Assistant hhs secretary admiral brancheau walk and stephen hahn. Good morning. The committee will please come to order. Administrative matters based on the attending physician, after we consulted with the department of health and Human Services and the centers for Disease Control and prevention, individuals in the hearing room are at least six feet apart. As a result theres no room for the public to attend in person. Representatives of the press are working as a pool to relay their observations to colleagues. The hearing may be watched online. Unedited recording will be available on the committees website. Witnesses are participating in Video Conference in a onetime exception. Some senators including the chairman are participating via Video Conference. Senators, weve been advised may remove their masks to talk into the microphone when theyre in the hearing room as theyre six feet apart. Im grateful to the rules committee, sergeant at arms, the press gallery, the capitol police, Committee Staff, and everyone all for their hard work to keep us safe. In our hearing last thursday, i said that all roads back to work and back to school run through testing. And that what our country has done so far on testing is impressive but not nearly enough. Over the weekend, senator schumer, the democratic leader, was nice enough to put out a tweet quoting half of what i said. He left out the other part, the impressive part. Let me say again what i meant by that. When i said impressive, i meant according to Johns Hopkins university study, the United States has tested over 9 million americans for covid19. Thats twice as many as any other country. We dont know what china has done. And its more per capita than most countries including south korea which many members of our committee had cited as an example of a country that had tested well. According to dr. Deborah birx, the United States will double testing the month of may which should get us up to about 10 million tests conducted. Heres what i mean by impressive. Here in tennessee, where i am today, first, anyone whos sick, First Responder or health care worker, can get tested. Our governor bill lee is also testing every prisoner, every resident and staff member in a nursing home, he has offered weekend drive through testing, done specific outreach for testing to low income communities. A tennessean can get a free test at the local Public Health department. The governors slogan is if in doubt, get a test. Governor lee sent his testing goals in to the federal may government as every state has done. The federal government is helping him make sure he has enough supplies in case he has trouble getting them through the labs and the other commercial sources. As a result, our state has tested about 4 of the population. The governor hopes to increase that by 7 in may. Thats one of the best in the country. This impressive level of testing is sufficient, we believe, to begin phase one of the going back to work, which is as i said last week is not nearly enough to provide confidence to 31,000 students and faculty members, what we hope will show up at the university of tennessee campus in august when school starts. Last week i talked with ut knoxville chancellor about that. We said what would persuade those 31,000 students as well as the 50 million k12 students in the country and the other 5,000 university students, what will persuade them to go back to campus in august . Thats where the new shark tank comes in, dr. Collins at the institute of health calls it rad x. We had our hearing about that on thursday, a remarkable scientific exercise to take a few early stage concepts that are swimming around in what we call that competitive shark tank to see if dr. Collins and his associates can find a few new technologies to create millions of new tests that will scale up rapidly and make it more likely that students will go back to school in for example, the fda august. Authorized last week its first diagnostic test using saliva that a person provides at home instead of a nose swab or blood. It authorized its first antigen test. Were hearing a lot about those like the ones used for flu or strep throat which involves the swabbing of the nose and you can get the result in just a few minutes. Another proposal not yet approved is to put in your mouth a sort of lollipop sponge, take a photo of that with your cell phone and send that to your doctor. If it lights up, youre positive. A university might send that saliva lollipop to a nearby laboratory which could be a gene sequencing laboratory which can deal with thousands of those samples overnight. That same process could occur at a middle school. It could occur at a factory. Of course anyone testing negative one day can test positive the next. But such widespread screening of entire campuses, schools, or places of work will help identify those who are sick, trace down those who are exposed. That, in turn, should help persuade the rest of us to go back to school and back to work. In addition to more testing, i expect dr. Fauci will talk to us about additional treatments that will be available to reduce the risk of death and the administrations plan to do something that our countrys never done before which is to start manufacturing a vaccine before it actually has been proven to work in order to speed up the result in case it does work. Those vaccines, those treatments, are the ultimate solution. But until we have them, all roads back to work and school go through testing. The more tests we conduct, the better we can identify those who are sick and exposed and we can quarantine the sick and exposed instead of trying to quarantine the whole country. In my opinion, this will require millions of new tests, many from new technologies. Some of these will fail, but we only need a few successes to get where we want to go. Thats why i said on thursday that what our country had done so far in testing is impressive but not nearly enough. First squeeze all the tests we can out of current technologies. Next try to find new technologies to help us contain the disease and persuade us to go back to work. Now, one other thing. This is a bipartisan hearing to examine how well were preparing to go safely back to work and to school and to determine what else we need to do in the United States senate. Such an exercise sometimes encourages finger pointing. Before we spend too much time finger pointing, i would like to suggest that almost all of us, the United States and almost every country so far as i can tell underestimated this virus, underestimated how contagious it would be, underestimated how it can travel silently in people without symptoms to infect other people, how it can be especially deadly for certain segments of our population, the elderly. Those with preexisting conditions, minority population. Let me go back to the march 3rd hearing that we had in our committee on coronavirus. Six weeks after the first case was discovered in the United States, a day when only two deaths were recorded in this country, i read at that hearing this paragraph from the New York Times two days earlier on march 1. They reported this. Much about the coronavirus remains unclear, the times reported, and its far from this is march 1 that the outbreak will reach severe proportions in the United States or affect many regions at once. With its top notch scientists, modern hospitals, and sprawling Public Health infrastructure, most experts agree United States is among the countries bestprepared to prevent or manage such an epidemic. That was the New York Times on march 1. A lot of effort has gone into trying to make our country wellprepared. Over the last 20 years, four president s, several congresses in response to 9 11, bird flu, katrina, ebola, h1n1, mers passed nine major laws to try to help get this country ready for what were going through today. These laws stood up the Strategic National stockpile, created the assistant secretary for preparedness. It created incentives for the developments of vaccines and medicines that were using today, strengthened the centers for Disease Control and created barda. Thanks to the leadership of senator blunt and senator murray for five straight years, we have significantly increased funding for the National Institutions of health. This was part of a shared goal. Democrats, republicans, several congresses, four president s tried to get ready for what were going through today whether it was known like anthrax or unknown like covid19. But despite all that effort, even the experts underestimated covid19. This hearing is about how we improve our response to this virus as well as the next one. During the oversight hearing, i also intend to focus on, as i just said, the next pandemic, which we know is coming. What can we learn from this one to be ready for the next one . Can we what can we learn from the fast tracking of vaccines and treatments that were about to hear about that will make it even faster the next time. How can we keep hospitals and states from selling off protective equipment when their budget gets tight . How can we make sure congress does our share of the funding responsibility . How do we provide enough extra hospital beds without cancelling elective surgery, hurting other patients, and bankrupting hospitals . Whose job should it be to coordinate supply lines so that protective equipment and supplies get where theyre supposed to go when theyre supposed to go . Whats the best way to manage the stock pile . My preacher once said im not worried about what you do on sunday. Its the rest of the week that concerns me. Im afraid that during the rest of the week, between pandemics, we relax our focus on preparedness, we become preoccupied with other important things, our collected memory is short. Just three months ago, this country was preoccupied with impeaching the president. Now that seems like ancient roman history. Now while this crisis has our full attention, i believe we should put into law this year whatever improvements need to be made to be wellprepared for the next pandemic. If there is to be finger pointing, hope theyre pointed in that direction. Were fortunate today to have four distinguished witnesses with the heart of the response in the coronavirus. Were grateful for their service to our country. I have asked them each to summarize their remarks in five minutes. Then well have fiveminute round of questions from each senator. Ive agreed well end our hearing about 12 30 after we have a full round of questions. Every senator will have a chance to have his or her five minutes. Senator murray will then have an opportunity to ask the last question or to close the hearing, and i will then close the hearing. There will be other hearings to follow this hearing like last thursdays hearing, and senators may submit their questions in writing within the next ten days. Staying at home and definitely is not the solution to this pandemic. There is not enough money available to help all those hurt by a closed economy. All roads back to work and back to school lead through testing, tracking, isolation, treatment, and vaccines. This requires widespread testing. Millions more tests, created mostly by new technologies to identify those who are sick and who have been exposed so they can be quarantined by containing the disease in this way give the rest of america enough confidence to go back to work and school. For the near term, help make sure those 31,000 ut students and faculty members show up in august, we need widespread testing. Millions more tests created mostly by new technologies to identify those who are sick who have been exposed so they can be quarantined by containing the disease in this way give the rest of america enough confidence to go back to work and back to school. Senator murray. Sen. Murray well, thank you very much mr. Chairman. My thoughts are with you and your team right now as you try to navigate the same challenge so many in our country are worried about. We all wish your staff member a speedy recovery. And as everyone works to take appropriate safety precautions today, i would like to thank not only our witnesses for joining us today, but also our Committee Staff for working to set up a safe format for members and witnesses and the public to participate in this hearing remotely. Families across the country are counting on us for the truth about the covid19 pandemic, especially since it is clear they will not get it from President Trump. Truth is essential. So, people have the facts, so they can make decisions for themselves and their families and their communities. Lives are at stake. The president isnt telling the if the president isnt telling the truth, we must. And our witnesses must. And were counting on you today. And families need us to take this opportunity to dig into the facts about where things did go wrong so we can finally get them on track because the Trump Administrations response to this Public Health emergency so far has been a disaster all on its own. Delays, missteps, have put us way behind where we need to be on diagnostic testing and allowed inaccurate Antibody Tests to flood the market. Corruption and political interference have impeded efforts to secure desperately needed personal protective equipment and promoted dangerous, unproven treatments. And we recently learned that after experts at the centers for Disease Control and prevention spent weeks developing a detailed guide to help our communities understand how to safely reopen, when the time comes, the Trump Administration tossed it in the trash bin for being too prescriptive. But this is far from the first time this administration has silenced experts who were doing their job and putting Public Health first. The fact of the matter is President Trump has been more focused on fighting against the truth than fighting this virus, and americans have, sadly, paid the price. Since this Committee Last heard from these witnesses on march 3rd, we have seen over 900 deaths in my home state of washington, over 80,000 deaths nationally, and the numbers continue to climb. Still, President Trump is trying to ignore the facts and ignore the experts who have been very clear we are nowhere close to where we need to be to reopen safely. My hope today is that we can cut through this and have a serious discussion about what is needed to safely open, how close we are as a country to meeting those needs, and how we actually get there. One thing thats abundantly clear, we need dramatically more testing. It is unacceptable we still dont have a National Strategic plan to make sure testing is free, fast, and everywhere. That is why i fought to make sure our last covid19 package included an initial 25 billion testing fund and a requirement that the Administration Submit a plan by may 24th. And when i say a plan, i dont mean a pr plan. I mean a plan with specific timelines and numeric goals for supply and funding needs, one that actually addresses the issues were seeing on Testing Capacity and distribution and disparities and building out our Public Health system, and makes clear to states and tribes, employers, and the American People what they can expect and what the administration will do to keep americans safe. Testing alone wont be enough to reopen our country. We still need far more personal protective equipment than has been available for our Health Care Workers on the front lines. And we will need far more for other workers as we reopen. So, we desperately need this administration to step up and get that equipment to states who are doing everything in their power to purchase supplies but simply cannot get nearly enough. Because the reality is unlike states, the federal government has the tools to actually fix the problem if only the administration would use them. And we also need that equipment to actually work and for the fda to act promptly if it does not, not weeks later when people may have already been exposed. And just as importantly, we cant expect people to go back to work or to restaurants or to confidently send their kids to school if there isnt clear detailed guidance about how to do that safely. Schools from Early Childhood through college need to know how to keep their students, their staff, and their educators safe. When should they wear masks . How do you run a School Cafeteria or a school bus . If they cant reopen classrooms, schools and families need to know were working to ensure every student gets an education. Tools like Online Learning can only get us so far if we dont address the Digital Divide so that every student can access them. And even then, there will be learning loss that could deepen existing educational disparities among lowincome students, students with disabilities, english language learners, and other vulnerable populations if we dont make sure they get equal access to resources and support. And of course, schools arent the only workplaces weve got to be thinking about. We need to make sure that industries across the countries know how to safely reopen and that people know their workplace is safe. Secretary scalia needs to stop dragging his feet and do his job and have the department of labor set forward a rule that makes clear worker safety is not optional. Mr. Chairman, i hope this committee can hear about those Critical Issues from secretary scalia and secretary devos as well as other experts in this space in the days ahead. This is especially important to protect nurses and residents at our Nursing Homes and care facilities where weve seen some of the most deadly outbreaks. And as the rash of outbreaks at meat packing plants shows, this isnt just an issue for the health care industry. It is an issue for everyone. And just as we need a plan before we can start to reopen, we also need a plan well before we have a safe and effective vaccine to guarantee that we can quickly produce and distribute it on a global scale and make it free and available for everyone. So, i will be asking about our progress on those issues today. Today, safely reopening our country may be a ways off, and the administrations planning may be way behind. But theres still a lot that Congress Needs to do. There isnt time to spare. Some some, including the white house, say weve already provided enough Economic Relief. My question to them is what good is a bridge that only gets you to the middle of the river . We dont need to wait around to see if people need more help. We know they do. We need to work quickly on another addressive dont need to wait around to see aggressive relief package, and we need to make sure our priorities in that bill are protecting our workers, our students, and our families and addressing this Public Health crisis, not bailing out corporations or protecting big business from accountability. People across the country are doing their part. They are washing their hands and Wearing Masks and social distancing and staying home. They need their government to do its part too. They need leadership. They need a plan. They need honesty, and they need it now before we reopen so they can rest assured that we are doing things safely and competently with their health and well being as a top priority. Thank you, mr. Chairman. It is an important hearing. I know lots of people maybe watching for the first time. I hope they notice we have 23 members of this committee, one more republican than democrat. We have some very strong views but are able to Work Together and express those views and respect each other and our witnesses and a big part of that goes to senator murray and her staff. Thank you for that. Each witness will have up to five minutes to give his testimony. Thank you for making an exception and agreeing to testify by video because of these unusual circumstances. And thank you for what youre doing for our country. Our first witness is dr. Anthony fauci. Hes director of the National Institutes of allergy and Infectious Diseases at the National Institutes of health. Hes held that position since 1984, which meant hes advised six president s and worked on hiv and aids, influenza, ebola, and other Infectious Diseases. He was involved in treating ebola patients at nih and also worked on vaccine trials for ebola. Next, well hear from dr. Robert redfield. Hes director of the u. S. Centers for Disease Control and prevention which has its headquarters in atlanta. More than 30 years hes been involved with Clinical Research related to chronic human viral infections, Infectious Diseases, especially hiv. He was the founding director of the department of retroviral Research Within the u. S. Militarys hiv research program. He spent 20 years with the u. S. Army medical corp. Third, admiral brett, assistant secretary for health at the u. S. Department of health and Human Services. That puts him in charge of Public Health policy recommendations. Hes taken on the responsibility for coordinating testing, and focused on the increasing number of tests we can do with the existing technology. His federal Service Includes a variety of activities with our Defense Department and advanced research. Throughout Reduction Threat reduction. He was part of the Blue Ribbon Panel to reform the u. S. Veterans Health System. Finally, well hear from dr. Stephen hahn. Hes commissioner of the food and drug administration. Before joining fda, he was the chief medical executive at the university of texas md anderson cancer center. He was chair of the department of radiation oncology at the university of pennsylvania. He was the senior investigator at the National Institutes of health. Hes commander of the u. S. Public Health Service board. Now well ask each of our witnesses to summarize their remarks in five minutes. Following that, each senator will have five minutes for questions and answers in order of seniority. Dr. Fauci, lets begin with you. Welcome. Dr. Fauci thank you, very much, mr. Chairman, Ranking Member murray, and members of the committee. Thank you for giving me the opportunity to discuss with you today the role the National Institutes of health and research addressing covid19. The Strategic Plan we have is four fold. One to improve the fundamental knowledge of the virus and the disease it causes. Next, to develop new point of care diagnostics. Next, to characterize and test the therapeutics. And finally, the most safe and dust develop safe and effective vaccines. First, with regard to diagnostics, as you probably heard from dr. Francis columns last thursday, the nih has developed rapid acceleration of Diagnostics Program with a an award to that specific program of up to half a billion dollars to support the development of covid19 diagnostics. It is a National Call for Innovative Technologies that will be evaluated in a shark tanklike Selection Process to get to either success or failure rapidly. Moving on to therapeutics, ill talk a bit about the remdesivir success antiviral in a moment. But let me emphasize that there are a number of Broad Spectrum antivirals that are in various stages of testing. In addition, well be looking at convalescent plasma, which is plasma from individuals who recovered from covid19 to be used in passive transfer either in prevention or treatment. In addition, hyperimmunoglobulin which can be used as a gama globulin shot. Well be looking at repurposed drugs as well as immunebased therapies and host antibodies. Host modifiers. And finally, antibodies. Let me take a moment to describe the remdesivir placebo controlled randomized trial which was done internationally with the power of more than 1,000 individuals in sites throughout the world. It was in hospitalized patients with lung disease. The end point was primarily time to recovery. The result was statistically significant but really modest and we must remember it was only a modest result showing that the drug made a 31 faster time to recovery. We hope to build on this modest success with combinations of drugs and beat and other drugs. Moving on to vaccines, there are eight candidate covid19 vaccines in clinical development. The nih has been collaborating with a number of pharmaceutical companies at various stages of development. I will describe one briefly which is not the only one but one we have been involved in heavily developing. Its a messenger rna platform. You might recall in this committee that in january of this year, i said it would take about one year to 18 months if we were successful in developing a vaccine. The nih trial moved very quickly. On january 10th, the the sequence was known. On january 11th, the Vaccine Research met to develop a plan. On the 14th of january, we officially started the Vaccine Development. 62 days later, we are now in phase one Clinical Trial with the two doses already fully enrolled. There will be animal safety. The phase one will directly go into phase 23 in late spring and early summer. And if we are successful, we hope to know that in the late fall and early winter. There are some important issues, however, in covid19 Vaccine Development. We have many candidates and hope to have multiple winners. In other words, its multiple shots on goal. This will be important because this will be good for global availability if we have more than one successful candidate. We also, as the chairman mentioned, will be producing vaccine at risk which means well be investigating considerable resources in developing doses even before we know any given candidate or candidates work. I must warn that theres also the possibility of negative consequences where certain vaccines can enhance the negative effect of the infection. The big unknown is efficacy. Will it be present or absence, and how durable will it or absent, and how durable will it be . Finally i want to mention the nih has launched a publishprivate partnership Publicprivate Partnership called accelerating covid19 therapeutic interventions and vaccines. The purpose of that is to prioritize and accelerate clinical evaluation of therapeutic candidates with nearterm potential. Hopefully our Research Efforts together with the other Public Health efforts will get ussic quickly get us quickly to an end to this terrible ordeal were all going through. Thank you very much. Happy to answer questions later. Thank you, dr. Fauci. Dr. Redfield. Welcome. Dr. Redfield good morning, chairman alexander and Ranking Member murray and members of the committee. Our nation is confronting the most serious Public Health crisis in more than a century yet were not defenseless. We have powerful tools to fight this enemy. We have tried and true effective interventions such as early identification, isolation, and Contact Tracing combined with important mitigation strategies including social distancing, frequent hand washing, and face covering. These Public Health tools have and will continue to slow the spread of covid19. I appreciate the opportunity to provide a brief overview of some of cdcs work in response to covid19. Cdc has been working 24 7 to combat the pandemic. Public Health Partners in building core capabilities, particularly work force, laboratory, and data and predictive analytics. Epidemiologists are conducting surveillance for covid19, as well as conducting Health System surveillance. Community mitigation teams are providing guidance on Contact Tracing and our Laboratory Experts are performing serological testing to better define the extent of asymptomatic population. As local leadership makes decisions to reopen, theyll require varying degrees of federal support. Each location will be different and will face unique circumstances. Cdc has conducted a state by state assessment of Public Health testing, capacity, and Contact Tracing capacity as well as surge plans. Cdc is providing Technical Assistance and funding to the state provided through the supplemental cares act. Were working directly with the state Public Health leaders to define their needs for testing and testing devices, supplies, and manpower, surveillance, Data Collection and reporting, Contact Tracing, Infection Control, and outbreak investigation. I want to take a moment to focus on several key elements. First, testing. Rapid, extensive, and widely available timely testing is essential for reopening america. Cdcs role in testing continues cdcs role in testing continues to support diagnosis and Contact Tracing surveillance and outbreak. When we work with the Public Health partners to define their particular testing strategy, their jurisdiction, well address the testing components of the response in greater detail. Contact tracing, increasing state and territorial and local and tribal Contact Tracing capacity is critical. Its a critical part to stop the chains of transmission and prevent the occurrence of sustained Community Transmission. Cdcs role is to provide technical training, assistance, and support for the states as they hire and build a work force necessary to be fully prepared to effectively respond to the Public Health challenges posed by the pandemic. This will be an expansive effort. Surveillance. Our nations Surveillance Program is built on a combination of systems including existing respiratory , it influenza, and syndromic viral disease Surveillance Systems have been combined with research lab platforms in our case reporting form system. Krdc cdc is adapting these and optimizing it to have a Surveillance System in response to covid19. Importantly, in light of the significant occurrence of asymptomatic infection, the surveillance for asymptomatic infection becomes an important Public Health tool for early case identification. Cdc is working with each Public Health jurisdiction to develop a Perspective Program to include active surveillance among those that are most vulnerable such as individuals in longterm care facilities, inner city clinics, and homeless shelters. We need to rebuild our nations Public Health infrastructure, data and Data Analytics, Public Health laboratory resilience and our nations Public Health workforce. Now is the time to put it in place for the generations to come not only for the Public Health system that our nation needs, but for the Public Health system our nation deserves. Before i close, i want to recognize the tireless Committee Commitment of the dedicated cdc staff who have deployed two every corner of this nation to fight covid19. More than 4,000 employees have deployed here and globally. Science and data continue to be the backbone of cdc contributions to the u. S. Response. I extend my serious gratitude to the Health Care Workers on the front lines as well as their family and the essential Emergency Personnel as well as the American People to say thank you for adhering to the stayathome guidelines in protecting the most vulnerable. Its important to emphasize were not out of the woods yet. The battle continues, but we are more prepared. We need to stay vigilant with social distancing. It remains imperative. We are a resilient nation and i am confident we will emerge from this pandemic stronger together. Thank you. Chair alexander thank you, dr. Redfield. Admiral, welcome. I am here to provide you with an update on nations progress in testing for covid19. On march 12th, secretary azar requested that i lead the covid19 testing efforts within hhs including the oversight and coordination of the fda and cdc with regard to testing. Since then, the nation has performed more than 9 million covid19 tests, a number far greater than any other country and double the per capita test performed to date in south korea. To reach this point, we implemented a phased approach to meet testing needs during mitigation. And now during phase one reopening of america. Beginning march 20th, we pioneered 41 communitybased drive through testing sites in locations prioritized by the cdc. These sites have been a profound success, testing over 167,000 highrisk individuals and demonstrating a prototype that is being duplicated multifold in nearly every state. Next, the administration leveraged trusted retailers including cdc, rite aid, cvs, right aid, walmart, kroger, and health mart who providing testing at 240 locations in 33 states, 69 of which are in communities with 69 of which are in communities with moderate to high social vulnerability. To meet the need for collection supplies like swabs and media tubes, we first supply the secured the Global Supply chain through a military air bridge. With manufacturers to increase the mastic production. We collaborated with the private sector and domestic production. We collaborated to expand supplies while minimizing the need for ppe. Finally we used title three of the defense production act to further invest in domestic manufacturing to prepare us for reopening. To support the need for surveillance testing during reopening, on april 27th, we issued a new testing framework that also prioritized testing for persons without symptoms who are prioritized by Health Departments or clinicians for any reason including screening of asymptomatic individuals according to states and local plan. Next, our federal Multidisciplinary Team conducted multiple calls with leadership from each state to set statespecific testing objectives. Collectively, states and territories established an overall goal to perform 12. 9 million tests over the next four weeks. The federal government is able to, and well, support the achievement of this goal. Specifically, the federal government is shipping to states 12. 9 million swabs and over 9. 7 million tubes of media in may alone. Last month we also detailed the location and capacity of every lab machine it in every state that could potentially run covid19 assays and our team has worked with test suppliers to match reagents to these machines. Looking forward between now and the end of 2020, the federal government will procure over 135 million swabs and 132 million tubes of media and distribute these to states as requested to supplement the now robust commercial supply. We anticipate marked increases in current tests as well as the dramatic expansion of new point of care tests like the first in class antigen test authorized by the fda just last friday. They anticipate being able to distribute 300,000 tests per day within just a few weeks. So, by september, taking every aspect of development, authorization, manufacturing, and supply chain into consideration, we project our nation will be capable of performing at least 40 to 50 million tests per month if needed at that time. And if new technologies are authorized like whole genome sequencing approaches or any Novel Solutions uncovered by nihs new diagnostics initiative, that number will be much higher. Finally, i want to acknowledge and express my heart felt gratitude to the officers of the u. S. Public Health Service commission corp. , the uniform service i am empowered to lead. 3471 men and women have deployed in support of this pandemic on the cruise ship in japan to our military bases repatriating americans, to our Community Testing site and international airports, to fema and our task forces, to nursing facilities including washington, and to feel top field hospitals and hardhit communities across the nature and. Across the nation. I thanks each and every one of these officers and they families and on their behalf i thank the members this committee for supporting our Training Needs to supplement our ranks in future national emergencies. Thank you for the opportunity to provide these remarks. Chair alexander thank you, admiral giroir. And now dr. Stephen hahn, our fourth and final witness. Dr. Hahn chairman alexander, Ranking Member and members of the committee, thank you for inviting me to participate in this hearing today. I first want to start by thanking the American People for their incredible efforts at mitigation and extend my condolences to those who have lost loved ones. From day one of this pandemic the 18,000 fda employees who are just incredible, scientists, doctors and nurses have taken an active role in the government response to this pandemic. The fda has worked to facilitate the development of medical Counter Measures to diagnose, treat and prevent covid19. Weve worked closely with laboratories, manufacturers, academia, product developers, companies that dont even make medical products but want to pitch in. For example, by making hand sanitizer, personal protective equipment and ventilators. Every decision we have made has been driven by data with the goal of protecting the health of the American People. In a Public Health, the health emergency, however, our response is balanced by the urgent need to make medical products available with the provision of a level of oversight that helps ensure the safety and effectiveness of those medical products. I would like to tell you what the fda is doing to help the country at , for americans to return to work and school. It starts with testing as others have mentioned. The fda has worked with more than 500 developers, who have or said they will be submitting requests emergency youth emergency use authorization requests for covid19 tests. This includes some newer technologies that heretofore have not been used as part of diagnostic tests in response to a pandemic. 92 emergency use authorizations for test kit manufacturers and laboratories have been issued, and we have been informed by more than 250 laboratories they have begun testing under the regulatory flexibilities we outlined in march. We are conducting rolling reviews of ua submissions so we can quickly authorize tests in which the data supports. In a Public Health emergency, the accuracy of diagnostic tests is important not only for the individual patient but for the patient at large for the public at large. Fda is helping to ensure the availability of tests providing accurate answers. We are also monitoring the marketplace for fraudulent actions to protect the public fraudulent tests and taking appropriate actions to protect the Public Health. We are working to provide more clarity about which tests have been reviewed and authorized by fda and which have not. Seroligic tests will play a role. Unlike diagnostic tests, which detect the presence of the virus serologic tests measure the , amounts of proteins or antibodies in the blood when the body is responding to an infection like covid19. These tests can help identify individuals who can overcome an infection and have developed an immune response. We will continue working with labs, manufacturers across the government to find a balance between the assurance an Antibody Test is accurate and timely access to such tests. Of course, the way we will eventually beat this virus is with a vaccine. The fda is working closely with our fed partners including the nih, vaccine developers, manufacturers and experts across the globe. We intend to use our regulatory flexibility to help ensure the most Efficient Development of a safe and effective vaccine to prevent covid19. Until a preventative vaccine is approved, however, we need medical products to bridge the gap. The fda has been working for several months to facilitate the development and availability of therapeutics as expeditiously as possible, and weve created an Emergency Program for this acceleration called the Coronavirus Treatment Acceleration Program or ctap. We have reassigned staff to work with urgency to review requests from companies, scientists, doctors who are developing therapies and using every available authority and regulatory flexibility thats appropriate to facilitate the development in a safe and effective product to treat covid19. A variety of therapeutic areas are being evaluated as mentioned by dr. Fauci and others as well as immunotherapies and convalescent plasma hyper immunoglobulin. As dr. Fauci also mentioned we recently announced the trial of remdesivir and treatment of hospitalized patients with covid19. Two other promising treatments that i mentioned are the antibody rich products, convalescent plasma, and im willing to go in more detail if members of the committee have questions about this. But we are working very aggressively and closely with stakeholders to facilitate the development of a device which if shown to be safe and effective could act as a bridge therapy to the development of a vaccine. We recognize therapies need to go handinhand with ensuring there will be sufficient supplies for our country. So were also working with manufacturers to make sure that this supply chain is robust. Mr. Chairman, Ranking Members of the committee, please know that in the fda you have a dedicated team of some of the nations finest scientists, Health Care Providers and health professionals. We are guided by science and data and we wont let up until we facilitate the development of products our nation needs to get back to work. I look forward to your questions. Chair alexander thank you, dr. Hahn and thank you for your expertise to your dedication to our country and your hard work. Well now begin a round of fiveminute questions from each senator on the committee alternating between republicans, and democrats. Each senator has, if you are on Video Conference you have a time clock at the bottom and i would ask you to try to stay within five minutes for your questions and answers. I will start. I have a question for dr. Fauci and then admiral giroir. Doctor, lets look down the road three months. There will be about 5,000 campuses across the country trying to welcome 20 million college students, 100,000 Public Schools welcoming 50 million students. What would you say to the chancellor of the university of Tennessee Knoxville or the principal of a Public School about how to persuade parents and students to return to school in august . Lets start with treatments and vaccines first, dr. Fauci. If you could save half of my five minutes for dr. Giroir for testing, i would for admiral giroir for testing, i would appreciate it. Dr. Fauci thank you very much, mr. Chairman. I will be realistic with the chancellor and tell him that when we are thinking in terms chair alexander its a her in this case. Dr. Fauci im sorry, sir. I would tell her, im sorry, sir, that in this case the idea of having treatments available or a vaccine to facilitate the reentry of students into the fall term would be something that would be a bit of a bridge too far. As i mentioned the drug that has shown some degree of ef wasome degree of efficacy modest and within a hospitalized patient, not yet, or maybe ever, to be used as prophylaxis or treatment. So if the issue is that the young individuals who would be going back to school would like to have some comfort and a treatment probably a thing that would be closest to utilization then would likely be passive transfer of convalescent serum. Were not talking about necessarily treating a student who gets ill but how the student will feel safe in going back to school. If this were a situation where we had a vaccine that would really be the end of that issue in a positive way. But as i mentioned in my opening remarks, even at the top speed we are going, we dont see a vaccine playing in the ability of individuals to get back to school this term. What they really want is to know if they are safe. And thats the will have to go with what we discussed earlier about testing. So im about halfway through the remarks. I would like to pass the baton to admiral giroir who would address the question of the availability of testing and what role that might play in returning to school. Thank you, sir. Admiral giroir thank you. Chair alexander thank you, dr. Fauci. Admiral giroir, you said while were doing about 10 million test this is month we might be as high as 40 million or 50 million by september. Which is a significant increase. If im chancellor of the university of tennessee could i develop a strategy where i say to my students we have antigen tests, for example, which is quick and easy, we want everybody on campus to take it once before you begin school and that will at least let everybody know that on that day weve isolated anybody who is positive and then we can continue to monitor. Is that strategy possible in august and september . thank you, mr. Chairman. And i may reserve 20 seconds for dr. Redfield as well. The strategy that will be employed really depends heavily on whats the Community Spread at the time. If theres almost no Community Spread, your strategy will be different. If theres high Community Spread it will also be different. Yes, technically we have have the we will have the ability and your chancellor will have the ability. We expect there to be 2530,000,000 point of care tests per month available. It is possible to test all the students, or it is much likely that there would be a surveillance strategy done where you may test some of the students at different times, be to give an assurance there is no circulation, that would be done in conjunction with the cdc and the local health department. There are strategies still needing to be validated but a pooling sample. We know in some experimental laps 10 or 20 labs as many as 10 or 20 samples can be pooled. Essentially one test could test 20 students. And finally there are some experimental approaches that look interesting if not promising, that for example, wastewater from an entire dorm or an entire segment of a campus could be tested to determine whether theres coronavirus in that sewerage, the waste water. So there are other strategies being developed and i would like to give 20 seconds to dr. Redfield who really will be working on the strategy of how to employ the tests given different Community Spread. Chair alexander dr. Redfield . Dr. Redfield yes, just some quick comments, sir. First, i think its important to evaluate critically the role of changes in social distancing on College Campuses and schools and the situation, not to forget the importance of what weve learned. Clearly also developing Aggressive Program for wellness education, making sure people understand when theyre symptomatic they need to seek evaluation. I think we are going to have to look at the role of testing. I think there will be an Important Role of testing in this circumstance, and i think it will be individualized based on where these Different Schools are, how much infection is. Chair alexander im going to wrap it up there so i can set a good example for the other senators with their five minutes. Senator murray . Sen. Murray thank you very much, mr. Chairman, and thank you to all of our witnesses. Dr. Fauci, you have warned of needless suffering and death if we push to reopen too soon. The president has actually been sending the opposite message. I want to ask you today what is the most Important Message you have for communities and states that are reopening even as our Public Health experts make it clear its too soon . Tell us what the consequences are. Dr. Fauci thank you very much for that question, senator murray. As i have said many times, we have worked out a guideline framework of how to safely open america again. There are several checkpoints in that with a gateway first of showing, depending on the dynamics of an outbreak in a particular region, state, city, or area, that would really determine the speed and the pace with which one does reenter or reopen. So my word has been, and ive been very consistent, i get concerned if you have a situation with a dynamics of an outbreak in an area of such that you are not seeing that gradual over 14day decrease that would allow you to go to phase one and then if you pass the checkpoints of phase one go to phase two and phase three. What ive expressed then what ive expressed then and again is my concern that if some areas, cities, states or what have you, jump over those various checkpoints and prematurely open up without having the capability of being able to respond effectively and efficiently my concern is we will see little spikes that might turn into outbreaks. So, therefore, i have been very clear in my message to try to the best extent possible to go by the guidelines which have been very well thought out and very well delineated. To go by the guidelines which have been very well thought out and very well delineated. So if a community or a state or a region doesnt go by those guidelines and reopen, the consequences could be pretty dire, correct . The consequences could be serious particularly, and this is something that i think we should Pay Attention to that states even if theyre doing it at an appropriate pace, which many of them are and will, namely a pace commensurate with the dynamics of the outbreak, that they have in place already the capability that when there will be cases, there is no doubt even under the best of circumstances when you pull back on mitigation you will see some cases appear. Its the ability and the capability of responding to those cases with good identification, isolation and Contact Tracing will determine whether you can continue to go forward as you try to reopen america. Its not only doing it at the appropriate time but the appropriate constraints but having in place the capability of responding when the inevitable return of infections occur. Well, thank you for that. Its very clear in order to do that we need knowledge, which is about testing and this administrations approach to testing has really been plagued by unrealized goals and disregard for problems within that supply chain. Last week an average of 250,000 tests per day, that is a small fraction of what we need. And yesterday President Trump had the gall to declare the u. S. Prevailed on testing in a press conference that was filled with misinformation. Dr. Giroir, Public Health experts do not think the u. S. Has prevailed. Im glad you committed to states, including my home state of washington, will receive enough tests to meet goals for may and june but this administration has had a record of giving us broken promises that more testing supplies are coming and they dont. And we know testi ining needs w continue long past june. So i wanted to ask you today will the administrations forthcoming Strategic Plan that is now required under the covid package that was just passed into law, will that Strategic Plan on testing include specific numeric targets for Testing Capacity, supply chain capacity and projection of shortages . Thank you for that question and statement, senator murray, yes, we are, as ive stated, we continue to have a work in progress as we build the Testing Capacity we have established with over 12 million tests. We think the targets will be good in may and june. As dr. Fauci said, we really have to be evidence based. We expect the targets to go up as we progressively open as communities go through phase one and then into phase two and certainly those numbers will need to go up significantly again in the fall when we potentially have influenza circulating with covid. The targets will need to change based on the evidence that we see. We are highly committed to securing the supply chain. Weve worked daily with every manufacturer. Im pleased were able to get ahead of the states so we can supply them what they need so they have those assurances. There will be no doubts about that. When you put out that specific plan that you are required to do we will see numbers that you are going to tell us that you will reach, targeted for testing and supply chain capacity and projection instead of just saying we hope to have a million this week, next week, you will give us the specific targets, correct . Ill say, yes, maam, we know the specifics. We know the specific amounts of tests we have over the summer. How many we need . Yes, maam, we developed the need statement by working with the states individually with epidemiologists, with the cdc so overall in may well be testing 3. 9 of the u. S. Population. Over time, senator murray. How many we will need not just for may but in the coming months so that we can be prepared to have them . Yes, maam, and not to be repetitive but we need to be evidence and data driven. What we see in may and june will drive the goals we have. We need to be very humble about this. To look at the data. Testing needs will go up as we progressively open and we will do our best to predict that. We have to see what the data and the evidence shows at the time. Mr. Chairman, what our Strategic Plan requires is what is the goal, not how many we have but how many we need, and thats what well be looking for. Thank you. Thank you senator murray. Thank you, mr. Chairman, and i appreciated your Opening Statement where you had very succinct list of preparations we need to learn from this pandemic for the next one. Not only should we be working on this and preparing but we need to look and i think weve learned a lot. Were fighting a virus at the same time we are learning about it. We need to be nimble and be prepared for the second wave that could go along with the flu system stretching our Health Care System even more than it already has been. Admiral giroir, i thank you for your comments. I think theyve been comforting about what has been done and what can be done. I agree with senator murray that we need to have some specific goals. As an accountant thats always one of the things im looking for. For questions, dr. Hahn, our understanding of the clinical picture of covid19 continues to evolve. What first looked like a respiratory illness seems much more comprehensive, potentially affecting the heart, the brain, the kidneys. How does this impact the ability to evaluate the appropriate clinical end points for review of vaccines . The evolving clinical picture and the way this is manifesting around the country clinically does, in fact, inform the end points that we will work with developers of therapies on so that we can get the absolute most efficient and most Accurate Information in appropriate end points to make the necessary authorizations and approvals. We have set up this program called the Coronavirus Treatment Acceleration Program where our top scientists and clinicians have been at the table consulting with our colleagues at nih and cdc to address those questions. What are the appropriate end points . Ill give you an example. We do know that in some circumstances patients who had severe covid disease have developed thrombotic or clotting episodes. We prioritize a review of agents we think might be beneficial and the clinical end points for those trials will be different than an agent thats an antiviral like remdesivir where were looking at time to recovery. We want to adapt it to the type of therapy put before us. Thank you. Another question to dr. Hahn. We have made a lot of progress in Vaccine Development already. Domestic is a significant gap in the pandemic preparedness. What has hhs done in advance of potential Vaccination Campaign to ensure that we have sufficient capacity to administer a vaccine . This is an important point because its not just about the vaccine or hopefully vaccines developed. Its all about its also about the supplies needed and a plan for administering the vaccine. There is a program that includes dr. Collins, dr. Fauci, his colleagues at nih, the department of defense as well as other members of hhs and fda. Helping coordinate that and working closely with dr. Fauci and his team. Weve created a chart to look forward what are the necessary supply chain issues, syringes, needles, et cetera, depending on the various vaccines being developed how many times they have to administer. So weve been leaning in on this supply chain. To ensure when a vaccine is ready to go we will have the necessary supplies to administer it. I have a couple more questions but, again, the clock is not visible there. I suspect ive used up my time. Ill submit those in writing. Senator sanders . Thank you very much. Let me thank the panel for the hard work and for being with us today. It is sad we have a president of the United States, the leader of our country who from down one down played the dangers facing this country from the pandemic, who told us that the crisis would be over in a few months, that we did not have to worry, who fired those members of the government who wanted to act aggressively and, among other things, at a time we need International Cooperation cut funding for the world health organization. Let me say we understand facts are terribly important. Not everybody that we dont fully understand all of the ramifications of the covid19 epidemic. But let me ask dr. Fauci a few questions, if i might. The official statistic, dr. Fauci, is that 80,000 americans have died from the pandemic. There are some epidemiologists who suggest the number may be 50 higher than that. What do you think . Im not sure, senator sanders, if its going to be 50 higher, but most of us feel that the number of deaths are likely higher than that number. Given the situation particularly in new york city when they were really strapped with a serious challenge to their Health Care System there may have been people who died at home who had covid and werent counted because they never really got to the hospital. I think you are correct that the number is likely higher. I dont know exactly what percent higher but almost certainly its higher. Dr. Fauci, let me ask you this, in the terrible pandemic of 1918, the virus exploded in the fall, it came back with a vengeance. Are we fearful if we dont get our act together as bad as the situation is now it could become worse in the fall or winter . Senator, thank you for that question. Its a frequently asked question. I think the possibility does exist. However and the reason i say that, when you talk about will this virus just disappear, and as ive said publicly many times, that is just not going to happen because its a highly transmissible virus. Even if we get better control it is likely there will be virus somewhere on this planet that will eventually get back to us. So my approach toward the possibility of a rebound and a second wave in the fall is that, a, its entirely conceivable and possible it would happen. B, i would hope that between now and then given the capability of doing the testing youve heard from admiral giroir and the ability of us to stock up on personal protective equipment and the workforce of the cdc under dr. Redfield will put forth to identify, isolate and contact trace, i hope that if we do have the threat of a second wave, we will be able to deal with it very effectively to prevent it from becoming an outbreak much less. We have heard a lot of discussion about vaccines, everybody in congress and in this country wants a vaccine, we want it as quickly as possible. Let me ask the honorable fda commissioner, sir, if god willing, a vaccine is developed and if were able to produce it as quickly as we all hope we can, i would imagine that vaccine would be distributed to all people free of charge. Make sure at least everybody in america who needs that vaccine will get it regardless of their income. Is that a fair assumption . Senator, i certainly hope so. The fda is very committed to making sure all populations in the United States including those most vulnerable are included in the Clinical Trials. Thats not what im asking. What im asking is if and when the vaccine comes, it wont do somebody any good if they dont get it. And if they have to pay a sum of money for it in order to profit the Drug Companies that will not be helpful. Are you guaranteeing the American People today that vaccine will be available to all people regardless of their income . Sir, the payment is not a responsibility of the fda. I share your concern that this needs to be made available to every american. Does anybody else want to comment on that . Mr. Giroir, do you think we should make that vaccine when it is created available to all regardless of income, or do you think poor and working people should be last in line for the vaccine . Im sorry, senator, were you asking me . Yes, i was, sir. Yes, i was. No, i my office is one of the offices committed to serving the underserved and we need to be absolutely certain that if a vaccine or an effective therapeutic or preventive is available that it reaches all segments regardless of their ability to pay or any other social determineants of health that there may be. Good. So what youre telling the American People today regardless of income, every american will be able to gain access to that vaccine when it comes . They should gain access to it. You represent an administration that makes that decision. I will certainly advocate that everyone is able to receive the vaccine regardless of income or any other circumstance. Youre over time, senator sanders. Thank you, mr. Chairman. I dont want to cut senators off and its hard to see the time clock but if we could stay as close as possible to five minutes, all the senators can get their questions in. Thank you, senator sanders. Senator burr . Thank you for what youve done for the people in this country and their safety and people around the globe. Dr. Fauci, youve been at a majority of the press conferences. Has anybody ever asked you to take the foot off the gas of trying to find a cure or any type of Counter Measure . No, senator, not at you will. We at nih, as you know, have been right from the very beginning put our foot right on that accelerator in every aspect including the development of vaccines in therapeutics. As i described in my Opening Statement we actually started that in january, literally days after the virus was known. No, i have never been told by anyone to pull back on the development of any Research Project weve been involved in. Thank you, dr. Fauci. This question is for dr. Redfield. We have authorized in this committee and appropriated out of congress multiple times over the last few decades money and you talked about it. In the past four years from fy16 to fy20 its been 23 million a year and with the c. A. R. E. S. Act is over a billion dollars. Weve seen the private sector go out and use Data Available to track the progress and spread of coronavirus around the world. Why has the cdc not contracted with private Sector Technology companies to try to use their tools for biosurveillance . Senator, thank you for the question. This is a critical issue, as you know, and, also comes into one of the core capabilities i talked about Data Analytics which were appreciative of the additional Funding Congress has given. This is under critical review now. Trying to make the availability in all of our jurisdictions across the country. In april of last year june of last year we reauthorized the pandemic which authorized 30 new employees at cdc in surveillance. As of april zero of those had been filled. How many would this committee authorized been filled today . I know our staffs have been in discussion and i know were in the process of continuing to try to figure out how to move that forward, sir, if i can get back to you on it. You brought that to light. Well, i brought it to light the first of march and now were in midmay. Im hopeful we wont just talk about surveillance well execute it and focus the unbelievable amounts of money. Dr. Fauci, let me come back to you. This is one of the fastest Development Time lines weve ever seen for vaccines and the American People and hopefully people around the world will be the beneficiary of what you find and the licensure of the product. Dr. Hahn, if you have anything to add after that to this, please do. Dr. Fauci . Thank you very much, senator burr. A couple things are inherent, first of all, theres no guarantee that the vaccine is actually going to be effective. You can have everything you think is in place and dont have the immune response thats protective and do you rememberably protective. One of the big unknowns it will be effective. We will get an ef kaficacy sign. One thing well be able to get around by doing the tests properly is do you get an enhancement effect . A number of vaccines, two in particular, when the vaccine induces a suboptimal response and when a person gets exposed they actually have an enhanced pathogen sis of the disease. Those are the two major unknowns. I still feel optimistic we will have a candidate that will give some degree of efficacy, hopefully a percentage enough that will induce the kind of herd immunity that would give protection to the people at home. Dr. Hahn, anything to add to that . Yes, thank you for the question. The obstacles are being met by the approaches taken out of hhs and that is a common pathway so we can assess one vaccine against the other and then a master protocol that allows for a common control group and an assessment of very common end points. We will evaluate approximately ten candidates and then in the phase one and phase two studies and take four to five into phase three studies in this effort. I think those are the obstacles that will allow us to ensure safety and effectiveness. Yesterday North Carolina started to publicize the recovered numbers, those individuals who had coronavirus but have recovered. Its my hope that nationally we will start reporting the recovered numbers. I think thats important for the American People to hear. I yield back. Thank you, senator burr. Senator casey. Thank you for the hearing as well as Ranking Member murray. I wanted to start today with a question regarding Nursing Homes, in particular across the state like ours weve had, as you might know, a high number of cases in pennsylvania. At last count over 57,000 cases. The number of deaths have gone above 3,700 and, of course, a lot of those deaths are in Nursing Homes. Were told that nationally more than a third, as high as 35 of all deaths have been in Nursing Homes, either the death of a resident of a nursing home or worker. I want to start with a question for dr. Redfield. Doctor, when we consider this challenge in our longterm care facilities, when we look at the number of deaths in Nursing Homes, i think a lot of families want basic transparency and thats one of the reasons senator wiyden and i sent you a letter dated april 2nd directed to you as well as the administrator of the centers on Medicare Medicaid services. We asked for basic information about what the administration was doing to track the outbreaks in Nursing Homes, to provide information, basic information, to families and residents the families of residents in Nursing Homes, to the workers as well as to the community and Public Health officials. It took you about a month to respond to that. In your response you didnt give us any information about the time lines. These families need this information. Now were told by the cms administrator after pressing her, senator wyden and i did. This information may not be available until the end of may. I need to hear from you why has there been a delay, a threemonth delay in basic information that families and people within a Community Need about the outbreaks in Nursing Homes. Tell us when we will see that information. Youve highlighted one of the great tragedies weve all experienced together, clearly the longterm care facilities have been particularly high hit by this pandemic. Several things have been done and i can get back to you in terms of where theyre at in terms of activation. Really all Nursing Homes now are required to report cases in either individuals that are patients there or staff to the cdc. Second secondly a policy in place that all Nursing Homes are required to notify members of that nursing home of the existence of covid in that nursing home include Family Members. Verify in terms of if thats today or next week. One of the most important things we talk about key and reopening as tony mentioned. We need to be to do tracing. The other thing we really need to do is surveillance. This virus does appear to have a high propensity for asymptomatic infection which means our traditional ways of identifying cases will be blunted. Were developing a national Surveillance System and to do surveillan surveillance, the cdc will be doing that in partnership. I think will have the responsibility to do it within the inner city clinics that are selected and Health Service clinics. This is critical. We get in front of this and do comprehensive surveillance of everybody in these Nursing Homes. Weve also done aggressive outreach in all of them and enhancing Infection Control procedures, et cetera. The cdc has been out to help with that and the guidance. Ill get back to you im confident its already operational but i need to doublecheck to make sure. Theyre all report to go cdc now any infection in workers or patients and are required now to notify other members in the nursing home as well as Family Members. Mr. Chairman, i just have one question for dr. Fauci. Doctor, i wanted to ask you in your testimony earlier in response to a question by senator murray, you outlined a basic concern you have with regard to states reopening. Can you restate that for us. Yes. My concern is states or cities or regions their attempt, understandable, to get back to some form of normality, disregard to a greater degree the checkpoints that we put in our guidelines but when it is safe to proceed in pulling back on mitigation. I feel if that occurs there is a real risk you will trigger an outbreak and may not be able to control which, in fact, paradoxically will set you back not only leading to suffering and death but could even set you back on the road to trying to get economic recovery. Turn the clock back rather than going forward. That is my major concern, senator. Thank you, doctor. Thank you, mr. Chairman. Thank you, senator casey. Senator paul . Dr. Fauci, it has been shown monkeys infected with covid19 cannot be reinfected. Several studies have also shown that plasma from recently infected coronavirus patients neutralizes the virus and lab experiments. In addition influential of convalescent plasma based on the idea recovering coronavirus patients are developing and it can be beneficial as donated. Studies show the recovery of covid19 patients from the asymptomatic to the very sick are showing significant antibody response. Studies show that sars and mers and yet the media continues to report that we have no evidence patients who survive coronavirus have immunity. I think the truth is the opposite. We have no evidence that survivors of coronavirus dont have immunity and a great deal of evidence to suggest that they do. The question is linked to Health Policy and workers who have gained immunity can be a strong part of our economic recovery. The Silver Lining to so many infections in the Meat Processing industry is that a large portion now have immunity. They likely wont get it again and instead of being alarmed by media reports there is no evidence of immunity. Can you help set the record straight that the scientific record as being accumulated is supportive that infection of coronavirus likely leads to some form of immunity, dr. Fauci . Thank you for the question, senator paul. Yes, you are correct, that i have said given what we know about the recovery upon coronavirus in general or even any Infectious Disease with very few exceptions that when you have antibody present it likely indicates a degree of protection. I think its in the semantics of how this is expressed when you say has it been formally proven by longterm Natural History studies which is the only way you can prove, one, is it protective which i said and would repeat, is likely that it is but also what is the degree of antibody that gives you that critical level of protection and what is the durability . As i often said and repeat you can make a reasonable assumption that it would be protective but Natural History studies over a period of months to a year will then tell you if thats the case. I think thats important. The vast majority of people have immunity instead of no evidence, the w. H. O. Fed into this by saying no evidence of immunity and theres every evidence stacking up. A lot have shown it is unlikely you get it again in the short term. With regard to going back to school one thing left out of that discussion is mortality. Shouldnt we be discussing what the mortality of children is . The mortality for 0 to 18 approaches zero. It almost approaches zero. Between 18 and 45, the mortality in new york was 10 out of 100,000. So really we do need to be thinking about that. We need to think what happened in sweden where the kids kept going to school. The mortality rate is less than france, less than italy, less than spain, less than belgium, less than the netherlands, about the same as switzerland. Basically i dont think theres anybody arguing that what happened in sweden is unacceptable. I dont think any of us are certain when we do these modelings, more people have been wrong than right. Were opening up a lot of economies around the u. S. And i hope that people predicting doom and gloom, oh, we cant do this, will admit they were wrong if there wasnt a surge n. Rural states we never really reached any sort of pandemic levels in kentucky and other states. We have less deaths in kentucky than in an average flu season. Really outside of new england weve had a relatively benign course nationwide. I think the one size fits all is ridiculous. We ought to be doing it School District by School District and the power dispersed because people make wrong predictions. The history will be wrong prediction after wrong prediction starting with ferguson in england. We ought to have a little bit of humidity in our belief that we know whats best for our economy. As much as i respect you, i dont think youre the end all. We can listen to your advice but people on the other side say theres not going to be a surge and we can safely open the economy. If we keep kids out of school for another year whats going to happen the poor and under privileged kids are not going to learn for a full year. I think we should look at our kids getting back to school. I think its a huge mistake if we dont open the schools in the fall. Thank you. Mr. Chairman, can i respond to that only though there are only 32 seconds left. Yes, and you might make it clear whether or not you suggested that we shouldnt go back to school in the fall. First of all, senator paul, thank you for your xhenlcomment. I have never made myself to be the end all. Im a scientist, physician and Public Health official. I give advice according to the best sign particular evidence. There are a number of other people who come into that and give advice more related to the things you spoke about, about the need to get the country back open again and economically. I dont give advice about economic things. I dont give advice about anything other than Public Health. The second thing is that you used the word we should be humble about what we dont know. I think that falls under the fact we dont know everything about this virus. And wed better be very careful particularly when it comes to children. The more and more we learn were seeing things about what this virus can do that we didnt see from the studies in china or in europe. For example, right now children presenting with covid19 who have a very strange inflammatory syndrome similar to kawasaki syndrome. I think we need to be careful were not cavalier in thinking children are completely immune to the deleterious effects. Youre right in the numbers that children in children do much better than adults and the elderly and particularly those with underlying conditions. I am very careful and hopefully humble in knowing i dont know everything about this disease. Thats why im reserved in making broad predictions. Thank you, senator paul. Thank you. I want to cover a lot of territory in my five minutes. I would certainly be appreciative of concise answers. I want to start with dr. Redfield. Dr. Redfield, the current testitest ing protocols at the white house presents a model for other essential work places. Im sorry, senator, you broke up at the beginning of your question. If you could just say it again. Im sorry. Yes, dr. Redfield, do you think that the testing protocols currently in place in the white house present a model for other essential work places. Well, thank you for the question. I think one of the important things you bring up is the essential worker guidance the cdc put out and i think it was originally modeled on Health Care Workers where there was significant shortages. Im asking if you think the white house protocol testing are a model for other essential work places. I would say i think each work place has to define their own approach how to operationalize. Had some considerable comment on the fact osha has not stood up an enforceable mandatory temporary standard for workers in all sorts of work settings. That aside, would you say that the ppe rules and protocols in effect right now in the white house are a model for other essential work places . We would, in my own view, go back to the guidelines the cdc has put out for people if they are an essential workforce, that they go in public, maintain six feet distancing. Okay. Admiral giroir, you have testified about how far youve come with testing assessments. I want to ask if you believe we already have a National Testing strategy today that spans from the nationwide testing Needs Assessment to the nationwide testing supply assessment and a strategy to fill that gap to procure domestically what we need in terms of bridging that gap with testing platforms, swabs, specimen collection media and reagents and the ppe needed to conduct those tests. So thank you for that. We do have a strategy that spans us at least to the fall and beyond. As i mentioned were working individually with every state, and i think senator paul is correct that kentucky, wyoming, or new jersey, rhode island are different and there are vastly different testing needs. The east coast will have multiples of testing versus other states and were working those individually. So i know you testified earlier that not only are you working with the states but youre working with every lab in every state. Correct. To increase capacity. What about working with those who would be those who would need testing to, say, reopen their school, their university, their business, each of them have identified what they think are their testing needs based on guidance not mandatory enforceable rules. Are you in contact at that level . Is your dashboard have visibility at that lowest level or mostly in contact with the states and with the labs . So over the last few months weve done a lot of the individual work at Nursing Homes, at meat packing plants, down to the very granular level. We are really working with the state leadership, with the Public Health lab, the state epidemiologists, the state health officials. They need to understand what their sum will be. And in the funding were asking specifically in the cdc funding for specific plans for schools, Nursing Homes, underserved, et cetera. I have two more points to make. One is about transparency of that Needs Assessment, can the public see it . Can the state see it . Can the Health Committee members see it . Is it publicly available . And, secondly, the delivery of the supply is a critical issue. It seems to me the logistics for getting this out whether its ppe, testing or medical equipment is still extremely fragmented. We need to stand up the full power of the defense production act. Would you like me to comment on that, maam . Im happy to have you comment with the indulgence of the chairman. Weve gone over time. Give a succinct answer, admiral giroir. Yes, maam and yes, sir. Particularly for things like swabs and media there is still a very, i would say, nonmature industry and thats why weve made the decision to distribute that to the states. There are too many variables to control. Thats an example where we really moved into that and used dpa for swabs to help support american industry. In more mature aspects of the industry, helping to direct them to make sure the states get what they need that were not procuring them directly by us but, again, were going to be evidence and data driven as we move on. Thank you, sir. Thank you very much, senator baldwin. Senator collins . Let me begin by first thanking each of our Witnesses Today for their expertise, their dedication and their hard work. Dr. Redfield, i want to start with you. I am hearing from dentists all over the state of maine that the fact they cannot practice in our state, despite following very strict Infection Control protocols is causing growing health problems. Dentists tell me that teeth with cavities that could have been filled with now going to need root canals. Teeth canals. Teeth that could have been treated with root canals are now going to require extractions. People with oral cancers cannot get the treatment, the cleanings that they need before beginning their treatment. Dental health is clearly so important and maine state officials, as well as our dentists, are seeking assistance in reaching the right decisions. 47 other states either have reopened dental practices or have a date set for them to reopen. So my question to you is this. If dentists are following the American Dental Association guidelines, if theyre instituting strict protective measures for their patients, their staffs, their hygienists, themselves, and if theyre closely examining and seeing a decline in the number of covid19 infections in their county, are these reasonable factors for states to consider in reopening the practice of dentistry . Yes, senator, thank you for the question. Weve been interacting and talking with dentists and working with the state and local Public Health officials to update your guidelines on reopening a variety of medical services, as you know. And i think you raise a very important point and i would not disagree with what you said about looking at the American Dental Associations, as well as the reality of the outbreak in the area. But we are in the process of updating those guidelines and they will include direct guidelines for dental practices. Thank you very much, doctor. Dr. Giroir, and dr. Hahn, recently theres been a significant demand for remdesivir, i may be mispronouncing it, which transferred to receiving an emergency use authorization. Last week two of maines largest Hospital Systems contacted me with questions about how this therapeutic will be allocated going forward. Hhs finally released a statement on saturday about allocations going to states, interestingly not directly to hospitals. But once again, the decisionmaking behind these allocations is very unclear. Hhs and the assistant secretary for preparedness and response say that each state is expected to receive an allocation, but no timetable has been provided. Beyond those who are being treated with this drug at Maine Medical Center through a Clinical Trial, im concerned that hospitalized patients in maine will have little or no ability to be treated with this promising therapeutic for the foreseeable future. As this and more therapeutics and ultimately a vaccine come onto the marketplace, how can these allocation and distribution issues be resolved so that patient care is not delayed and so that it doesnt depend on which state you live in whether or not youre going to get access to these treatments and ultimately a vaccine . Senator collins, this is admiral giroir. Go ahead, commissioner. Senator collins, i think we completely agree with you that this has to be an evidencebased approach, getting the medical therapeutics, vaccines, remdesivir, whichever it happens to be, to the people in need. I think we can all agree upon the fact that weve learned a lot of lessons from the remdesivir situation. And as you mentioned, thats being led by hhs. What youve seen in the most recent announcement is that what the test did was provide guidance to hhs regarding where the most significant outbreak of hospitalizations where the outbreak occurred and where those hospitalized patients were. This represented about a quarter of the supply of drug that we have and more will be allocated according to methodology to where those hospitalized patients are. I think valuable lessons can be learned and will be learned with respect to other therapies and to vaccines in particular, and we must incorporate those into our operational plans moving forward. Thank you, doctor. Admiral, do you have anything to add . Im over time. Sorry, thank you. If you have anything to add, if you would do so for the record. No maam, i agree with the commission. Its absolutely critical that its evidencebased, based on the people that can benefit from it and just and fair throughout our country. Thank you, senator collins. Senator murphy. Thank you very much, mr. Chairman. Thank you to you and senator murray and thank you to all of the witnesses for your services. This is obviously an exceptional hearing today in that three of our witnesses are in quarantine. So i just want to start by asking a Pretty Simple yes or no question that i think i know the question to. Im correct that all of you are drawing a salary, as you should, during your period of quarantine, is that correct . Senator, let me start. I think we better be careful about the issue of quarantine. We are essential workers as part of the essential infrastructure, and we are, when needed, which is often, to do our duties in respective places at the white house. I was at the white house yesterday and i will likely even perhaps be there today. And in my office at the nih. So it is not really, strictly speaking, a quarantine as we know it. But it is performing our duties as critical workers and i would be happy to have my colleagues also respond to that. Senator murphy, this is steve hahn. I agree with dr. Fauci. And yes, i am drawing a salary and i have continued to work during my quarantine. And as an essential worker, will participate in meetings face to face when that attendance is considered critical. My point here, you all should draw a salary while you are taking precautionary steps because of the contacts you have made. My point is that quarantine is relatively easy for people like you and me. We can still work and get paid. We can telework. But there are million of other americans who work jobs that cant be performed from home or are paid by the hour. And its just remarkable to me that this administration has not yet developed a mechanism for states to implement and pay for a quarantine system that will work for all americans. Your plan to reopen america requires states develop that plan, and yet my state has no clue how to implement and pay for that system without help from the federal government. Which leads me to my second question. Dr. Fauci and dr. Redfield, youve made news today by warning us appropriately of the dangers of states opening too early. But as senator murray mentioned, this is in fur rating to many of us, because it comes hours after the president declared that we have prevailed over coronavirus. Which im just going to tell you is going to make it much harder on state leaders to keep social distancing restrictions in place. It comes days after the president called on citizens to liberate their states from social distancing orders. And i think youre all noble public servants, but i worry that youre trying to have it both ways. You say the states shouldnt open too early, but then you dont give us the resources to succeed. You work for a president who is, frankly, undermining our efforts to comply with the guidance that youve given us, and then the guaidoan guidance that you have provided is criminally vague. And i want to ask my last question on this topic. Obviously the plan to reopen america was meant to be followed by more detailed nuanced guidance. What is a downward trajectory . What happens if the trajectory is down in some states and up in others . What happens if you open and theres a spike in one location or another setting . And of course you knew this because you developed this guidance, this Additional Guidance that sitespecific, that frankly is helpful. Some of this is on the cdc website, but some of it is not. And we need it. My state needs it. We dont have all of the experts that you have and so we rely on you. So reporting suggests, dr. Redfield, that this guidance that was developed by you and other experts was shelved by the administration, that it was withheld from states in the public because of a decision made by the white house. So my specific question is, why didnt this plan get released, and if it is just being reviewed, when is it going to be released . Because states are reopening right now and we need this Additional Guidance to make those decisions. Senator, i appreciate your question. Clearly we have generated a series of guidances, as you know, and as this outbreak response was evolved from the cdc to an allofgovernment response, as we work through the guidances, a number of them go for interagency review and input to make sure that these guidances are more broadly applicable for different parts of our society. The guidances that youve talked about have gone through that interagency review. There are comments that have come back to cdc. And i anticipate theyll go back up to the task force for final review. But were reopening in connecticut in five days, in ten days. This guidance isnt going to be useful to us in two weeks. So is it this week . Is it next week . When are we going to get this expertise from the federal government . The other thing i will just say is that the cdc stands by the Technical Assistance to your state and any state upon any request. I do anticipate the guidance, though, to be posted on the cdc website soon. Soon . Soon. I can tell you your state can reach out to cdc and well give guidance directly to anyone in your state on any circumstance that your state desires guidance from. Soon isnt terribly helpful. Thank you, mr. Chairman. Thank you, senator murphy. Senator hasset. Thank you for your service and i will have a set of questions. I appreciate your answers to be brief. Dr. Hahn, in your testimony you mentioned that the testing for the populations and the vaccine trials now includes older americans. I guess my question, though, is what about children . Does it include children . Does it also include the obese, the diabetic, the immunocompromised, those who are at risk to having a mitigated response to vaccination . Can you comment on that, please . Yes, sir. Thank you, senator cassidy. When the phase two, phase three trials are in place, they will include our most vulnerable populations, including the individuals that you described. Were working very closely with if i can interrupt. Phase two would normally check for safety. You would not have to do a separate phase two in the patient who was younger. Do you follow what im saying . Can you assume the safety data from the adults applies to that of the children . We would also want to assess safety as well in children. So the current phase two trials, do they include children . Theyre in phase one stage right now, sir. I thought dr. Fauci said we have a phase two going on. I think its about to start for the moderna vaccine. Perhaps dr. Fauci can answer that. No, i did not say phase two. I said we are in the second dose of the phase one and we will proceed when we finish the phase one to go into phase two. So i think im hearing that children will be included in phase two trials . No, so thats under discussion between fda and nih at this time, sir. Because we do realize that its important for us to understand what this is in children. Dr. Redfield, to build back on what senator murphy said, the school opening, obviously youre about to modify. I notice as i read through them theres nothing about testing. We speak about testing, targeted testing, but the guidelines has nothing about how to integrate testing. Will these be in those guidelines that are being released . Senator, thanks for the question. Clearly theres going to need to be, as already has been stated, an integration of a testing strategy that is going to be different for Different School settings, as well as different jurisdictions. And that is going to have to be integrated into each of those. Theres general overarching guidelines, and then the testing strategy which i think is important is including the surveillance strategy and needs to be an individualized let me comment on that, dr. Redfield. In all due respect, i think children, whether youre rural, frontier, suburban or urban, is the one setting in which there is a remarkable commonality, and i will echo what senator murphy said. The resources that the federal government has greatly exceeds all but the most sophisticated populus wealthy state. And even then it exceeds it by some extent. So i do think it would be good to have okay, in a Primary School setting, this is best practices or these are three options and choose between one of these three. To say that each School District or each private or parochial or Independent School work with your state board of health, figure it out, seems a wasted effort. I say that because Children Play such a role in both protection of disease, the spread of the disease, et cetera. So your thoughts on that . Because it really seems thats the one setting where you can have, you know, not cookie cutter, but certainly a pattern which can be followed. Senator, i must have been misunderstood. When i was talking about differences, i was thinking of the difference between an elementary school, a high school, a college in terms of how a trade school. There may be differences in how you integrate a testing strategy. But i do think having a testing strategy with different options for people to evaluate based on different principles will be important in terms of guidance. Dr. Fauci, you persuasively argue that the risk of reopening prematurely is great. But i think the frustration, if i think of children in particular, the risk benefit ratio of a child being at home, potentially away from enhanced nutrition without the parent able to work because School Provides daycare, without the monitoring as sometimes occurs for incidences such as child abuse, but perhaps most importantly for all children, the opportunity cost of a brain which is forming not having access to the information that will help that brain form optimally. Now, has there been any sort of risk benefit ratio for the child . Yes, they are at risk for kawasaki, but they are at particular risk for missing out on a year of education, particularly those from less than rich backgrounds. I guess im very concerned about that tension. What are your thoughts on that . You make a very good point, senator cassidy. Its obviously very difficult of the unintended consequences of trying to do something that broadly is important for the Public Health and the risk of having a return or a resurgence of an outbreak, and the unintended deleterious consequences of having children out of school. We fully appreciate that. I dont have an easy answer to that. I just dont. You just have to see on a stepbystep basis as we get into the period of time with the fall about reopening the schools exactly where we will be in the outbreak. I might point out something that i think has been alluded to throughout some of the questions, that we have a very large country and the dynamics of the outbreak are different in different regions of the country. So i would imagine that situations regarding school will be very different in one region versus another. So that its not going to be universally or homogeneous. But i dont have a good explanation or solution to the problem of what happens when you close schools and it triggers a cascade of events. Mr. Chairman, ill close by asking permission of the chair to submit for the record an article that just came out in the journal of pediatric nursing, children are at risk for covid19. It will be included. Thank you, senator kcassidy. Senator warren. Thank you, mr. Chairman, and thank you to our witnesses for being here today. I hope everybody is staying safe and healthy. In the past 16 weeks over 1. 3 million americans have been infected with coronavirus. We now know that about 80,000 people have died and 33 Million People are out of work. Dr. Fauci, you have advised six president s, you have battled deadly viruses for your entire career, so i would just like to hear your honest opinion. Do we have the coronavirus contained . Senator, thank you for the question. Right now it depends on what you mean by containment. If you think that we have it completely under control, we dont. If you look at the dynamics of the outbreak, we are seeing a diminution of hospitalizations and infections in some places, such as in new york city, which has plateaued and is starting to come down. But in other parts of the country, we are seeing spikes. So when you look at the dynamics of new cases, even though some are coming down, the curve looks flat with some slight coming down. So i think were going in the right direction. But the right direction does not mean we have by any means total control of this outbreak. So the right direction, as i understand it, we have 25,000 new infections a day and over 2,000 deaths a day. I think those are the right numbers. And some are estimating we could be at 200,000 cases a day by june. Is that right . I dont foresee that as 200,000 new cases by june. I am hoping and looking at the dynamics of things starting to flatten off and come down that we will be much, much better than that, senator. Just so i understand. We are right now at 2,000 new infections a day 25,000 new infections a day and 2,000 deaths a day. Right. And thats where we are right n now. Right. So we know it is possible to get this virus under better control. Other countries have done it like south korea, but we are now three months into this pandemic and basically weve continued to set records for the number of people who are diagnosed and the number of people who die. Dr. Fauci, you recently said that a second wave of coronavirus in the fall was, quote, inevitable, but that if america, quote, puts in place all of the countermeasures that you need to address this, we should do reasonably well. And the countermeasures you identified were things like continued social distancing, significantly more testing, widespread Contact Tracing. You also said that if america doesnt do what it takes, and this is your quote, we could be in for a bad fall and a bad winter. So right now were about 16 weeks away from labor day. Thats about the same length of time since the virus was first detected here in the u. S. Dont we have enough robust Counter Measures in place that we dont have to worry about a bad fall and winter . Right now the projection, as youve heard from admiral giroir, with regard to the testing and other elements that would be needed to respond, the projection is that by the time we get to the end of the summer and early fall that we will have that in place. Thats the projection. We dont have it in place now, but we are projecting that well have it in place. And let me just ask the other side of this. If we dont do better on testing, on Contact Tracing, and on social distancing, will deaths from coronavirus necessarily increase . Of course. If you do not do an adequate response, we will have the deleterious consequence of more infections and more deaths. And thats the reason why you quoted me senator, quite correctly. Everything you said. And i will stand by that. If we do not respond in an adequate way, when the fall comes, given that it is without a doubt that there will be infections that will be in the community, then we run the risk of having a resurgence. I will hope by that point in time in the fall that we have more than enough to respond adequately. But if we dont, there will be problems. I appreciate your hope and i wish we could tell the American People that the federal government has this pandemic under control. But we cant. In fact, you have said that the virus isnt under control in the u. S. We havent yet taken the measures necessary to prevent a second wave of death and we all know that the people who are going to be most affected are going to be seniors, essential workers, the people who are out on the front lines. The president needs to stop pretending that if he just ignores bad news it will go away. It wont. The time for magical thinking is over here. President trump must acknowledge that the federal response has been insufficient and that more people are dying as a result. We are running out of time to save lives. And we need to act now. So thank you, dr. Fauci, for all youre doing. I preerappreciate it. But the urgency of the moment could not be clearer. Thank you. Thank you, senator warren. Senator roberts. Thank you very much, mr. Chairman. And thanks to all the witnesses. You all are like the fab four. I guess it was the fab five back in the day. But you are shining the light of truth in the darkness with individual flashlights, for sure. Thank you, mr. Chairman, for emphasizing that we have to be bipartisan in this approach or were not going to get anywhere, and that obviously is in the eyes of the beholder. Im happy to say that we have a great relationship with governor kelly, who happens to be a democrat, and obviously im a republican. And her Emergency Management team is spoton. Dr. Lee norman is doing a great job. This morning i talked to lee. The situation in kansas is not very good. Kansas received 7,000 new covid tests for Food Processing facilities. You see this mirror behind me. Thats a stage coach coming into dodge as opposed to getting out of dodge. That city is my home town. We are the hot spot in regards to kansas, mainly because of two pabing plan p packing planl packing plants. We have 26 of the cattle market. At any rate, kansas is going through a tough time. We shouldnt be worried about the safety, but the Food Supply Chain i think nationwide is under a great deal of stress. We see that in dairy and poultry and in pork. Theyre euthanizing bigs and obviously the livestock industry. Perdue, the agriculture has stepped up, so has the president , declaring that they are a national asset. With progress, when we first started out, our city had five tests. Thats between four and six. Its not 50 million as we hoped to receive or has been said by one of the witnesses. The reason i am really harping on all of the problems were having are on top of the fact that the relationship with china is such that even at first breakthrough with regards to trade to china seems to be on hold now. And thats another price and this has been going on five or six years where our prices have been below the cost of production. The end result, our consumers are figuring out that food doesnt come from Grocery Stores and im very worried that the harm to the food value chain is very real, not to mention the financial situation that our farmers, ranchers and growers all face. Having said all of that, i want to ask admiral giroir, youve spoken about the importance of having diversity in the kinds of tests that are available. The five packing plants we have in kansas, if we could get a rapid test and we could get it as we hopefully asked for because of the hot spots that are developing not only in kansas, but also doing great harm to the food value chain, that would be absolutely wonderful. Would you speak to that, sir . Yes, thank you, senator. Both dr. Redfield and i have been very actively involved in getting strategies for the industry, particularly in kansas. We are supplying very heavily the Public Health labs with rapid diagnostics, as well as surging them to areas like that. The one tradeoff, however, is that the rapid point of care diagnostics are very slow. So each machine can only two four per hour and thats very, very slow. So its a mix of testing that you need at these kinds of situations, sort of the high throughput tests that are available at quest labs there in kansas, as well as a mix of the rapid testing. And thats what were supplying in order to provide a comprehensive holistic solution. And i believe cdc is on the ground as well in kansas supporting that. I appreciate that. If youre only doing four an hour, thats not a rapid test. Maybe its a rapid slow test. Im not quite sure how you define that. But i, for one, think that as we reopen and by the way, governor kelly started the opening process the first of this month, and then we go to june and the hope is we can open up. But we do have contingency plans that if that doesnt work, as aptly described by dr. Fauci, i think well be all right. But this is going to tbbe a tou go. I have to tell you that in terms of agriculture, were not in good shape. I appreciate everybody and the job that you are doing. Well stand beside you when youre taking the booze and behind you when youre taking the bows. Thank you, senator roberts. Senator cane. Thank you, mr. Chair. To the Committee Leadership and witnesses for calling this important hearing. The last time dr. Fauci and hahn were before us was march 3. I have a slide that i want to put up that shows whats happened in america since then. The chart which is here compares the experience of the United States and south korea on three dates. On january 21 both nations experienced their first case of covid19. At that time the unemployment rates in both countries were essentially identical. On march 3 when the witnesses were last year, south korea had experienced 28 covid19 deaths and the u. S. Had experienced nine. Again, the economies of both nations as measured by unemployment rates were nearly identical. But now the story changes. As of yesterday, more than 81,000 americans have died and the u. S. Economy has experienced job losses not seen since the great depression. Meanwhile, the economy of south korea has not changed dramatically at all. And the death toll is now at 256. South korea is smaller than the United States, one mf sixth of our population. But even if you bulk up on death toll, the per capita in the u. S. Is more than 45 times the rate in south korea. And health care carnage here is causing a near depression, while south korea has protected its economy by managing correctly. I could have done this chart with other nations. The u. S. Has the seventh highest per capita death rate in the world. Our death rate is off the charts higher than that in india, australia, new zealand, and mexico. Its nearly three times the death rate in germany, twice as high as canadas rate. The question is why. If we want to open up our economy and schools, we have to learn the lessons of nations that have managed this well. Here are some things that dont explain the difference. Our hospitals are as good or better than those in south korea. Our Health Care Providers, heros, are as good or better than those in south korea. Our Research Capacity is as good or better than that of south korea. And we have more resources than south korea. Our gdp is 12 times south koreas and our per capita income is 50 higher. So to dr. Fauci, the death rate in the United States, especially when compared in other nations, is unacceptable, isnt it . Excuse me. Sorry, sir. Yes, of course. I mean, a death rate that high is something that in any manner or form in my mind is unacceptable. And dr. Fauci, the experience of other nations shows that the u. S. Death rate is not only unacceptable, but its unnecessary, isnt that correct . I dont know if we can say that, senator. But would you say that the u. S. Has to do better . Of course. You always have to do better. I mean, as a physician and and the experience of south korea shows how a nation manages the Health Care Crisis has a huge impact also on its economic condition, isnt that the case . That is the case, sir. I understand where youre going with this, but i have to tell you there is a big difference between south korea and the United States and the outbreak. And let me get to that. I want to get to factors that do explain the difference since we know its not resources or our health providers. First is testing. South korea began an aggressive testing much earlier than the u. S. Now in the fifth month of the pandemic, weve surpassed south korea in per capita testing, but in the critical month of march, south korea was testing its population at a rate of 40 times the testing in the u. S. Admiral giroir, dr. Giroir has set out the standard for us. When we get to september, he says the United States needs to do 40 to 50 million tests a month to be safe. That equates to about 1. 3 million to 1. 7 million tests a day. Yesterday we did 395,000 tests. Weve got a long way to go. A second factor is Contact Tracing. South korea embraced a rigorous Contact Tracing program right from the beginning. The United States still has not engaged in a national Contact Tracing program, isnt that right . Would that be dr. Fauci or dr. Redfield . I think that question would best be directed to the cdc. When the outbreak started, sir, we had an aggressive Contract Tracing program, but unfortunately as the cases rose it went beyond the capacity and we went to mitigation. So we lost the containment edge clearly moving forward. And that was key to the economy as well because south korea did testing, Contract Tracing and then they didnt have to do the shutdowns which helped their economy. Social distancing is one we talked about. But finally the last one, Health Care Systems. Would you agree with me that it helps keep people safer from serious conditions or death from covid19 if they have access to health care . Yes, of course. Of course thats the case. In south korea 97 of the population have Health Insurance. In the United States before covid19, millions didnt have it and lacked access to health care. The massive job losses in the last months threatened to take Health Insurance away from millions more. And President Trump is doing all he can to dismantle the Affordable Care act, which would take Health Insurance away from tens of millions more. Lets learn the lessons from those who are doing this right. Thank you, mr. Chair. I yield back. Can i make a clarification, please, mr. Chairman . I just wanted to clarify that i did project that we will have the ability to perform 40 to 50 million tests per month in that time frame, but i said if needed at that time. I am not making a proclamation. We have to really understand where the epidemic is, what the Community Spread is before we can estimate the number of tests that are needed. I was simply stating the fact that our combination of testing capabilities will be at that level even barring new input from the nih. Thank you very much. Thank you, mr. Chairman, and gentlemen for being here this morning virtually, but also for all you have been doing for these many, many months. Alaska is doing okay right now from a numbers perspective, and quite honestly, we want to keep it that way because we know we have exceptionally vulnerable populations and a geography that is challenging and facilities that are very limited. Last hearing we had an opportunity to hear from dr. Collins and he shared where they are with the radx and also spoke to radx up, which was very interesting about what we can be doing in rural areas. But by focusing on hot spots. And as i reminded him, we dont want to be a hot spot in alaska. So every effort that we make to keep the virus out of alaska is lives that are saved. I educated him on the community of cordova that is just getting ready to open its copper river salmon fishery in two days and was able to share that they had had one worker tested positive as he was coming in from the lower 48 to come to work. The good news on that is that all the protocols that we had put in place seem to be working. The quarantine, the isolation, not only for that individual but for others that he had come in contact with were secured. So i want to recognize the assistance that we have received from the administration, dr. Eastman is in the state at this moment to be the chief medical officer for the department of homeland security, going out to Rural Communities to really better understand our vulnerabilities, going to some of our fishing communities to again understand how we can successfully prosecute when you have to bring workers in from the outside. We thank you for the assistance with regards to additional Testing Capacity. Ive been in contact with our chief medical officer of the state this morning and the mayor of cordova understanding do we have the tests that we need, what do we need on the ground. And one of the things that i would like to have clarified, and this is probably to you, because you have been so helpful in kind of shining the light on what we need to be doing in these rural areas. But so much of the focus has been on hot spots and responding to the hot spots. But how do you keep those rural, remote small communities from becoming the hot spots in the first place . Are we doing enough . And right now the strategy has been we just lock it off. The travel restrictions that are in place are apparently working. But theyre also devastating our economy, whether its tourism, whether its our resource industries, or whether its the potential for our fisheries. So admiral, if you might speak to that aspect of it, and i have a very important question as it relates to Contact Tracing that i would like to direct to either admiral giroir or dr. Redfield. So thank you, senator. And as you know, you have an outstanding state Health Officer in dr. Anne zink and ive had the privilege of working with her and you have a very good protocol in trying to keep alaska safe by isolation over a period of time when you come in. As you know, we also work with the state to meet your very challenging testing requirements, because you cant really send labs out 1,000 miles away. So we put a real customized mix of point of care and also the machines, i think we sent nine or ten new to alaska and about 50,000 tests, which is about four times than youve done to date collectively in order to provide that support. So again, i do think theres a comprehensive strategy that you do have. But again, the mitigation to the degree that you can, given the circumstances, the face masks, the hand washing, the hygiene, we understand fully the challenges, particularly in the fishing environment and the remote, but all of these have to come together, the testing, the tracing, the mitigation, the hygiene factors, to try to keep your community safe. And we really understand culturally that many of your communities were almost annihilated in if 1918 influenza pandemic, and that memory is still very sharp and very hurtful to some of the citizens. So we want to do our best to assure them that we are giving them all the protection we can. So admiral, let me turn to dr. Redfield, because this relates to Contact Tracing. I think, and this is a very key part of how we move forward into getting people back to work, getting people back to school. Right now we have about 100 people that are involved in Contact Tracing in alaska. Thats clearly not sufficient. Theres been talk about a National Strategy, but i think we recognize that we have teams in place, whether its america or peace corps or our Public Health corps. What more do we need to be doing to make sure that once youve been tested positive, you know then what happens after that. Who else needs to be brought into this . And im not convince had were focusing enough on that aspect of how we move to reopening if we havent done the Contact Tracing. Thank you very much, senator. I want to just reemphasize what you said. I think Contact Tracing capabilities is critical. Its going to be the difference from succeeding in containing this outbreak from widescale Community Transmission or not. Were positioned, as you know, to redeploy a number of cdc, over 500 cdc individuals. We have another about 650 that were trying to put in. But most importantly, were trying to work with your health department, with the resources that weve been able to give. Also, as you mentioned, with these other agencies, with lab corps, with americorps, with the Census Bureau to Work Together. Some states have reactivated national guard. I agree when you, when i said its going to be a significant effort to build the Contact Tracing we need, it will be state by state, but its going to need to be augmented probably in your state from what you just said five to ten fold. And were there to work with the states to help them get that accomplished. That needs to get in place before september. We need to move on to the next question. Thank you. Thank you, senator murkowski. I dont want to cut any senator off, but we have eight more senators who have fiveminute rounds and its 12 30, so i would like to request that the senators and the witnesses, succinct questions and try to stay within five minutes, it would be appreciated. Senator hasset. Thank you, mr. Chair. Thank you and the Ranking Member for having this hearing and thank you to our Witnesses Today and please pass our thanks along to all of the hard working men and women in your agencies who i know have been working virtually around the clock to try to improve our response and keep americans safe. And mr. Chair, i hope you and all the witnesses are healthy and safe today, as is everybody on your team. I wanted to start by echoing the comments by colleagues have made about leadership from the cdc and our Public Health experts on how we are going to use facts and evidence as guidance so that our schools and our day cares and our businesses have the information they need to create safe and sustainable plans to reopen. And of course that means that our Testing Capacity not only has to be enough, but it has to be flexible enough to meet our needs. The key distinction between south korea and the United States is not how many tests per capita over a certain amount of time weve done, but the fact that at the onset of this pandemic south korea was much more able to do a lot more tests per capita than we were and then followed that with all the other measures youve talked about. So we continue to need to identify the need and then build our capacity towards the need, not the toother way around. I wanted to start with a question to you, dr. Fauci. First of all, thank you for your work and expertise. I wanted to talk about Nursing Homes for a minute. In New Hampshire and across the country, a huge number of the deaths from covid19 that we are seeing have been in Nursing Homes. We all know people who have lost a friend or Family Member in Nursing Homes and the grief, come pounded by the fact that people couldnt be at their loved ones bedside. Yesterday dr. Birx said that all 1 million nursing home residents should be tested wip tthin the t two weeks. As a shortterm goal that makes sense to me. But after that, what will the ongoing federal recommendations look like . How frequently do we need to test patients and staff on a continuing basis and what other muz u measures will be necessary to keep our loved ones in these facilities safe . Thank you for the question. The general plan, as you mentioned, that was recommended by dr. Birx is a sound plan, as you said, in the immediate. The question is in the long range, we will have to have Infection Control capabilities in Nursing Homes that are really pristine and really unassailable. We have to do the kinds of surveillances and have to have the capability of when you identify someone, you get them out of that particular environment so that they dont spread the infection throughout. So general testing for all i think is a good start. But when you look, where are you going to go in the future . It has to be a considerable degree of surveillance capability. Thank you, doctor. The white house is now requiring all staff to wear masks and anyone in regular contact with the president tested daily. Do you think Nursing Homes should implement those same measures to help make sure that our seniors can get the same level of protection . I think there should be a system in place for the optimal protection of people in Nursing Homes, and that would be not necessarily testing every person every day. Thats one approach that might not be practical when you think of all the Nursing Homes in the country. But very strict regulations and guidelines about who is allowed to go into the nursing home and the staff i believe needs to be monitored very carefully with intermittent testing to make sure that we dont have introduction into the nursing home of infected individuals. Im not sure you can practically do it testing every day. That i dont think would be feasible. But something that is much more aggressive than has been done in the past i believe should be done. Well, thank you. I have one last question for dr. Fauci and dr. Redfield. I would also just say that if we are able to get masks to everybody in the white house, i hope we can get masks to every nursing home employee who needs it. Dr. Fauci and dr. Redfield, the u. S. Needs to be preparing now to ensure that we have capacity to manufacture and administer vaccines, something youve both touched on. Both for an eventual covid19 vaccine, as well as other illnesses such as the flu. The failure to ramp up production of testing and personal protective equipment early on during this crisis made things worse here and those mistakes cant be repeated when it comes to vaccine production and distribution. We are already seeing reports that some children are not receiving routine immunizations as it becomes more difficult to access inperson care. Dr. Fauci, what steps do we take now to ensure that we have sufficient manufacturing and distribution capacity for a covid19 vaccine without putting at risk our capacity to manufacture and distribute other important products such as a flu or measles vaccine . And my followup question to dr. Redfield would be what efforts are under way at cdc to ensure that all routine vaccines are accessible during the covid19 Public Health emergency. Ill answer it as quickly as possible. I alluded to it m in my introductory marks when i was talking about vaccines for covid19. And what we said is as we do the testing on vaccines, we are going to make production at risk. Which means we will start putting hundreds of millions of dollars of federal government money into the development and production of vaccine doses before we even know it works. So that when we do, and i hope we will and i have cautious optimism that we will, ultimately get an effective and safe vaccine, that we will have doses available to everyone who needs it in the United States and even contribute to what is the needs globally, because we are partnering with a number of other countries. The other part of your question about making sure that when we get into a situation like the socalled shutdown that we might be in now, that we make sure that children get the vaccinations that they need, that would be an unintended consequence of shutting down as we are right now. Its a very good point and we want to make sure we dont fall behind on that also. Thank you. Thank you very much. And ill take my answer from dr. Redfield offline. If you so much. Thank you. Senator scott. Thank you, mr. Chairman and to the panel, thank you all for being here virtually. Without any question, we find ourselves in a situation that we wish we were not. Im very thankful for dr. Birx, dr. Fauci and many others for your dedication 24 7. Our nation is safer because of your hard work. I want to direct my questions to dr. Fauci. One specific question, and im thinking about the reopening of america and specifically the reopening of South Carolina. Im taking into consideration the fact that South Carolina, a overall our cases are moving in the right direction. Unfortunately we have 350 deaths. Our Hospital Capacity is actually better now than it was when the pandemic started. Our ability to isolate hot spots and mitigate the spread of the virus is, i think, where it needs to be. With that in mind, i flew into washington from South Carolina yesterday. We have plans to test additionally 220,000 more residents by the end of this month. Focusing on atrisk populations. By the end of this month, they will have tested 100 of nursing home residents and the staff that takes care of them. And after increasing our Contact Tracing workforce twenty fold in a matter of weeks, our States Health department announced yesterday that we were going to increase it by an additional 1,400 contact tracers. We have built and continue to build the tools necessary to better detect and isolate cases, to map their exposure and prevent substantial spikes moving forward. Most importantly, our Health Care System, thanks in part to flexibilities from this administration, has the beds and the equipment necessary to address the most serious cases when they arise. Now, with these tools in hand, we have begun to reopen. To be clear, we continue to scale up testing and to take measures to protect the most vulnerable. And the data points are increasingly clear. For older americans, and for those with chronic conditions like diabetes and higher blood pressure, this virus remains a threat. A dangerous threat. A recent report suggests that in new york roughly 90 of the fatalities had underlying issues, twothirds of the fatalities were 70 years or older, 95 over the age of 50. In South Carolina, the median age of patients who have died from the virus, 76 1 2. Nearly twothirds of the fatalities have been patients older than 71 and nearly 90 were over the age of 60. And roughly 98 in South Carolina are over the age of 50. Contrast that with those age 20 and younger, where weve seen no deaths. Fewer than one percent of deaths in my state have been under the able of 40. Every single death in a tragedy. Every single one. And we mourn with our Family Members who have lost their loved ones. We are taking every measure to protect our older south caroline yens as well as those with conditions. But when we set out to flatten the curve by taking unprecedented measures, like stayathome orders and mass Small Business closures, we didnt set out with the goal of preventing 100 of fatalities. That would be unrealistic. It is impossible. And we didnt set out to keep quarantines in place until we found a safe and effective vaccine. That would take too long. Dr. Redfield, your agency put out a helpful graphic showing two curves, which one spiked quickly and peaked high, reflected daily cases without protective measures. The other, flatter curves, showed those measures in place and the whole point the graphic illustrated was to make sure that we did not exceed Hospital Capacity. So while i respect the need for caution, we are too often presented with a false dichotomy. Either saving our economy or saving lives. Weve seen the goal posts around flattening the curve move and i think thats unfortunate. Because at the same time were doing that, businesses have collapsed, mental and physical health have declined. Depths of despair escalate. Education outcomes nose dive as we wait in our living rooms praying for some good news around therapies and around vaccines. We set out to flatten the curve and i think weve done a pretty good job of that. We need to do better and we will do better. My question, dr. Fauci, is as we start the process of moving towards reopening South Carolina, what else would you suggest that we could do to protect our most vulnerable populations . Thank you, senator scott. You gave a really very eloquent description of what i think would be a model way, the way youve approached this. You have put things in place that i think would optimize your capability of reopening and as i was thinking as you were speaking, i would almost want to clone that and make sure other people hear about that and see what youve been doing. The issue of your direct question to me about the vulnerable populations, is that as we have said in our guidelines, and it looks likes you are ready to progress carefully because youve put into place a very good system, that the vulnerable, the elderly and those with underlying conditions, should be those who are at the last lifting of mitigations, it should be those who are left in a situation where they might be in danger of getting infected. In other words, protect them right up until the very end of the relaxation of your mitigation. Because as you said very correctly, those are the individuals that are the most vulnerable for the morbidity and mortality. So those are individuals, particularly i might say, sir, those in the minority group, the africanamerican and hispanics, who for a variety of situations that are the social determinants of health, have a greater likelihood of not only getting infected, but also having the underlying conditions that would make their risk for a higher degree of morbidity and mortality higher. So it looks like youre doing things well and i would encourage to continue to follow the guidelines as you get closer to normalizing your state. Thank you. Thank you. Ill just simply close with this since im out of time. Thank you for the many conversations that you and i have had about those vulnerable populations to include minorities, as well as our senior citizens. I will say that without any question when you look at Nursing Homes, its typically africanamericans and hispanics are the certified nursing assistants who are providing care for the elderly population. So your focus on those two very vulnerable groups is much appreciated and thank you for your expertise. Thank you, senator scott. And senator smith. Thank you so much, chair alexander, and Ranking Member murray and thanks to all of you for being here today and for your service. Dr. Fauci, i have to say you are in the unenviable position of being the person that so many minnesotans trust to give us information we trust. You are about the facts and not the politics and thats a good thing. So i have to ask you a question a lot of americans want to know, which is how are you doing . How are you holding up . Its been an unbelievable effort. Im doing fine, senator. Thank you very much for asking. This is such an important problem, it transcends all of us individually and us to be working as a team and i enjoy very much working with your senators and the governors because its at the local level that were going to make this thing work. So im fine. I appreciate your concern. Well, a lot of people are thinking about you and are grateful for your service, as we are for all of you. So were gathered today to think about what we need to do to reopen our economy, and i think first about whats happening in my home what is happening in my home state of minnesota where agriculture is such an important part of how our state works. It is a part of our history and our future. Pork processors right now are looking at the reality of euthanizing thousands of hogs a day. Because there is no place to process them because of what is happening in the Processing Plants. And the working people who do the hard work in those Processing Plants are getting sick. So here is one story, this is one worker, the startribune wrote about this named joemar dejesus and is a mom that works for a contractor that do the cleaning in the Processing Plant and she works for 14 an hour, seven hours a day and five days a week and she sanitized the machines that process the meat into ground meat and she started feeling sick on april 11th but she kept going to work and on april 21st when one of her coworkers fainted as she told her supervisor that she felt sick and so she was told to go home. But if she didnt show any signs of illness she should come back. She went to the doctor and paid 115 to get a test and found out a few days later that she was covid positive and shes still at home, not getting paid and she doesnt have Health Insurance. And nearly two weeks ago President Trump deployed the defense production act to keep these Processing Plants open. But the usda gave really limited guidance about what would be safe for those workers. It said, for example, in response to testing, which is such a big part of what weve been talking about today, they said, this is a quote, the facilities should consider the appropriate role of testing in workplace Contact Tracing of covid19 positive workers in a work site and assessment. So, dr. Fauci, as we think about how we move forward, we all want to open up the economy, what guidance would you give us in the situation like this here in minnesota . Well, i can give you my common sense guidance, although this is not the area of my expertise. It is more in others but it would seem if you want to keep things like packing plants open, that you really have to provide the optimum degree of protection of the workers involved, the ability to allow them to go to work safely, and if and when individuals get infected to immediately be able to get them out and give them the proper care. So i would think when you are calling upon people to perform essential services you have the moral responsibility to make sure theyre well taken care of and well protected and again, that is not an official proclamation, that is just me speaking as a physician and as a human being. Well, thank you, dr. Fauci. And i think that you speak as a human being but also speak as the chief epidemiologist of our country and the person that we all trust and this is the point that i want to make and drive home with everybody, which is this is the kind of guidance that we should be getting and following and these are the tools that we have got to have in our country if were going to reopen our economy as we all want to do. And this we move forward with reopening our economy and yet we still have circumstances like we had in these Processing Plants in another places around the state we are going to be right back where we started and except even in the worse place as i think you pointed out, dr. Fauci. Thank you, senator. And again, it really does relate to one of the questions that one of your colleagues senators asked me before. That one of the things that i keep emphasizing and ill just repeat it again because it is important, that when you are in the process of opening up and pulling back on mitigation, you really must have in place the capability of responding when you do have the inevitable upticks in cases. That will absolutely occur. It is how we deal with it and how successful we are in putting the clamps on it that will prevent us from getting the kind of rebound that not only from the standpoint of illness and death would be something that is unacceptable, but it will set us back in our progress towards reopening the country. Thank you very much, senator smith. Senator romney. This hearing and the participants in it. Admiral giroir, im going to take off where senator hassan spoke. I understand that politicians are going to frame data in a way most positive politically because they expect that from admirals but yesterday you celebrated we had done more tests per capita than south korea but ignored fact that they accomplished theirs at the beginning of the outbreak while we treaded water in february and march and as a result by march 6th the u. S. Had completed just 2,000 tests whereas south korea had conducted more than 140,000 tests so partially as a result of that they have 256 deaths and we have almost 80,000 deaths. I find our testing record nothing to celebrate whatsoever. The fact is their test numbers are going down, down, down, down now because they dont have the kind of outbreak we have. Ours are going up, up, up and that is important as we think about the future. On a separate topic, my impression is that with regards to a where im critical of what we have done on testing, on vaccine we have done a darn good job moving ahead aggressively. Yet the president said the other day president obama is responsible for our lack of a vaccine. Dr. Fauci, is president obama or by extension, President Trump, did they do something that made the likelihood of creating a vaccine less likely . Are either President Trump or president obama for the fact we dont have a vaccine now or in delaying it in some way . No, senator, not at all. Certainly, president obama nor President Trump are responsible for our not having a vaccine. We moved, as you said i described it in my Opening Statement rather rapidly no one has gone from knowing what the virus was to a phase one trial as fast as we have done. So i dont think thats something that one should say anybody is responsible for doing anything wrong on that. I think thats right. Thats the correct way to do it. Thank you. That was my impression. I was surprised by the comment, but that was my impression. Dr. Redfield, we wrote a letter to you expressing our dismay at the lack of Real Time Data at the cdc. Im talking about granular, demographic, hospitalization, treatment data. How is it possible in this day and age that the cdc has never established such a real time system with accurate data . What can congress do to rectify that so we never have to look at Something Like this again . Sorry. Senator, thanks for the question. I think youve hit one of the [no audio] Data Analytics and predictive data analysis. Congress has moved forward in providing funding for data modernization. Where he in the process of implementing the reality is, theres an or archaic system. This nation needs a modern data analytic system that can do predictive analysis. I think its one of the many shortcomings have been identified as we went through this outbreak. I couldnt agree with you more. Its time to get that corrected. Thank you. Please help guide us as to what we need to do to make sure that happens. I presume its not build it ourselves but work with companies that have that capacity and use that capacity in our favor. Dr. Fauci, one last thing, which relates to a virus. I know im asking you the impossible question. Were all hoping for a vaccine, obviously. Its the objective of our administration to get it as soon as they can and from what i can tell, theyre pulling out all the stops to do exactly that. Given our history with vaccine creation for other coronaviruses, how likely is it . Is it extremely likely were going to get a vaccine within a year or two . Is it just more likely than not . Is it a long shot . Its not a long shot. It is more likely than not that we will. Because this is a virus that induces an immune response. People recover. The overwhelming majority of people recover from this virus. Although, there is morbidity and mortality in certain populations. The fact the body is capable of spontaneously clearing the virus tells me that at least from a conceptual standpoint, we can stimulate the body with a vaccine that would induce a similar response. So although theres no guarantee, i think it clearly is much more likely than not that somewhere within that time frame we will get a vaccine for this virus. Thank you. Mr. Chairman, i yield. Thank you, senator romney. I want to thank the witnesses for their patience. We have four more senators. Senator jones. Thank you very much, mr. Chairman. Thanks to our witnesses for your being here virtually and also for your Incredible Service during this time. I want to follow up real quick with an additional statistic that senator romney talked about with regard to south korea. That is the fact that we are a nation that has about six times the population of south korea but yet we have about 310 times the number of deaths from this pandemic. I think we have to be very careful in making comparisons around the world comparing the United States to other countries. Dr. Redfield, i want to follow up just a little bit with what senator murkowski and i think senator cane talked about Contact Tracing and where we are going. I understand that you are working with states to try to develop plans for reopening. The testing is important. The Contact Tracing is important. But using that data as well is also going to be important in terms of the quarantine plans that senator murphy talked about, childcare facilities to have allowed people to put their kids in a facility while they are still go back to work. All of those issues, including maybe even facilities like Vacant Hotels or motels that may be used for selfisolation, how is this plan being developed within the cdc . Are those plans individualized by state . Will we as a member of congress be anle to have access to the plans . How are states to going to pay . My state is already using the money that we have given them as a wish list. They are talking about building 200 million state house as opposed to developing the tests and doing the Contact Tracing. I would like to drill down a little bit on how these plans are going to develop, what access we will have to have those plans and be able to see them. Thank you very much, senator. This is obviously, as i said before, this is a critical component of us taking this time that we have now to get prepared for next fall and winter. Building that comprehensive Contact Tracing capacity. Were working individually with the leadership of the state Health Departments, local Health Departments, territorial and tribal, to let them what they think their capacity needs are. Those discussions have happened. Theres been a variety of federal agents together on testing and Contact Tracing. Cdc is in position that we have reprogrammed our individuals that we have across the country where 500 begin help each of the states. We have augmented that with personnel that we are bringing on board state by state. The money that congress appropriated into the states so they can begin to start thinking about, how do they want to hire for Contact Tracing capability. Then, of course, it was mentioned that were Government Programs each group is going to construct thier Contact Tracing piece to what they think their needs are. I think it is going to be similar to what we hear from the senator from South Carolina. These are significant increases. They will increase again. The point you brought up we already americans from around the country quarantine as you know military bases. Many of the state and local Health Departments where do they put somebody isolation who is homeless . How do you develop those systems . This has to be part of it. There are certain intrinsic hotels. The point that was made by one of the other senators is so important. About individuals that meat packing individual that has to go home and selfisolate. Go home and about 12 other people. Mechanisms need to brought in way to identify cases do the appropriate Public Health measure. These have to be comprehensive. I see no reason why these are not transparent documents as they get a tribute to what the congressional support that has been given so far. 1. 6 billion into the resources we have gotten. Its fundamental. People underestimate how important it is that we have a highly functional, comprehensive, aggressive Contact Tracing program so the next outbreak we dont have thank you, dr. Redfield. I appreciate it. It sounds to me like we have a lot of work to do. So thank you. Thank you very much, senator jones. Senator braun. Thank you, chairman. Theres been so much discussion about testing in general. I listened to senator romney earlier, i think senator cane mentioned it. Everybody has. Dr. Haan, do you remember when we first met, i said is the fda going to be more entrepreneurial . Talking then about how we fix the Health Care System in general. Now this has brought it into clear focus. I have a time line that im going to submit for the record that shows from january 24 through march 5. I want to emphasize what senator burr asked earlier, has the administration ever put an impediment in front of trying to get to testing . This will end up in a question in a moment. There was a span of time from january 24 through march 5 that i hope the American Public looks at. It gets back to whats wrong with our Health Care System in general. Early testing, from what im seeing, was created by the fact that the cdc said it was going to do its own test, the south korean test that gets cited so often was not going to belooked at. We were going to do our own. The long and short of this is that for nearly a month, this was in that bureaucratic swirl. The fda prevented private and Academic Development of tests for weeks. The cdc denied access to functioning tests, as i cited, in south korea. This created, through all the red tape and bureaucracy, to where we had to come up with a one size fits all approach due to the uncertainty of the virus. We are stuck with that now. I dont want to dwell on that, necessarily, because i think those were mistakes that we made. Im tired of having it heard that its the administrations fault. I would like to ask this question. In that spirit of what we talked about during your nomination process, here going forward, we will shed some of that stodgie stodginess . I fear if we treat through bureaucracy how we did the early period of test, we can belabor this into the distant future and at that point theres going to be not only the carnage from the disease itself but from the economy to deal with. I would like your comment on that one month stretch, what accountability the fda and the cdc have. And then whether it looks better in terms of moving more quickly into the future. Thank you, senator braun, for the question. Our time line of that period demonstrates that we began working with Test Developers beyond cdc on january 24 and had double digit number of Test Developers working with us. One of the issues that we identified was, in fact, availability of the virus and other supplies to get that Test Development done in a timely fashion. I completely agree this is an opportunity for us to take a look and determine how we can do things better. I think thats a really important thing for all of us to do and certainly the fda can promise you will do that. Looking forward, sir, i can commit to you that we will look at every one of our regulatory authorities. We have done so during this outbreak. We have provided significant flexibility and have tried to provide the right balance between regulatory flexibility and enabling of the great Test Developers and Therapeutic Developers in this country with the need to ensure that our Gold Standard of safety and efficacy is in place. We have leaned in with manufacturers. We have learned a lot from them as well as the other stakeholders. We will continue to look. We will, i commit to you, sir, implement the changes that are necessary to make sure we can act in a more nimble way but still protect the safety and efficacy of medical products. Thank you. Dr. Fauci, taking a page from your antiaids playbook that implemented a formal, clearly defined treatment review pathway, can we do that for covid19 in a similar parallel track that you put into place back then in the90s . In fact, ive got a bill called the promising pathways act that is based upon that protocol you put into place. Can we do that to more quickly get through to therapeutics and vaccines here with covid19 . Well, its a different story with some similarities. If you are referring to the parallel track i put into place back in the late80s, which was when there was no availability of drugs at all for hiv and when we were testing drugs within a protocol that we would make it available outside of the protocol in what has ultimately turned out to be compassionate use. So what he we did is we didnt want to interfere with the integrity of the protocol to determine in a controlled way what was safe and what was effective. But there was a dire need for some sort of accessibility to those drugs outside of the Clinical Trial for those who might even have some chance of having it. In fact, that was really in many respects the birth of the really firm concept of compassionate use. Theres a version of that which i will hand over to commissioner hahn that is when you have expanded access in emergency use authorization with drugs that have not yet been fully proven in a Clinical Trial. Theres an analogy and similarity in the 1980s and whats being done by the fda now. Steve, if you want to comment on that. I think thats right, dr. Fauci. The emergency use authorization process by statute allows us to have flexibility and assess the risk benefit ratio in a Public Health emergency. We have done that on a theraputic side on three occasions and continue to look at those requests as they come in. Thank you very much. Thank you, senator braun. Senator rosen. Here i am. Thank you, mr. Chairman, for bringing this hearing. I want to thank the dedicated Doctors Today for their lifetime of work and study and passion. We are a grateful nation for all of your life long commitment in fighting disease, not just the United States, but around the world. As i talk to nevadans about safely reopening the economy, one question that frequently comes up is, when are we going to have a vaccine, like everyone talked about. In nevada, travel and tourism are the life blood for us. The Jobs Associated with those industries can only fully come back if we know its safe to travel and visit our work and our hotels, casinos, restaurants and attractions. Ultimately, to make this happen, we have to build confidence in our visitors that its safe. We need a vaccine. That research is important. However, understanding that this takes time to develop and ensure safety and efficacy, i would like to hear more about what research is happening regarding preventative Medication Research that could be helpful in the time frame before a vaccine. Especially before one is widely available. I would like to ask if this could be part of the path helping us begin to reopen our economy safely and bring visitors not only back to nevada but across our country. Dr. Fauci, what research is happening to identify potential antibody preventative treatments or other therapeutics . If the right antibody can be identified, could this be used as a preventative medication to block covid19 from latching on to the cells like the treatments for rheumatoid arthritis, asthma or other diseases . Would preventative Medication Options like this help complement the effectiveness of a vaccine once its available . Thank you for that question, senator rosen. Thats an excellent question. In all of the therapeutic interventions that we are developing and you mentioned several of them. They could be direct, anti viralviral, but thats just one of a number of possibilities since there are several viral targets in the replication cycle. Using convalescent plasma in a preventative modality as well as antibodies in a preventative modality are, in fact, all feasible and will be pursued in parallel with the development of a vaccine. The model of using drugs and other interventions that are effective for treatment is really a Great Success story in the issue with hiv aids. Many of the interventions that were developed for the full treatment of an infected person are effective in preventing infection of hiv. So thats the kind of model that we work out in parallel with treatment for disease. Using as treatment as prevention. I believe that will be a part of our effort at the same time as were putting a full court press on trying to get a vaccine. So its an excellent question. Very relevant. I know i have a short time left. I will abbreviate this. The second most important question that i get not just from First Responders and people worried about work, but generally what does the next generation of ppe need to look like for all of us as we go about our lives . Not just as workers, depending on your work, you may need something stronger, more specific, but as all of us as we want to shop or out to eat or whatever those things are, get on an airplane. Should masks be made of a certain material . Gloves, hankerchiefs effective . The best ppe for the general public if possible right now is to maintain the physical and social distancing. As we have said i think all of us would agree there are certain circumstances in which it is beyond your control when you need to do necessary things like go to the drugstore and get medication, go to the Grocery Store and get your food. You need some supplement to physical distancing. Some time ago, the recommendation was made i believe it was dr. Redfield at the cdc who said about getting some sort of a covering we dont want to call it a mask. Back then, we were concerned we would take masks away from the Health Care Providers. Some sort of masklike facial covering i think for the time being should be a very regular part of how we prevent the spread of infection. In fact, the more as you go outside right here where im sitting in washington, d. C. , you can see many people out there with masks on. Which gives me some degree of comfort that people are taking this very seriously. Thank you. Senator loeffler. Thank you all for being here and for your service. Before i start my questions, i want to recognize your new role in the u. S. Representative to the world health organization. Mitigating a resurgence of this will take global cooperation. In order to do that, we need accountability and transparency at the w. H. O. This organization was established to ensure the timely flow of accurate, unbiased information on Global Health emergencies just as this. Reforms must be made in order to restore the trust that we need here. I hope you will work with our allies to push for these reforms. This question i have two questions. The first is for dr. Redfield. Dr. Redfield, georgians are wondering how we got here today, 1,400 deaths, a third of georgias work force out of work. Im concerned about the coverup and misinformation coming from china and their efforts to suppress life saving information at the outset of this outbreak. As we continue to reopen our economy safely, we have to take steps to ensure that another outbreak cannot take hold of the world in this way. I understand cdc has worked with the chinese cdc on Global Health security for decades. You can comment on can you comment on the level as this virus emerges . Thank you very much, senator. I want to echo how important Global Health security is as a National Security priority for this nation. Were going to need to be able to be able to respond to that as long as we are a nation. Cdc has had relationships with many countries around the world. We have offices in over 45 countries right now. One of those happens to be china where we have a us cdc with the chinese cdc. We have worked together for decades, particularly on influenza and emerging Infectious Diseases. Thats been a very productive collaborative scientific interaction. When this original outbreak of pneumonia of unknown etiology came from the original seafood market, there were discussions with u. S. Personnel i had discusses as early as i think cdc as myself, january 3 we discussed this. We had very good interaction. Thats different than the broader Chinese Government level. Thank you, dr. Redfield. I have a final question for each of our great Witnesses Today. Its one that my constituents often ask me. The mainstream media, some of my colleagues in the senate, seem to want to paint each of your relationships with our president during this wartime effort as confrontational and lacking consensus. Can you say here to the American People today whether this is true or untrue . From your testimony today i have seen a very coordinated effort to address this with the administration to combat this pandemic. Can you give me a sense of whether this what the characterization is whether its true or untrue . Thank you. I would ask dr. Fauci to answer that first. There is certainly not a confrontational relationship between me and the president. As i mentioned many times, i give advice and opinion based on evidencebased scientific information. He hears that. He respects it. He gets opinions from a variety of other people. But in no way, in my experience over the last several months, has there been any confrontational relationship between us. Thank you. Dr. Redfield, dr. Hahn . Again, i would echo what dr. Fauci said. Were there to give our best Public Health advice. Thats what we do. Its grounded in data and science. Ive always felt free to give the best Public Health advice that i think needs to be given at the time. Its been done in a very professional way. Senator leoeffler, this is steve hahn. I have not had a confrontational relationship with the president. He asks questions. I have given him my honest answers rooted in data and science. He has listened respectfully to those. Incorporating that into his decision making. I have nothing else but to echo my colleagues. We work very closely together, all the scientists, all the physicians, of course, ambassador birx. We have a productive working relationship with each other and with the president and vicepresident. It would not be confrontational. I feel that we have the ability to honestly state our opinions and recommendations. Thats been that way since the beginning. Thank you, senator loeffler. Senator murray, do you have closing comments . I i have two quick questions. Sure. Dr. Fauci, while President Trump claimed otherwise, theres no question that an essential part of reopening our economy safely and successfully, is developing a vaccine for covid19 covid19. We need to plan now to deploy a vaccine once its proven safe and effective. But its absolutely crucial this planning process from the Clinical Trial to distribution recognizes and addresses racial and ethnic disparities in our Health Care System that as we all know for too long have been overlooked and unacknowledged in this country. We have to ensure equitable access to this vaccine for every. Dr. Fauci, let me start with you. What steps are nih taking to make sure that Clinical Trials for covid19 vaccine and therapeutics account for racial and ethnic disparities . Thank you very much. Thats a very relevant question, senator murray. In fact, in the design of our Clinical Trials and the sites that we have chosen in our Clinical Trial network, its going to be very representative of being able to get minority populations and populations at most risk to be part of the trial so that we know during the trial what the relative efficacy as well as potential adverse events. Its something we started in the days of hiv, when we tried to get good demographic representation. Were going to do that with these trials. Thank you. Dr. Hahn, tell me what steps fda is taking to make sure the United States is prepared to produce a sufficient number of vaccines, including the necessary manufacturing, supply chain capacity, for viles and stoppers and syringes. Thank you. Sharing of data with the agency nih and manufacturers so we can understand what the capacities are, what the needs are from the supply chain and then how to actually share that so that if one manufacturers vaccine doesnt go forward, we can use the capacity of that manufacturer for another vaccine. Im happy to report that the work of dr. Fauci has led to that effort. We developed, as i mentioned before, this gant chart that describes the steps, including the supplies you described. Its complicated in that we may well have hopefully five to seven candidate vaccines that may need different supplies associated with them. We have been up front identifying the supplies, where they are available and then working with the manufacturers to make sure they are available. Thank you. Thank you very much. Mr. Chairman, thank you. Thank you to all of our witnesses for joining us today. It is clear to me we have more work to do before we can safely get back to work and school and some semblance of normal life in our country. We still need testing to be fast, free and everywhere. We need the white house to lay out a Detailed National plan to make that happen. We still need adequate personal protective equipment, for our Health Care Workers and for workers at our businesses and at schools when the time comes. We need guidance from our experts so our communities have the information that they need to reopen schools and businesses safely, confidently and competently. Public Health Workers and Health Care Providers have the information they need to keep patients and communities safe. While experts have been clear that the day we can safely reopen may be a ways off, theres plenty for us to do in the meantime. Both to plan ahead, for example, to make sure once we have a safe and effective vaccine we can produce and distribute it to everyone quickly, and at no cost and to make sure there are Mental Health resources for everyone who is coping with the challenges that are presented by this virus. From the stress of physical isolation, loss of income, to the trauma and anxiety of patients and workers on the front lyonsines. I will press to provide the action and leadership we need. I hope that we will continue to have the opportunities like this to hear directly from the experts and ask pressing questions about how to get our country through this crisis. Its clear we have a lot further to go, a lot more to do. So i hope that as our efforts continue, we will bring many of you back, our witnesses, for another hearing soon. Thank you to all of you for joining us today. Thank you, senator murray. Ive got a clarification question and a couple of comments. Then we will thank the witnesses and wind up our hearing. My clayrification, i want to make sure i didnt create confusion by the way i asked the question about going back to school. I asked dr. Fauci first about treatments and vaccines and then about testing. What i thought i heard was that dr. Fauci said that vaccines are coming as fast as they ever have but it will be later in the year at the earliest before we see that. Theres some treatments that have that are modest but are promising. There could be more. But that doesnt mean you shouldnt go back to school. That would be more for testing strategy, am i right, dr. Fauci . You didnt say you shouldnt go back to school . No. Absolutely not. What i was referring to is that going back to school would be more in the realm of knowing the landscape of infection with regard to testing and it would depend on the dynamics of the outbreak in the region where the school is. I did not mean to imply at all any relationship between the availability of a vaccine and treatment and our ability to go back to school. You are quite correct. Thank you. What i heard from the admiral was that you are ramping up current technologies, you are hopeful for the National Institutes of health, but you would expect to have the capacity in the fall of 40 to 50 million tests a month and that ought to be adequate for the principal of a middle school or the chancellor of a campus to design a testing strategy that could provide, for example, to screen all the students if necessary . Is that correct . Yes, sir, mr. Chairman. We want to make as many tests available as absolutely possible. What i said is what i feel comfortable with knowing the production schedule being in the position of being able to work with the fda and cdc that we should have 40 to 50 we will have 40 to 50 million tests available per more that need to be deployed in a strategic way depending on the dynamics in the region. Having testing widely does not nullify the need that we are going to have to change our practices in terms of sanitation, personal cleanliness, distancing, face massmasks, given what the dynamics could be. Thank you for those comments. Assmasks, given what the dynamics could be. Thank you for those comments. Ssmasks, given what the dynamics could be. Thank you for those comments. Masks, given what the dynamics could be. Thank you for those comments. Masks, given what the dynamics could be. Thank you for those comments. Given that number of tests available in three months or as we ramp up to that number three months from now, that should give every principal, every chancellor of every College Campus we have about 5,000 campuses and 100,000 schools, some reassurance that testing as well as the common sense hygiene practices you talked about could be used to develop a strategy for reopening school in august. Two quick comments. One is, senator murray talked about the national plan, which was in the legislation that we all voted for. Theres a little bit of a push and tug between whats national and whats federal, what washington should do and the states do. I thought its a mistake to say federal equals national. In other words, covid19 is a national problem. But that doesnt mean the federal government is supposed to do everything. For example, in testing, the law requires states to tell you what their plans are, what their needs are and then you said that month during may, had state plans that identified 12. 5 million tests and you thought you could help meet that. You have noticed some supplies the federal government is buying and allocating to the state. We dont want to get in a situation where we are telling all the states what to do. Governor lee doesnt want you to tell him what to do. He wants to tell you what he is doing. Let you comment on it. I dont think Governor Cuomo wants President Trump telling him what to do. A push and tug between what washington does and what the states do, i think we have a testing, Contact Tracing, isolating, National Strategy and plan led by the governors, designed by the federal government as a National Effort and then the National Effort clearly is to do the research for treatment and the vaccines. What we heard is thats coming along on a faster track than we have ever seen before. Finally, i want to reiterate i thought this was a very helpful hearing. I thank the senators for their questions. I think anybody who took the time to watch would be impressed by the diversity of opinion and the honest answers we got from four really remarkable experts who are in the midst of this every day. I want to reemphasize what i said earlier, that i intend to make sure that we focus, senator murray suggested we need more hearings. I agree with her. As we deal with this pandemic, we need to make sure were ready for the next one. What can we learn about faster treatments and vaccines for the next one . What can we learn about the stockpile, what ought to be in it, manage it for next one . What can we learn can we learn anything about having hospital beds so we dont have to shut down hospitals and bankrupt them in order to create beds for sick people from the pandemic . What about states and hospitals that sell off their ppe in between pandemics . How do we keep our focus in between pandemics when we are have so many important things to be worried about in this country . How do we make sure we in congress sustain and fund all the things we need to do . I want to make sure that we do that this year. We are collective our collective memory is short. While were worried about this, we need to not only deal with this crisis but get ready for the next one. I thank the witnesses for their s washington journal. Missouri republican congressman and Maryland Democratic congressman discussed the federal response. And dr. Joshua gordon, director of the National Institute of Mental Health, will be on to talk about the impact of the pandemic on Mental Health in the nations mental Health Care System. Watch washington journal live at 7 00 eastern wednesday morning. Join the discussion. Live wednesday on the cspan networks, at 10 a. M. On cspan, the Supreme Court hears the first of two cases regarding the Electoral College and whether electors are required to vote for the winner of the state contest. That is followed by the case challenging the replacement of an elector who refused to vote for the winner of the election. At noon, the National Constitution center in philadelphia reviews the days for all units. The house select subcommittee on the Coronavirus Response holds a briefing on what is needed to safely reopen the country amid the coronavirus pandemic. On cspan2, the senate returned to take up changes to the foreign Intelligence Surveillance act, known as fisa. At 10 a. M. On cspan3, the Senate CommerceCommittee Hears testimony on fcc efforts to bridge the Digital Divide during the covid19 pandemic. House Speaker Nancy Pelosi unveiled a new 3 trillion coronavirus Economic Relief package on tuesday. The speaker said the House Democratic proposal is largely based on the four previous bipartisan bills and will focus on reopening the economy, honoring essential workers, and putting money into the pockets of the American People. The house is excited to vote on the legislation friday expected to vote on the legislation friday. Ms. Pelosi good afternoon. In february, sadly we learned that the first known coronavirus death in the United States. Since then, over 80,000 americans have died and nearly 1. 4 million have been infected. 33 million americans have filed for unemployment insurance