective equipment . One product of our work has been the network that was created post2014. We have also in the north new a responsea started network with mass General Hospital working to train and prepare people, so that will be one mechanism where we can get training out how to manage the coronavirus. We use some of the people at mass general used in the repatriation. , i think it will be important. In the proposed dh budget, there are cuts to programs that train First Responders in this kind of work, so i want to make sure we are focused on that i think you both, and thank you mr. Chair. Chairman. Ou mr. We appreciate your roundtheclock work. Surprise the virus is moving fast. Nevada reported its first case of the virus today. And stressedhasize the importance like other senators have here how important it is to keep those clear lines of communication open with canly good data so they respond with boots on the ground. I would like to address federal assistance for the impact on individuals. If larger measures are needed what plans are in place to help those who may miss work due to a governmentimposed quarantine . What can fema do to help alleviate this in the shortterm . What do you need from us . Has been emplaced for almost a month now assisting him, bringing the expertise to Disaster Response to this effort. The lead federal agency, of course. Step back and this is a disaster of sorts. The response mechanism is not the same. It is not anticipated you would problemintensity of the will be different in nevada then it will be in virginia, for instance, so there is a base can makee governors 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 dollar disaster, this is a base fund was 640 million or so in it. Some places are reporting school closures. We could anticipate closures of Senior Centers. Or reduceds on free lunch, free breakfast, Senior Centers where those seniors are reliant on those meals every day. How do we ramp up if there is a to get meals to these kids and their families . Can you speak to that . I believe the secretary has ,ome authority to expand aid welfare programs under the circumstances, fema nor dhs do not have dollars available that would legally fit the description of the relief you are describing senator. Coverede that is being and addressed in the supplemental, and that is the appropriate vehicle, and i would know more generally to the Planning Efforts that have gone before this all arose. Envisionedn, it was that the financial vehicle to deal with an outbreak of this nature was via supplemental, so we are sticking with that plan, and as we said six weeks ago, we will come to congress in that discussion is going on and is including the kinds of things you are describing. Beso our governors would able to request this what you are saying . No, you are mixing two things. If the supplemental includes money to address the type of financial shortcomings you are describing, then the answer would be yes but there is nothing in place that fema has available to fulfill the need your describing. So we may have to look to that in the future to take care of those vulnerable populations. The next thing i would like to ask you is immigrants seeking care nevada is diversity and strength and living in households with immigrants and are undocumented. As we work to contain the coronavirus that there is timely access to medical care for everyone that needs it regardless of their status it is a Public Health and safety issue. Living left but its all communities at risk. No one should be afraid to seek care and as the coronavirus spreads putting counties at risk would you refrain apprehension of vehicles of the immigration status while seeking care . Much like the cdc relationship to preexist the virus i. C. E. Also has it already in place the sensitive location policy they do not do enforcement in Healthcare Facilities with single case exigenct circumstances. There is no reason anyone should expect us but what about the intimidation factors such as placing vans outside of Community Centers where people may go . That would be consistent with the policy. Thank you. I yield back. Very quickly we discussed this looking at the supplemental zero dollars for dhs and we talk ed about this in the cloakroom describe the thinking of congress and how dhs needs the funding to do the things that you need to do in the situation . So the starting point is that fema is in the Office Every Day assisting hhs. That is financed by hhs so there is interagency agreements in place so the dollars that flow to hhs to address the challenge. They do flow to dhs when we provide those supportive efforts from any agencies or components. There is a mechanism in place . So you are not concerned when you look at the supplemental . Where are our support or resources . Through het this to a hs. A request for 2. 5 billion dollars. We will give him a billion dollars in resources p that should not be a problem. Thank you for being here and the excellent work you are doing to address this outbreak very. I am very concerned about the spread of the virus and what this has exposed. Fragility and vulnerability of her medical supply chains. You address this moments ago. Too many of our drugs or pharmaceuticals themselves are manufactured in other places and now we have seen reports about potential drug shortages because of the chinese manufacturing closures. This is something we have to scramble to address now that if this outbreak continues we dont have severe medical shortages , but also Going Forward that we take necessary action. So let me start with you, can you describe the actions of the task force are taking to ensure our Health Care Providers have uninterrupted access to personal protective equipment like masks, gloves . We have been working with the Key Manufacturers in the United States with distributors and again it is a delicate balance to ensure what is made available is available to the stockpile, not only our stockpile, but to distributors so they can provide for private Health Care Workers and institutions. Many states have unlimited stockpile, and our intent is to basically provide support to the states by providing interiors as we did to the state of washington to supplement what on hand and what is available commercially so they dont run out in the emergency of this nature. This stockpile works handinhand with partners to monitor shortages. Can you elaborate . Basically again if not daily or weekly conversations with major suppliers, dupont, 3m, honeywell, to basically understand their allocations to the private sector and the needs for the federal government as well. There are Many Department agencies that have needs as well, so we are monitoring that so we can moderate perceived needs versus actual needs to make sure we have enough in the pipeline to meet firstline needs. Its my understanding the fda is working with the manufacturers to monitor the shortfalls. To what extent are they complying . Through a this confidential business arrangement, so i do not have the ability to know exactly what the particulars are. This point, there is only one been identified. There are alternative products that could be substituted, so the impact of that limitation doesnt seem to be great, but they are monitoring that to make sure they can identify the risks to our medical pipeline. Because we need to give the fda authority to see where the drugs come from and then give them the authority to speed up approval of alternative devices of drugs manufactured in other areas. I have introduced legislation to do that. Let me turn to you. Do i need to be considering expanded travel restrictions and how do you evaluate that . Yes, because we have been considering them on a daily basis. The driving factors would the transparency of the nation under consideration. You compared chinas com dramaticncy to korea, difference. The ability of their Health Care System to respond to the outbreak in their country, and the capacity remaining after they do so. The state departments warnings early on about china were not outbreak,se of the they were also directed to key all employees say. If you got in a car accident completely unrelated in Hubei Province, there wasnt a doctor to take care of you on the subparts of their systems were and are overwhelming. That is another consideration. Other hand would be very different consideration. You compare the Health Care Systems. Mongolia close the border very fast. They do not have the ability to respond. We are talking about strengths and weaknesses and what we can do better in the future, but they have no ability, of those factors weigh in on those other countries. You are reevaluating this on a daily basis. Process an interagency and we are using two scales to both the state Department Travel advisory scale , and the cdc health scale. Their numbers naturally are off by one as we go up or down. , as the deputy secretary would tell you, i dont think i have ever seen such responsiveness to their travel advisories. We have never seen such consumption by the american downloads of their business guidance in the last 24 to 48 hours, so that is having meaningful effect without mandates. There is a proclamation with china. The tsa issued security directives with respect to korea and italy, but minimal legal impact. Very good. Let me come back to you. Im sure you are aware of other reports and other countries. Performing 10,000 diagnostic tests per day. Scale likenot that that . Preciseexplain the reason for the defective kits . I can provide the exact reason for the defective kits, but in terms of scaling, we are scaling up now by commercialization of test kits and Public Health laboratories, but engaging the private sector in the commercial labs that can do large volume testing. That will significantly expand the ability of testing in hospitals and clinics and doctors offices to use commercial laboratories. That would be rapidly turned around. We may not get the drivethrough swabbing, if you want to call it that, but also i want to comment on that. You have to do it with some precision how you take those slobs, so the risk as you can swab somebody and get a false negative, so it does take a little bit of training. I wouldnt think jackinthebox would be swabbing anytime soon. Senator scott . Have got a lot of information out. I havent seen anyone talking about the risk for pregnant women. Any precaution they have to take . There needs to be a better understanding of that. That is a vulnerable population for a variety of reasons, two lives, and the effects on the women in the babies. There has been a coronavirus case and a newborn in china, but that is the only thing. It is an anecdotal case, but certainly that is a major issue and concern. So nothing has come out of south korea or japan . Nothing yet. Were getting high level statistical data, but no reports. Thank you. Have 150 million passengers at our airports, and cruise ships. What advice are you giving to our airports and our seaports . We have so many people coming from all over the world from countries with coronavirus. What precautions are you putting in place . The coast guard, tsa in particular, have regular communications with the cruise lines and airlines. I have been doing that as well. You will have noticed that for the first time ever, we were talking about travel advisories. We issued a travel advisory specifically related to cruise ships, not a country, not a location, but cruise ships, because they have proven to be a risky venture from a health standpoint. That was unique. It was effective in terms of the responses. That is not economically good for the cruise ship industry. The diamond princess was a viable disaster. That seriesepeat of of mistakes that will really take a long time to understand completely has driven a lot of that response. On the airline front, we are seeing pointtopoint declines in traffic. I had data on some of that if you would like. Chinas flights have gone through the floor. Declined, but may be by half, japan by 25 , just by way of example. There are good reasons for that. The cruise ships themselves that i have discussed with the representatives are trying to avoid bringing on passengers from these hot stones. Zones, and to avoid a repeat of quarantining a ship. Ports, and in the you have many of those in florida, the captain of the port , the coast guard person in command at that port is an absolute control of that port, and we hold ships offshore when needed, and we have done this throughout this time, primarily triedshipping, because we hard to keep the cargo flowing, not for dollar reasons, but because of the interne interconnected nature of our supply chains. We have taken steps keeping cruise on ships, allowing offloading without the usual coming a short. And a passenger context, that is more difficult. We continue to contend with these. We are dealing with one coming into San Francisco as we speak that is being dealt with direct pay. The captain of the port will work directly with the regional cdc head to address these on a casebycase basis in terms of dealing with passengers. Having been governor of florida weou can appreciate that if 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 that is our counterbalancing challenge that we rely on the cdc to make the state and local arrangements. We really are handling them one at a time, but it is within, not. Ringing a short virus spread that is a priority and part of why we warned americans not to go on them in the first place. So what will it take to do the same thing you did, restricting travel out of china . Taken in thewas epicenter in 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 taking case numbers up fast. When you take a snapshot of todays cases, one week, to wakes, threeweek lagging indicator of what was already there. There are lots of areas where we lack knowledge. If you are in the cruise business or airline business, that will keep hurting you for that that while. We dont know how long. Our challenge is to keep americans safe. I dont believe the information to me out of china, a communist country run by the common party. Do you have any intention to open up travel from china . That is not on the table. We are not talking about it right now. Are you going to Start Testing everybody coming off . Would be a casebycase. We wont be able to for a few nows, however, we are right as we speak flying test kids to a cruise ship off San Francisco off california. They are dropping on the ship and bringing kids. Was that captain is talking to the local cdc authority, they have been working as an action group with the cruise line themselves. We have been working it for days. Thank you. In terms of available testing kits because it is such a unique situation, i would think that would be one of the priorities to get test kits. Senator harris . Thank you, mr. Chairman. As you know my state home of 40 Million People with the largest number of cases, 62 yesterday, our governor declared a state of emergency for the entire state. Presents anrus interesting convergence between Public Health concerns and equity concerns, specifically two thirds of low income workers do not have paid sick leave. And as we know, we have been encouraging people who are sick to stay at home. Often people who are in that category are also in the service industry. They work in restaurants, hotels childcare, and 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 issue. What is the Administration Planning to do to encourage employers to have paid sick leave for employees so they will stay at home and not have to make that decision whether it is Public Safety or put food on the table. , will speak first to the communications we have had with people across the private sector. In addition to accelerated communications with local and state level officials, we have also been talking to nonhealthcare, private enterprises, and encouraging them in this direction as well, recognizing the burden imposes on business and on the employee. You identified certain businesses where it is important for everyone else, not just coworkers, for that person to stay home. If you are serving food then if the customers in that restaurant, they 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 . Hasas agency already standing sector consortiums they are talking to, and this is one subject they have talked to him about, supporting employees who are asked to stay home. We are also asking businesses in those lines of work where its possible to make telework arrangements that people can keep working and keep getting paid. You dont function as well, but they can still earn money for their families. My concern is for the majority of low income workers who do not have paid sick leave , they are in the service industry, so that is not an option for them. Perhaps we can follow up to determine how we can support your effort to figure out ways to make sure these employees dont have to make a decision between paying the rent or contributing to what we know there is money available but i would refer to hhs. One other area, on the White House Task force, secretary mnuchin, mr. Kudlow, and the National Economic council are about smallays business to support those individuals and how they can do that, so i am sure they will welcome the opportunity to work with congress to support individuals who are facing this problem who are challenged. Thank you. Federal employees. We have many federal employees who their job does not allow tsa, postalcommute, workers. What is the administrations plan for those workers in terms of what is seen to be enumerators for the 2020 census , which starts what is the april 1. Administrations plan for dealing with those federal workers who do not have the facility to telework and do their job . So one of the subgroups in the task force is dealing with the federal workforce. And of course to use the department of Homeland Security as an example, we have a building in Washington State unfortunately we had an employee test positive. That is an Office Building setting, one setting that dhs operates. That is a lot different than a Border Patrol station or a tsa desk were a bunch of people go by in close proximity each day. For those folks, people like the we have made tpp available to them. The medical guidance does requires appropriate training to use in a way that is advantageous to the wearer. I have been out to the airport myself was china flights were coming, and i observe the difference in the employees. Employeesce, some when i arrived at the airport with no flights had their uniform on and otherwise looked like you in me. When china flights were arriving, gloves and masks were on. And that is available to all employees, and that is true for the front line folks across the government. That is being closely studied and we are pulling down unnecessary travel, other things where we dont create risks for our employees of the general public. Thank you. In followup to senator rosens questions about undocumented immigrants, the reality is we have many undocumented immigrants in americas workforce. We also recently had an announcement from ice that they were going to increase enforcement. Legitimate and real concern that undocumented immigrants in particular and their family members are in fear of an certainly 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 to issue a Public Statement that during the crisis we are now facing that there will not be ice enforcement at these Public Health facilities, hospitals, medical clinics, places of that nature . We issued a statement yesterday in response to similar inquiries. Obviously the statement was based off the existing policy. We did restate that publicly just yesterday. That is great. And for both witnesses, there has been a lot of discrimination against asian immigrants and Asian Americans. Public Health Experts agree that the coronavirus does not focus or target any group by race or ethnicity, yet we are seeing many reports of intimidation and profiling and threats to the Asian American community and friends, so what is the administration prepared commit to actively dispelling misinformation about this issue . Because it is very real, and we have enough fear about the Public Health crisis, but to compound that with fear about being profiled is something very real. So obviously we are trying to calmly lots of different information about a virus and much of which is unknown and we have woven into our remarks at every level of government the same concern that you have just voiced. Because periodically, we do it candidly when we have instances brought to our attention so that in the department of Homeland Security and other places, with in our soon thereafter Public Statements is when we try to knock that back. We want to be very clear as you task force, without question, there is no difference this virus shows black or white black, white,e hispanic, or anything else. The dangers starts to the same people regardless of race or ethnicity and our responses should be irregardless of their skin color or ethnicity and thats how the federal government is responding to it. At the same time, i use the northern border with the china proclamation from more canadians have been barred on the northern border then the chinese because of that proclamation. It was travel base. It wasnt that you are chinese. It is you have been in the hot zone of the targeted time period of 14 days. We will continue to operate that way and to make efforts to knock down storylines or narratives that say anything different from that. Thank you. To our witnesses for participating in todays important hearing. Arizona, state with confirmed coronavirus cases. I would like to acknowledge the Arizona State lab and Maricopa County a Public Health and Arizona State university took for their swift actions to care for those individuals and mitigate potential exposure to those in the community. We need to see that same level of cooperation and coordination on the federal level. I have constituents quarantined on air force base received little or no information about going home after another individual who has been released tested positive for the coronavirus. They are on their way home some are still in quarantine and this lack of communication is unacceptable. Our constituents deserve straight answers under the guidelines and the efforts with to develop coronavirus vaccines and treatments. It must be driven by evidencebased Public Health expertise. My first question, Innovative Companies large and small are working to develop vaccines and therapeutics and better diagnostics, and they are lending their expertise from johnson andemics johnson, sanofi, merck and others are included with the all hands on deck effort. New innovators like the phoenix biometrics have submitted information to the cdc to evaluate Biosensor Technology to detect airborne viruses. Approved, what is the process and strategy for deployment to target those vulnerable populations of seniors with Underlying Health conditions . And also, what about frontline workers like Border Patrol at ports of entry or healthcare workers in servicemember s stationed abroad in hardhit countries . I would take it first. Quite frankly, we have been reaching out to Innovative Companies. We actually have met with 1500 commercial entities and universities and the like, so we happy to receive a white paper or suggestions from your folks on this. I would be happy to provide that information as well. The key thing here is we look across the domain. Yesterday, my director is behind me, but basically they put out a broad area announcement to look across theive ideas spectrum for medical countermeasures. So again, there is a way to engage in that area. Area of the vaccine, clearly that is not an imminent possibility. From earlier conversations, it is more like 18 months when we would have something and the scale of that availability is dependent on the kind of vaccine that would be developed. Primarily there are three candidates that are considered. Andson johnson has one, another, and sanofi is the third. So much that will be determined that youioritization identified. Clearly there is a National Security component to protect our forces. There is also how do we protect the people on the front line like healthcare workers, and then you identified the vulnerable populations which are significant. That all has to be factored into that. Toin, those are answers yet be determined based on what you said, evidence and Scientific Answers we can come up within the time that we have. With respect to the prioritization, you can expect to see when we reach that point what i call a traditional prioritization. You mentioned it yourself, senator, high risk categories. The mortality rate if you are over 60 with a secondary condition is much higher than if you are under 50. And so, limited supply will be funneled to the priority as typically happens already. We also have to work through exactly the kind of challenges you described, the force protection, as well as Frontline Law enforcement and First Responders, and healthcare workers. I am sure you are familiar with these sort of first doctor in china to speak publicly about this has now passed away. He was otherwise a healthy 34yearold. But healthcare workers are a limited resource in the sense that nothing any of us will do here will make more healthcare 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 it will 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 to man those posts and deal with people who dont come in with documentation or medical histories, and we have to be very very cautious in the circumstances. And frankly one or two people in a facility like that can wipe that facility out for utility purposes. Thank you. Itsecond question is that was recently announced that more types of respirators to be used as part of the response to address shortage concerns. This week, we introduced the Health Care Workforce protection act. It addresses manufacturer liability concerns by amending the Emergency Preparedness act to include respirators that are certified by the National Institute of Occupational Safety and health. Can you talk about the coordination efforts to ensure adequate supplies of protective equipment, including efforts to incentivize manufacturers to increase production . Thank you for that question. That is a critical issue that has to be addressed. I happened to be on the Health Committee at the time when that was originally considered and enacted, so i have firsthand experience. One thing we didnt consider at that time is the situation we have here right now, which is we thought the pandemic of influenza would be the principal threat, so we focused on the idea that medical countermeasures that would be necessary to protect the frontline Health Care Workers and vulnerable populations, like vaccines, diagnostics, and therapeutics like antivirals. So to be focused and did not include respirators. That was 15 years ago. A little bit of oversight, but has significant implications today. I want to thank you for introducing got big with senator fischer and the companion bill. I would hope that congress would take action on it. We did try to take an effort to have it included in the supplemental language, but were unable to, but this is vital for the producers of these products who, as you pointed out, the fda gave an emergency use authorization, which allows nonmedical respirators to be used by the healthcare industry. That is vital to do that. We have a requirement for healthcare workers depending on how severe the outbreak is for a billion to a couple of billion respirators. There was no physical way we can produce those respirators, particularly the medical ones, which are important in the operating room, intensive care units, but we can use other once used by industry that are splashresistant to protect frontline Health Care Workers. All we have now is that firstent to protect our responders. Thank you. A couple of questions. Much,ppreciate this very mr. Chair, and i appreciate our witnesses stamina. I know you started at 8 00 this morning. I just want to circle back to something you had talked about on the cruise ship issue. We learn from lessons from the diamond princess, the first test took several days at least before quarantine was implemented. At the end of the day, 3700 people on board, 700 tested positive, six deaths. So we determined, i thought, that it was not a good idea if there is a result on the cruise ship to keep everybody on that cruise ship together. Now a little bit of what you said in response to senator scott, we are hearing there is a cruise ship off california, which has 40 Million People and lots of military bases, lots of hospitals, lots of Public Health care facilities, and yet we dont seem to have a protocol to get those folks off the ships into quarantine in a way that would minimize the spread of infection. Thatcurious and concerned given the example of the diamond princess and what we thought we learned that we dont seem to have a protocol in place right now, that is clear. So 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 , that was a secondary effect of the bad quarantine. The lessons we learned were negative lessons. Im sure that doesnt surprise you. My point. T is it is sounding from news reports that would happen on diamond repeated on the ship. The initial assessment with the diamond princess before the spread accelerated the safest thing for all passengers was to bunker down and isolate in place and because the quarantine was not maintained effectively that did not hold. Had it been done well, it would have been the right course, and so we obviously dont want to use one bad example to set the rule for Everything Else and that is why we have flown test kits out to the ship literally as we are speaking that is going out so we have greater clarity on exactly what we are contending with. Then last but not least brought those suspected of infection off the ship separately to create range for local Health Care Facilities. We could do that because it was for people. If you start putting zeros on that number with the heavy suspicion they are positive, you can overwhelm local health care capacity. Understood, and i dont want to belabor the point. It is not as if we have to take all the positive people on a cruise ship, people who have tested positive, off and send them to one local health care facility. Some states are being hit a lot more than others. I think it is important that we have protocols in place. I understand the importance of factual, casebased determinations, but it seems like there is confusion going on. Thats just an observation. I appreciate the response. But we have the whole country available and we dont have to worry about overwhelming if i just could, we dont. There is a misconception about the capacity we could put together for quarantining. An important misconception that i think would be helpful. Why dont you address that, because if we dont have the capacity for at least a couple , a highly contagious virus was heading our way in all likelihood. What is our quarantine capacity and what do we need to do to increase it . In my state, we have a capacity to quarantine when we need to. Why dont you address that. Quarantine have the capabilities or treatment capabilities. Enforcementse made for ebola, it is singledigit kind of events. Unfortunately we have that. Apacity we maxed out the capacity particularly at the university of nebraska, where they have 12 beds that they expanded to 16 beds to basically help take care of the most seriously at risk personnel from the diamond princess. I think there is another area for congress to consider, how do we do this in the future given the nature of what we experienced . To the chairmans point, this aint the last one. And how do we ramp up now if we need to . We are americans. We know how to do things, and we do hard things, and we can ramp up capacity. We have a lot of resources and smart people, and we are good people who want to take care of each other, so lets figure this out. To follow up on something sarah harris was touching on, as we know, a lot of people who should stay home if they get sick cant stay home and still feed their families and pay the rent. I wanted to followup with you on a question i posed. 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 families to go beyond those typically eligible. Since we know many of our citizens cant afford to miss a day of work and face very real financial burdens, have you considered providing similar support during a Public Health emergency . Exploring allis these options to ensure those who need assistance can receive it. Assuming funding, there are authorities to not only reimburse hospitals, but potentially do these other things. Sen. Hassan when are we going to have a determination about when you are going to do it . We have a virus spreading in our country. If people know they can get snap benefits, they are more likely to self quarantine when we need them to. When is the answer going to come . I will have to get you a firm answer on that. Sen. Hassan it is a question that needs an answer. They sent you here to us today, so i would appreciate it as quickly as possible. Before i turn it over to senator peters, i want to go back to the definition of quarantine capacity. We are 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, if this becomes more and more significant, there are things we can do. Define, when you say you have limited capacity, im not denying that, but in what way is it limited . Quarantine,tutional we have limited capacities. Sen. Johnson quarantine, what does that mean . Having dorm rooms or places where you put people. The best place is in their homes. In the cases of wuhan and diamond princess, that is not necessarily feasible when you are trying to move a large group of people who are representative across the nation and realized they are at risk and potentially could be at risk for society, you have to put them in one place at one time. A distributiveut approach, cdc has been working with state and local authorities to do this, is for people who are being identified in travel screenings at airports, its trying to maybe get them to their home of record and having them self quarantine or isolate so that they can be a familiar be in familiar settings and not put a burden on anyone else. Johnson all of this is wrapping up to a certain level of sing of the cans when you start doing these things of significance when you start doing these things. I read a case where a kid went out to a party, should have been quarantine, and here he is in a place where a lot of people are coming in contact with him. Mr. Cuccinelli, do you have an issue . Mr. Cuccinelli yes. They used this tactic in smaller numbers. It was over 98 effective. I just want to give you a sense of scale. If you just look at the number of people who have been referred at the 11 finally airports, and thats it, for home quarantining, that is over 32,000 people in only 11 communities. They are all big cities, but they are not unlimited in their health care capacity. With the logistics in just getting that person safely and that means people getting to them to the next point must remain safe from point h appoint point b are very substantial. A to point b are very successful. Just moving a Single Person from b becomes aoint challenge. You get local authorities saying not to move them through here because of the fear factor. Sen. Johnson and thats just the beginning of this event. The only exclusion might be self quarantining, i guess there would have to be some kind of penalties at least threatened. Is that Something Congress has the authority on . Assuming something becomes far more significant, we are not suggesting mr. Cuccinelli yeah, but you noted earlier that we have used federal quarantine here on a scale not used in over 50 years. The last time was smallpox in 1969. It has been that long. The Real Authority in daytoday expectations is that local and state authorities are going to make these sorts of decisions because they have the most knowledge about their communities. Authoritieshe legal vary rather dramatically from state to state and with home rule states, locality to locality. But thats where we expect those to take place. I will give you an example one of your colleagues has talked about. It is at an airport. The cargo pilots and so forth going into town, there are their equivalent to secretary a czar has the authority to keep them in the plane. They can use two crews, turn them around, fly out like we are doing with ships frequently. A state authority, and they have the ability to make that decision in the case of their community. It has all these other impacts that we would rather not impose at the federal level, being federalist respect ors, on local authorities, but we obviously want them to be engaged and make wellinformed decisions. We stand with them shoulder to shoulder walking through those. Thats why i was talking to the attorney general and why we were talking to their health commissioner. So the federal governments role will be robust, but so will the state and governments role. We will be providing information. In some of these cases, this will really be dependent on local and state authorities to ok, thats awful. Senator thats helpful. Senator peters. Airlines indicate that they dont have all the requisite information that the cdc needs to help trace the spread of the viruses. It is primarily because passengers only provide a phone number or email when they purchase airline tickets, so it is difficult to track them on the plane, where they have gone and who they are sitting next to. What is provide by travelers when they purchase tickets, and what did airlines provide to the cdc . And should we be looking at that . Thinkccinelli yes, and i we both have elements to speak to on this. There has been a 15year battle going on with the cdc and the airlines, the cdc trying to get a regulation in place for what they say are the five key pieces of data they need to effectively do Contact Tracing if the need arises. The airlines have successfully fought it off for 15 years. We in the task force dealt with the 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 have the systems in place to do this, because it has to happen at the point of ticket purchase. Many people have already bought tickets already. I would also note that airlines are not the only ones who sell us our tickets. We will go to orbitz and travelocity and so forth, and they provide less information than the airline if you and i were to contact them. It is widely varying. As this broke out, cdp went through the databases, pulled manifest information going back two weeks from the previously existing wuhan flights. We are talking 7000 passengers over the course of two weeks, roughly. It took cdc time to process through using that information to try to contact those individuals. What they found is that they could only ultimately reach about 25 of them. When i say they, they are partners with a local and state Public Health officials. We mentioned how important they are. This is one of the roles they play in the investigation. We evolved senator johnson and i were talking in the midst of the changes we were making, only as a practical matter, not as a legal matter, where we used that secondary screening, we brought on more contractors and got cdc to give us, meaning the dhs personnel, their computers, and we started entering this one person at a time straight into their system. Since that time, they have been able to contact well over 95 of the people they have been trying to contact. They in this situation is heavily weighted to local and state Public Health authorities. Thats who gets this information. They are the ones pulling the oars on this work. That has changed dramatically. Is can expect when the ifr functionally in place and the airlines are collecting and delivering this information, we should maintain that level of performance above 95 contact rates. N mr. Cuccinelli this is one of the primate david this is one of the you are already on the case. You changed that procedure. Thats what im saying, from my own personal experience, this administration has been on top of these issues, grappling with gaps and then trying to correct them as they can as rapidly as they can correct these issues. Anyway, senator peters. About thes talking cooperation between industry and government in sharing that information, its also critical that we do that in the supply chain. Doctor, information sharing is important. Are you receiving information you need from interagency counterparts such as data from manufacturers collected by the fda to adequately access supply Chain Security and where those vulnerabilities are, and what more should we be doing . Adlek i look to dr. Hahn to provide his analysis of what is necessary, not getting into the details. He is part of our team. They have the insight authorities to do that kind of work. We look to them to broaden the guidance as well as awareness as to anything that may be a riot were at risk. Or at risk. My understanding is that the planned about directly addressed Drug Delivery devices, which is important for vaccines. Which steps is hhs taking to ensure these types of supplies are available to respond to the outbreak . Dr. Kadlec there are a couple of ways. You can do it the oldfashioned way and by it, however, a lot of that material is the ability to provide for pandemic influenza, you may need 800 or more, more like 800 million needles and syringes to do that. Thats a lot of needles and syringe is. Whether or not they can be stockpiled, we are looking to innovate around that. We have worked with Innovative Companies that are looking to mass manufacture a very simplified onedose, nonreusable needle and syringe. It is quite eloquent in its design. It can be used here not only domestically, but around the world, particularly in developing countries. We are looking at as a joint Publicprivate Partnership to address that. With the supplement of money, we intend to build capacity to do that supplemental money, we intend to build capacity to do that, as well as other innovative approaches, like Transdermal Administration of vaccines. Hasdoctor who leads barta been successful in their endeavors. Got 54. Obably the point is trying to look at innovation to 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 just as effectively. Sen. Peters final question, mr. Department is the considering the ms of the it tord act to issue allow the government to deploy incident management teams, mobile hospitals, or transportation support . We have done that a variety of times in the past with west nile virus, ebola, etc. The answer to the first part of the question is no, but that is not foreclose the usage of the imat. Are familiar with our teams at fema, senator, and they are sizable numbers of people. To fourreshuffled them and five person teams that we provided some additional training to deal with a virus situation versus hurricane, tornado in tennessee we are dealing with right now. The reason we did that is so, because the impact of a virus unlike a weather event can be everywhere at once, we created enough standalone teams that we can help all 50 states in smaller degree with the kind of support that fema brings in terms of experience and so forth. Not sitting idly, those are the kinds of changes we are making to our structures so we are responsive to what is out there today. But the stafford act does not envision a circumstance like this. I mentioned the availability of the base fund, another Disaster Relief fund. I think you have to go back to the 1990s. I think it was west nile. It was new york and new jersey, if memory serves, that made were west of the base fund made of the base fund to alleviate the easier example is a forest fire. If you help us now, we can keep this from getting bigger. Same idea. It has a waivable cap, and it is designed to avoid rolling damage to a system. In this circumstance, you are looking at a state having their systems threatened because they are getting hit harder than other parts of the country. There is money available for that purpose. I would say the stafford act is not really designed for this. Not surprising to you, we have analyzed it for these purposes, sort of backwards and forwards. You are seeing, even those imat teams would be deployed alongside hhs, and hhs would reimburse us, thats at the budget piece would work, for their deployment, just as they are for the fema team supporting them right now. Just really quick, i need to close us out here, but dr. Dr. Who is inc. Kadlec, who is in control of the stockpile . How many items are inventoried in the stockpile . Dr. Kadlec its about an 80 billion enterprise 8 billion or 80 billion . Dr. Kadlec 8 billion. Hundreds of vaccines, therapeutics, all kinds of supplies. Sen. Johnson so how are the inventory levels set . Dr. Kadlec we have requirements levels based on a requirements process. Some of it is on the basis of what can we buy, or what can we afford to buy. Sen. Johnson how close are we to actually having the required levels in inventory now . Dr. Kadlec i would have to give you a detailed answer back on that, but it is something we have a multiyear budget that looks at what we would need to do. You could look back over these last five years as what should be those levels of funding that reflect many of those requirements. Sen. Johnson the point was not to get the answer to my questions but just to raise the issue. Have thetandpoint, we short term situation about what we need now and how we are going to procure it. So if this thing continues to get worse and worse, weve got the supplies. In recognizing again, not to create unrealistic expectations, it takes time to manufacture things. If it is not in stockpile right now, those are going to be some issues. But i appreciate you pointing out that our first strategic stockpile is doctors, nurses, and Health Care Professionals, and that is a finite amount. Senatorm, i told holland on his way out, we need to take a look at how we feel , how this all ins up, what inventory levels should be there, what things should be inventoried, how much money should be spent. Hopefully we learn from this. I want to use this committee and i imagine you are 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 it is ridiculous im a manufacturer, ok . Im all for Global Supply chains, but when we have fda approving drugs for use in america, the fact that we have put ourselves in the position i think 78 of the api comes from india, correct . Dr. Kadlec a lot of stuff comes from china. Not aohnson but that is laborintensive manufacturing process. Drug here,approves a he needs to be manufactured here. We need to take a look at these things and be smart about this. You. Lly want to work with when the dust settles on this, weve got to prepare better, and i think that is going to require legislation and appropriation, but it is going to require thoughtful analysis. To close this out, i want to thank all the Community Members Committee Members for their respectful questions, for their attendance. And i want to thank you. I hope the American People are listening to the thoughtful responses. It would give them a fair amount of confidence. We dont know where this is going to go, but from my standpoint, having dealt rightly with members from the administration, first of all, i thank the men and women of every agency, but this is being carefully considered. We are thoughtfully working our way through this process in a very uncertain situation. Thank you, thank the men and women of your agencies. I really do appreciate the members of this agency being respect land thoughtful. Respectful and thoughtful. This hearing is adjourned. [gavel] [captions Copyright National cable satellite corp. 2020] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] to follow the federal response to the coronaVirus Outbreak, go to cspan. Org coronavirus. You can view hearings, briefings, and review the latest events at any time at cspan. Org coronavirus. Weeks Supreme Court oral argument on the louisiana abortion case, tonight. T 8 00 eastern on cspan2 listen anytime on cspan. Org or the free cspan radio app. To watch other oral arguments we have covered, go to cspan. Org supremecourt. A look at primetime schedule on the cspan networks. Starting at 8 00 p. M. Eastern, President Trump signs the 8. 3 billion emergency spending bill to battle the coronavirus. ,t 9 00 p. M. Eastern on cspan2 testimony from chapels on President Trumps 2021 budget request for the Homeland Security department. At 8 00 p. M. On cspan3, a look at the current state of the u. S. Intelligence community. Cspans washington journal, live every day with news and policy issues that impact you. Saturday morning, we will discuss the u. S. Response to the coronavirus and potential impact with a doctor from Childrens National hospital. Then, the shortage of life space being of lifesaving drugs that u. S. Hospitals and the impact on the coronaVirus Outbreak. Watch cspans washington journal, live at 7 00 eastern every saturday morning. Join the discussion. Tv, mayoral on book leadership, reflections from a watergate lawyer, and the effect of a twoparty political system on democracy. Saturday night at 11 00 p. M. Emanuel onhm innovation at the local level in cities across the country. Eastern, at 7 50 p. M. In her latest book the watergate girl, the author talks about her legal career, including her role as one of three special prosecutors in the watergate case. , 9 00 p. M. On after words an argument that the twoparty system is damaging americas democracy. What would be the chief advantages to having a multiparty democracy is all involved conflict because politics is conflict. The issues of consensus are not the political issues. The challenge is, we need to have some system by which we can agree that some set of rules are fair. And some set of procedures are fair. And we can abide by those outcomes. , jill oneahm emanuel banks, and afterwards with lee drummond, this weekend on book tv. Be sure to tune in next weekend for our to have day live coverage of the tucson festival of books on book tv on cspan2. Live, shortly from the White House Briefing room, we will get an update on the coronaVirus Outbreak. It is due to start at 5 30 p. M. Eastern time, any moment now, here on cspan. [crowd chatter, awaiting start] again, live here on cspan we are bringing you to the White House Briefing room. Expecting an update on the coronaVirus Outbreak. President trump and remarks as he signed the 8. 3 billion rotavirus bill passed by congress yesterday. Billion a 3 coronavirus bill passed by congress yesterday. We will show that now here ahead of the briefing. Good morning everybody. Good morning. We are to tennessee. To meet with the governor. A lot of people. And something. Guess some of your coming along. I assume. Right . Are you going . Ok. A . 3are signing the billion. I asked for 2. 5 billion. And i got 8. 3 billion. I will take it. Signing the 8. 3 billion. Ok. Clicking] here we are. Billion. It is an unforeseen problem. What a problem. We better know where. We are taking care of it. With things on the ship. A lot of things happening on the ship. People being tested right now. I just spoke to the governor. California avenue summit. Had a good conversation. We are both working on the ship together. It is close to 5000 people. So, big ship. We are doing testing on this people. Ok. Can i have those other papers im going to sign, please. Papersre additional relative to various things. [cameras clicking] ok. [indiscernible] do you have anything to say to the press . I want to make it clear that in terms of tests we have provided test to the state of washington and to the state of washington and to the state of california that they have asked for. The production and the shipping of tats we have talked about all we get complete leon schedule. All of the cdc tests, the tests available, up to 75,000 people, cdc has shipped to americas Public Health labs. Then idt the pirate private contractor working with cdc to ship to the private sector at hospitals has already shipped enough tests for 700,000 tests and the remaining lots are arriving at cbc this morning for Quality Control and should get out as we forecasted this weekend. Next week we will keep wrapping up production. So, as many as 4 million tests next week are going to be driving forward. So, everything is on schedule for the testing. President , why going to cdc today . He could tell you. We may go. They thought there was a problem. At cdc with somebody that had the virus. It turned out negative. So we are seeing if we can do it. But yesterday afternoon we were informed there may have been a. Erson with the virus and they now find out that that was negative test. They have tested the person very fully and it was a negative test. So i may be going. We are going to see if they can turn it around with secret service. We may be going. Here, steve, this is for you after covering me so well. [laughter] it is the first time i have done that to reporter. How big a hit to the economy . Job numbers just came out and they are incredible. The job numbers were tremendous. We picked up close to 80,000 new jobs from the last report. If you add that up it is over 350,000 jobs. The job numbers just came out a little while ago. They were shocking to the people analyzing. Do expect more gyration to the market . Know. A lot of people will be staying here. They will be doing their business here. It will be traveling here. They will be going to resorts here. We have a great place. So far, people calm. We are going to have americans staying home instead of going and spending money on other countries. Maybe that is one of the reasons the job numbers are so great great we have had a lot of trouble inside the usa. To think the u. S. Needs to take more action to diminish the risk of recession . All week and do is what we do. We are getting a lot of business from people staying. I have voiced liked anyway. You know for a long time. People are staying here and spending their money here as opposed to going to europe and other places. That will change when this goes away. Hopefully sooner rather than later. People, i would see virtually everybody, he saw the job numbers i guess, people are shocked because you had another 80 or whatever it is, a lot of numbers from last month, where they upgraded. So the job numbers were at a level nobody thought possible. They were incredible. [indiscernible] i do not know. We will see whether or not the fed wants to stimulate. In my opinion they should because europe is peered and china is. And everybody is but us. We have a fed that is not exact the proactive. I am being very nice when i say that. [indiscernible] i think what happens is the fed to cut and the fed should stimulate and they should do that because other countries are doing it and it puts us in a competitive disadvantage and we have the most crime. We are considered the most prime by far. And it is our dollar that everybody uses. The fed should stimulate and they should cut. And why should germany have an advantage of over us, with Interest Rates . So terminate Just Announced they are stimulating and their cutting. Asia is. All over asia they are. China is part china is. Tremendously. And we are really not. And we pay higher interest, we have a higher rate, and it is ridiculous, frankly. We should have the lowest rate by far and instead we pay more than other countries. Other countries are paying zero and less than zero. You know very well. Which are paying interest is a conservative approach. But it is not a good approach. Because we are competing against other countries. Even our friends we are competing against. [indiscernible] are you afraid that once the u. S. Pulls out the taliban will overrun the Afghan Government . Countries have to take care of themselves. We cannot be there for another 20 years. We have been there for 20 years. We have been protecting the country. It cannot be there for the next. Eventually they will have to protect themselves. You know. That should have been done a long time ago. Hold somebodys hand for so long. We have to get back to running our country as well. You understand that. [indiscernible] capable of long time . I will let you know later. I hope they are. But i do not nope youre i cannot answer that question. Any concern that the coronavirus is not supposed to happen that way but a possibly well. Any concern that the coronavirus is more widespread than originally thought because of the lack of testing. Is that any reason why you are not going to atlanta today . Know they had one person potentially infected. Speaking of that, i would like to go out so you guys are trying to work that out. I was going to tennessee first in any event and stopping in atlanta than going down to florida for meetings. I think theyre trying to work it out that i do go. Ive not heard that. I heard one person. Because of the one person have a high level. Because of the one person they do not want me going. But i would prefer going
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