Transcripts For CSPAN Select Subcommittee On The Coronavirus Crisis Hearing On Racial Health... 20240712

My prayers go out to the floyd family and the other families of a long list of other victims and loved ones. I stand in solidarity with all those who have peacefully patriotically challenging the status quo. Are about the treatment of africanamericans at the hands of police. They are also about the systemic racial inequities that have festered in our society for years. They are now magnified by the coronavirus that we are here to talk about. Inequity is particularly stark in health bare by has been laid this pandemic. Latinos,mericans, native americans, and other people of color have tested positive, been hospitalized, and died from covid19 at alarming rates. , african are dying at a rate that is double what would be expected given their share of the population. Infectedhat have been ina disproportionate rate every state that report these data. And native americans, who represent just 4 of the are 21 ofin arizona the coronavirus deaths in that state. Subcommittees briefing, we heard from mayors [indiscernible] urgent and Larger National conversation. The high rates of Coronavirus Infections and deaths among minorities and the consequence of underlying disparities, people of color are more likely to work in essential jobs, but they are at greater risk of contracting the virus. Also more likely to suffer from a lack of diagnoses and the treatment of chronic conditions such as diabetes, heart and lung disease, which increase the risk of death. Black and brown communities also have Inadequate Health care facilities and more crowded conditions. We need to address these disparities now. That they will have equitable access to coronavirus testing, High Quality Health Care to address these chronic conditions. Essential make sure workers have the protective equipment that they need and receive decent pay and paid leave so they are not forced to work when they are sick. We need to make sure the nations immigrant communities can get lifesaving treatment without being targeted by immigration officials. Ensure minority communities have the federal investment they need to thrive, both during this pandemic and after. To successfully address these Racial Disparities, we also need good data. Lawpril, Congress Passed a requiring the administration to provide racial data on Coronavirus Infections and deaths. , they did not provide the comprehensive data we need. Briefing istodays to examine Racial Health disparities in the coronavirus explore how we can ensure an equitable response. Are uniquelysses qualified to do this. We will hear from Public Health experts, physicians, who are treating coronavirus patients in minority communities and Community Activists who have seen firsthand how this virus has deepened existing inequities. This committee will approach these issues properly and search fory bipartisan solutions. Memberscognize Ranking Police for his opening remarks. Thank you, mr. Chairman. As we start this hearing, our country is facing two very different crises. We are facing the shutdown of our country and our economy with covid19 and the pandemic that has spread throughout the world, and we are also dealing with the anger stemming from the senseless murder of george floyd as well as the protests that followed and the violent rioting and burning down of some of our cities. Chairman, in my prayers are george floyd and his family and my prayers are also with retired police cap and david dorn who was senselessly murdered trying to stop a looter, as well as other Law Enforcement officers that were just trying to protect their communities from the senseless violence that has spread out of this. As we confront all of these challenges, this committee should be focused on following the fact and working on solutions to these very Serious Problems and challenges. The covid19 pandemic struck suddenly and has taken over 100,000 lives in this country and has caused a lockdown resulting in 40 million 40 million job losses. Sadly, thats not the only story. The Minority Community disproportionally. Covid has hit lower income americans especially hard. Covid has targeted the elderly. Covid has taken a pool toll on americans with Underlying Health conditions like diabetes and cancer. We face an insidious, people covid has targetedenemy, but wea united country. We understand the grief, we work to flatten the curve, we understand communities are trying to pull together to get through this. In my district, which includes parts of the city of new orleans, we lost over 1300 friends and neighbors, more than 400 nursing home residents have died from covid19. Our largest Hospital System just 77 ofd this week that hospitalized Covid Patients were africanamerican. More than half the facade half the tallies have been minorities. The names and faces of covid victims include people like a friend of mine, ellis marsalis, legendary jazz pianist, and educator, and the patriarch of the marsalis family. To theth draws attention impact on the musicians and artists, particularly in the Africanamerican Community that represent so much of the culture and diversity and vitality of our city. Also tried to take Rochelle Mcdaniels from us. She spent six weeks on a ventilator immediately after giving birth. She tested positive to be treated. When she emerged from a new orleans hospital after 72 days, she was finally able to hold her infant son for the very first time. He was delivered when she first went into the hospital and was immediately separated for his safety. Her doctors called her a symbol of hope during a time of death and defeat. Nationally, covid19 deaths are two times greater in minority communities and other communities. The navajo nation, the countrys largest reservation now has a higher death rate than any u. S. State except for new york, new jersey, connecticut and massachusetts. In new mexico, native americans are dying at rates 19 times that of all other populations combined. If we are going to do something about the disproportionate impact, we have to ask why this is happening. We know this is not an american problem alone. Andr income people minorities have suffered disproportionately. In america, we know Nursing Homes and assisted living facilities have been places where covid has spread into any people have died, including minorities. We can take immediate steps to reduce the suffering thereby learning hard lessons. Last week, this subcommittee heard from the mayor of jacksonville, florida who laid out reasons why florida has seen dramatically fewer deaths in Nursing Homes and states like new york. Lets hope the rest of the states follow those paths and learn from states like new york. Covid mortality and diabetes appear highly correlated. Africanamericans have a disproportionate rate of diabetes. President trump recognize this and moved to cap the cost of insulin at 35 a month for seniors. Last month, the president launched the advanced Kidney Health initiative which stated the goals of reducing the number of americans with endstage renal disease, having more patients receive dialysis at home and doubling the number of kidneys available for transplant. Perhaps congress should look at what we could do to help speed up some of these goals. As we discussed last week, reopening the American Economy is critical. The economic and Health Burden of the shutdown has definitely led to a disproportionate impact in minority communities. In my home state, almost 45 of Food Service Workers have lost their jobs. This is an industry dominated by low income and minority workers. Associated with higher stress, alcohol and drug abuse, and it leads to people delaying medical care. Getting people back to work is critical to improving health care outcomes, especially in minority communities. Mr. Chairman, we know we do not have all the answers and some of the Solutions Take time. Operation warp speed, which the president kicked off, will hopefully bring the vaccines we need soon, but we know it will not be today, so we need to keep working. That should not distract us from the things we know we need to do to help things on the ground and to know this administration and Congress Need to Work Together to get this done. I look forward to a good discussion today from our witnesses. Mr. Chairman, i yield back. I think the Ranking Member for yielding back. Let me think our panelists once again thank our panelists once again. We have an emergency physician who has treated coronavirus patients in new york and is the ceo of an organization that helps Health Care Providers to [indiscernible] to each patient. [indiscernible] and a former Health Commissioner for the city of baltimore. The president for the foundation of research of equal opportunity. We will hear from the president of the National Congress of serving theians, interest of tribal governments and communities. We will hear from a family physician who has worked on the front lines of the coronavirus treating migrant farmworkers and other patients in oregon. Thanks to all of you for being here today. Dr. Blackrecognize rock for opening remarks. Chairman clyburn and subcommittee members, good morning. Inviting me to speak at this critically important briefing on Racial Health disparities in the Coronavirus Crisis. I am an emergency medicine physician. Im also the founder of advancing health equity. The mission of my organization is to work with health care and related organizations to close the gap in Racial Health disparities. I originally founded this Organization Prior to the Coronavirus Crisis because despite significant advances in health care and technology over the last decades, Racial Health disparities have been both found and persistent. I would like to acknowledge the pain and trauma many black americans are currently experience due to the recent killings of george floyd, Breonna Taylor and ahmad arbery. Lay healths disparity symptoms Structural Racism and white supremacy. Black men have the shortest Life Experience eat Life Expectancy and black babies, the highest infant mortality rate and black women, the highest Maternal Mortality rate and this trend persists despite socioeconomic status and even the stress of dealing with daily racism results in the weathering effect, the premature aging of black americans bodies. Living in this country has essentially made black american sick. Over the last three months, we have witnessed a crisis layered upon a crisis as black communities across this country have worn the greatest verdant of illness and death from the Novel Coronavirus. Blackhan one in 2000 americans have died from coronavirus. Died atamericans had the same merit same rate as white americans come about teen thousand black americans would still be alive today. In midmarch, with my own eyes, i noticed the demographics of my patient patients in the clinic where i work switch from a diverse population to mostly black patients. Many of them were essential workers strivers, subway conductors, first roastery store workers. Medical underlying problems like diabetes, high Blood Pressure and asthma. Many with no other choice but to use Public Transportation and many displaying typical covid19 symptoms. However, we did not have adequate testing supplies at the time to test them. I have been a physician for 15 years and have worked in Emergency Departments with the sickest patients. Ive never been as scared for my patients as i have been the past few months. In particular, i remember and elderly black man who came in with shortness of breath and fever. His oxygen level was incredibly low. He lived by himself and i was incredibly worried about him and told him i would like to call an ambulance to bring him from Emergency Care to the emergency room. He told me he did not want to go, he did not want to die in the er. He told me he would not receive good care and felt safer at home. As you know, the distrust among black people for the Health Care System is not uncommon. Its based on a historical legacy of neglect, abuse, and explication of black communities and also current day inequities. Structural racism through policies that disadvantage black americans have placed them at risk for illness and death. It has been the Key Driving Force behind the factors that terman an individual and Community Health outcomes. Irg this subcommittee to act urgently urgently and swiftly to mitigate the appalling Health Disparities. This moment must be used for structural change in the form of among other social determinants, safe and adequate housing, gainful employment, access to quality education and healthy foods, and health care for all. Definitely needs a truth and reconciliation process around the racist policies and institutions that have left black lives devalued. This is an opportunity to intentionally acknowledge unjustified and ongoing wrongs, engage with black communities, and rebuild them equity equitably. Patientsst maybe, my and my two beautiful boys in the next room playing could have more than a fighting chance against the Novel Coronavirus. Thank you. Much. Nk you very [indiscernible] you for addressing the intersection of Racial Disparities and the covid19 pandemic. I come to you from the city of baltimore, where i am a practicing physician and had the honor of servant serving as its Health Commissioner. In my city, children worn today can expect to live 20 years more or less depending on where they are born and color of their skin. There are Racial Disparities across every metric of health. Throughout the United States, the currency of inequality is years of life. There is a terman medicine called acute nonchronic. This is what we are seeing, a new disease that has unmasked longstanding Health Disparities among africanamericans and other minorities who now bear the greatest brunt of the pandemic. My written testimony outline solutions to address acute issues and underlying problems and i would like to highlight four concrete actions for congress. First, the federal government must target Public Health resources to minority and underserved communities. I want to talk about testing, not only that it needs to be widespread and free, but the demographic information must be available for testing as a way to track resource allocations. Lets say the positive rate in the community is 10 when africanamericans are testing positive at 20 . That means africanamericans are under tested. My ideal scenario is for the cdc to post a dashboard on testing to make sure resources are directed to communities most in need. Also, our guidance for someone new tests positive is to selfisolate. What do you do if you live in crowded, multigenerational housing and have to do something that is impossible while also losing your ability to earn an income . Ive joined with other leaders to call for unused hotels and dormitories to become voluntary isolation facilities. The federal government must are clear andre clear directed guidelines to protect workers. Has changed. The language in the covid19 guidelines are not what im used to seeing from the cdc. People should not just be encouraged to do social distancing. Met exact standards must be in Office Environments versus meatpacking plants . Masks should be required. I want to see a clear statement such as if these criteria cannot be met, they cannot reopen. Osha should then enforce these rules as should local and state regulatory entities. If not, people of color and those who face systemic disparities will suffer most. The federal government needs to implement a National Strategy to prepare for the next search. That wenational shame ran out of masks and other ppe to protect our health care workers. There was no excuse last time and there should be no excuse moving forward. Ppe should not only be for doctors and nurses. Why shouldnt bus drivers and nursing home attendance who are disproportionately people of color also have protection . There must be a framework for thinking about equitable this abuse and of treatment and vaccines should they become available. Fourth, Congress Must provide further support for local Public Health. Cdc funding for Public Health preparedness has been cut by half over the last decade, forcing local officials to make impossible tradeoffs between critical programs. I think we can all agree treating covid19 should not come at the expense of preventing cardiovascular disease and reducing overdose deaths. Longerterm, there must be attention to how the disparities food deserts and a lack of transportation and there needs to be a recognition of the fact that racism is a Public Health issue, indeed a Public Health crisis in and of itself. I would like to end my testimony with a quote from the former chairman of the House Oversight committee, the late representative Elijah Cummings from baltimore. He would talk about the work we have in front of us as bigger than us, so much bigger than us and it is about our children who are messengers to our future that we will never see. That future is one in which the currency of inequality no longer equals years of life, one in which where people are born and what race they happen to be no longer determines whether they live. Thank you. We will now hear from dr. Roy. Chairman clyburn, ranking number scullys, and Ranking Members of the subcommittee on the Coronavirus Crisis, thank you for inviting me to speak today. The foundation for equal opportunity focuses on policies and ideas that can improve the lives of americans on the bottom half of the economic ladder. We have spent the last several months focusing on the impact of covid19 on lower income americans of all races and ethnicities and we welcome the opportunity to discuss our research specifically on minorities with you today. Contains astatement more detailed discussion of my findings and we will focus on three topics. I will discuss the mortality impact of covid19 on major u. S. Ethnic groups. I will discuss the critical subpopulation vulnerable seniors who live in Nursing Homes and assisted living facilities. Third, i will discuss how economic restrictions put in place have disproportionally harmed minorities. Believegood reason to minorities are at higher risk for covid19 severe illness and death from covid19 are associated with patients with preexisting conditions like high Blood Pressure, Heart Disease, and diabetes stop these conditions are disproportionally prevalent in africanamericans. The latest covid19 mortality data from the cdc indicates that in deed, blacks represent a greater share of covid deaths n the general population even for the fact that covid is more prevalent in cities. What may be surprised is that whites are also dying at higher than predicted rates. On the other hand, hispanics and asians represent a lower share of covid deaths than would be implied by their geographically adjusted share of the u. S. Population. Reason is morbidity and mortality is most common among the elderly. 81 of all covid deaths in the u. S. Have occurred in people aged 65 or older and whites are the oldest racial group in the u. S. With a median age of 44. Asians have a median age of 37, lacks, 34, and hispanics, 30. We would expect to see higher mortality rates in whites due to their age and indeed we do. On the other hand, african markets are relatively young, but we see higher mortality rates on blacks. We will have better data with which to assess Racial Disparities when the cdc releases data that breaks down mortality rates by race and age at the same time. My understanding is such data is forthcoming. Withay be familiar research we produced over the last several weeks on the tragedy taking place in our nursing home and assisted living facilities. Live and yet,ans 42 in this population lies of all u. S. Deaths from the Novel Coronavirus 42 . As you know, Nursing Homes are residential facilities for medically vulnerable seniors who have challenges with the activities of daily living like taking a shower or getting dressed stop they are disproportionally poor, nonwhite, and enrolled in medicaid. My colleagues and i wanted to see if states with high death rates in longterm care facilities were also associated with high proportions of black residents or residents enrolled in medicaid. Found no such correlation. A more granular analysis is done at county or facility level and we expect cms will be reducing that data in the coming weeks. No such ambiguity regarding the results of the economic lockdowns that states and localities have imposed on people and businesses in response to the pandemic. In late 2019, black unemployment reached its lowest rate in history, 5. 4 . Today, the black Unemployment Rate is 16. 7 . Hispanic unemployment reached three point 9 in late 2019, also a record. To today, it is 18. 9 . Pared to whites and asians instead, they see their jobs and hours , hourly wage work is down 50 , even more in places with the most stringent lockdowns. The decision may have made sense in midmarch when we feared our ics to be overwhelmed like in italy, but evidencebased three openings could protect and restore employment for low income americans. Plan called a new strategy for bringing people back to work during covid19 that details how it can be done and im glad to say a number of states have reopened in the ways we recommend. Its not important just for the Mental Health of minorities, but physical health. Andk of we can do better i look forward to working with the subcommittee to get there. Thank you very much. Good morning. I serve as president of the Indian Nation and resident of the conference of Indian Nation. We thank you for convening this hearing. We look forward to partnering with you in the future to address the disproportionate impact of covid19 to our community. Like all other governments, tribal nations work hard to keep our communities safe, healthy and strong. We have noted for centuries that our relationship with the United States is one born out of treaties. We have entered into sacred agreements whereby we seated millions of acres of land in exchange, the United States made promises to provide for the health care of our community. For over 200 years, the United States has recognized their trust and treaty responsibility and commitments to provide for our health care. Despite this fiduciary responsibility, the United States has chronically underfunded every sector of our health and socioeconomic life, creating a crisis in the 21st century that deeply affects our Public Health, our economy, and our social lives. These disparities have led to the vulnerability of our community during this pandemic and it has resulted in our highesties having the per capita covid rates in the United States. Currently, we are looking at not led toe funding that has our communities having the highest rates in the United States. Presently, the rate of infection and deaths from covid19 continues to grow in our community. The Indian Health Service Reports nearly 11,475 positive cases within the indian Health Care System. According to the cdc, over 395 in somehave died and reasons, the impacts are even deeper. Wenew mexico, for example, represent only 11 of the population, but we are impacted at a rate of 43. 7 . In arizona, we are 2 of the population, but we are impacted at a rate of 21. 6 . Statistics undercount the extent of covid19 for communities due to Data Collection issues. For example, there is not data on hospitalization mortality data for our communities within the indian Health Care System. The inability of our community to access testing and our limited resources, third, 71 of our population lives in urban areas and Data Collected by Health Care Authorities often omit or miss classify us. Compared to other groups, we have disproportionally higher rates of diabetes, Heart Disease and asthma as well as health to providethat serve a lethal impact to our community. Similarly, tribal communities experience overcrowding homes at a rate of eight times the national average, which makes quarantining an social distancing nearly impossible. Additionally, lack of access to water and sanitation has been a longstanding Public Health challenge for our community. Over 31 of homes on tribal lands are in need of sanitation and facility improvement while 13 of native homes, in contrast to only. 6 of nonnative homes, lack access to safe drinking water. These disparities are byproduct of the underfunding of the federal governments trust and treaty responsibility. With regard to health, services for over 2. 2 million individuals and i took expenditures per [indiscernible] of 2018, the commission on civil rights released a report entitled the , federalomises report funding shortfalls for native americans. It found several programs chronically underfunded and the Commission Found two things. First, as a result of the failure to honor the federal responsibility, vast Health Disparities exist in native populations. Inequitables compared to other federal Health Spending and covers only a faction only a fraction of Tribal Health care needs. Indian country has experienced unquantifiable harm during this pandemic. The death of each tribal citizen has meant the loss of part of our culture, our history, our language, and devastated many families were multiple members have died. We must structurally address Health Disparities to prevent this devastation from reoccurring. The broken promises report effectively laid out a Marshall Plan or a roadmap for addressing a precovid socioeconomic crisis in tribal communities. Now more than ever, such a plan is needed to address this pandemic in the conditions that created it. Irg the subcommittee to aid in the development of a Public Health and economic Recovery Plan by working with the commission on civil rights to supplement the broken promises report on evaluating the conditions that led to covids growth in Indian Country. Andimpact of legislative executive branch responses and propose solutions, including Technical Assistance to adopt the disparities in an updated report. I also urge the subcommittee to eight Indian Country by subsidizing its powers to address delays in federal funding that was specifically allocated by congress. Tribal nations have experienced funding. Accessing over two months after congers passed the cares act, over 3. 2 billion dollars of tribal covid funding has yet to be released by the department of treasury, education, interior, agriculture and commerce. I urge this subway to investigate these delays to ensure congressional covid relief reaches our committees. I thank you for your time and im happy to answer any questions. Thank you very much. Take a shortto break as it seems we are having some technical difficulties. To the Ranking Member are you back yet . They said there were some technical difficulties with the video. Is that working out . Icu. See you. Here is something. Can you hear me . Yes. I can hear you now. Good afternoon, chairman clyburn and members of the subcommittee. Can you see me . Yes. You, but i hear you. Good morning. Good morning. Good morning, everybody. Sorry. Good afternoon, chairman clyburn and the subcommittee. At a family physician Virginia Garcia Memorial Health center and im honored to be here today. I am also the proud daughter of a mexican immigrant and seasonal farm worker. My Life Experiences, along with the work i do today have provided me with a unique challenges on the faced by latino immigrants in farmworkers. This pandemic has laid bare the essential contributions of latino immigrants in farmworkers that they are making to our country. I have worked on the front lines at virginia garcia. We are a federally qualified Health Center serving more than 52,000 individuals every year. Over half of our population is latino. 98 of our patients live below the poverty line, and 20 are farmworkers. Our patients are some of the most vulnerable. Lack of access to appropriate housing and health care, Food Insecurity and unsafe working environments all contribute to higher rates of diabetes, respiratory issues, and a lower Life Expectancy. Covid19 continues to expose the heightened challenges of an increased increased vulnerability our committee faces. While oregon has seen an increase in the infection rate, the positive rate among latinos has increased. Oregon, latinos represent approximately 13 of the population, yet we are 30 of the positive cases. Offer you a closer look at the virginia garcia data. 1408 june 2, we tested individuals. Those tested identified as latinos, yet they would present 92 of the positive results. Oregon is not alone in this disproportionate rate. Across the nation, latinos count for 32. 7 of the positive testing results, but only 18. 2 of the population. Eating tohe facts can this disparity . Latinos make up a large portion of our essential workforce, laboring to keep food on our table, they work in agriculture, nurseries, and Food Processing plants. These jobs, while intensively physical take place both indoors and outside and require work in crews or groups, standing sidebyside in rows or on factory lines. Most often, they are without ppe. One came to me in late april, she was aysmptomatic but found out her coworker had tested positive the day before. That shed with me continues to work with her coworkers. She has not been wearing ppe and her employer told her if she wants ppe, she would need to get it herself and they would reimburse her later. It was not until an anonymous report was made to osha that changes in her working environment were made. Even then, her employer expressed frustration over the required changes and she would tote that she was told there would be retaliation. Adding to this, most latino immigrants in farmworkers do not have access to unemployment benefits, vacation, or paid sick leave. If they begin to experience symptoms, they go to work anyway because if they do not work, their family does not eat. Farm weeks ago, i tested a exposed to covid19. He was the single father of two young daughters with no family in the area. Although fearful of the prospect of infecting his daughters, even more distressing to him was the loss of income in finding alternative housing if he had to be quarantined. Complicating manners publication matters, many farmworkers are housed with multiple unrelated individuals, sleeping and living in one room no bigger than a 10 by 10 space. In some labor camps, you will find a single washing machine for 30 people and one shower shared by 10 people. For those who live outside of labor camps, there low wages make finding Affordable Housing a challenge. Often, multiple families live in apartments designed for single families stop this reality presents a massive barrier to observing social distancing and make it nearly impossible to selfquarantine if someone does fall ill. Havef these things facilitated the spread of the virus can led to the infections ofte covid19 among this already vulnerable population. Im here today to address three things workplace protections to promote a safe and healthy work environment, expansion of worker benefits such as health care for all, unemployment and sick leave for all workers considered essential, improvement and labor housing for all workers and labor camps. I ask you to join me today in creating solutions that will ensure safe working and Living Conditions for this vulnerable, essential population. Thank you. Thank you very much. Before i turn to the ranking want to ask about the backstops. Do you have any specific suggestions as to what you think we need to do to address the issues you have raised here today . Absolutely. Strategies we can employ in the shortterm and longterm. Its clear to me this pandemic will be with us for some time and i think we can mitigate some of the devastation by doing several things. We need to equitably allocate resources to black communities as quickly as possible, and we and contactting tracing and isolating sick individuals are some of the key fundamental intervention strategies we can do. In terms of testing, its not just about testing, but ensuring that it is accessible. Walk up testing, mobile testing needs to be available in black areas. Contact tracing in itself is a very sensitive area because when you Contact Tracing buddy, they will have to tell you exactly who they have been in contact with. We need to make sure we are engaging with black communities, so i see a role for educators or Community Health workers to be involved in the Contact Tracing efforts. The stitching and outreach will be incredibly important because the distrust we have in black communities toward the Health Care System is going to be an issue in terms of access and down the road in terms of vaccines. And then ensuring our essential workers not only have personal protective equipment but also have hazard pay and Financial Assistance for lost wages will be key. As well as ensuring food banks are well supplied and we are addressing housing and instability needs of these communities. Going torm omma we are need very profound investment in longerterm, we are going to need investment in housing, education, and jobs, ensuring we create policies that we are using a Racial Equity lens to examine these problems. Thank you very much. About aquestion guyen. On for dr. N i agree with what dr. Ckstock said in turn must interns of the access issue. We know it works when it comes to Public Health infrastructure to combat covid19. We need testing, Contact Tracing, that these are the pillars, if you will, of being able to contain this disease and we need treatment as well. All of that needs to be accessible. Me, having worked in baltimore, i can tell you for many of our residents, they are not going to go to their Doctors Office or their hospital to get a test. That testing needs to be brought to them, to places like churches, two public housing, to other places where they are to make a difference. On top of that, we need for there to be data and surveillance that actively captures demographic information so we can tell if testing is not targeted to committees of color and we are under testing in certain committees, we can immediately identify that problem in real time and target our resources and interventions accordingly. Thank you very much. Heardeciate what we have from all of our families here today and im sure all members would agree that you have given us a lot to work with. Let me yield two Ranking Member scullys. Thank you, mr. Chairman, and as we are looking at the data, obviously we are seeing in the United States, theres a disparity. African americans are more than two times more likely to die from covid19 then in white communities. When you look around the world, some places it is hard to get data, but lets say the united kingdom, we see data that shows it is even worse, where it is maybe four times more likely someone would die in the black community there than in the white community. Dr. Roy, i know you have done some research on this, and while data is not as widely available in all countries, in the countries you have been able to get data on, are you seeing a similar Racial Disparity around the world . To youris important member when you look at the data is covid, like many infectious diseases, is going to be more contagious and spread more rapidly and highly dense communities. In other words, cities. Theyou have to adjust statistics for where some buddy lives. States, thed tristate area around new york city represents more than half of all covid cases and deaths United States than the northeast corridor, it represents an even greater share. If you the cdc does this in the statistics they publish every day, which is what we based our analysis on. If you adjust the baseline demographic you are comparing to that, who lives in new york city, what is the demographic composition and then compare that to the death rates by race and ethnicity in new york city, that is the analysis we have presented. Ised on that analysis, that something you do see there isonally because regional variation but urban and dense environments are part of the equation. If you adjust for geography, you get to the statistics where africanamerican mortality is an outlier compared to other races and ethnicities and we will need to address more of our interests along with the issue of Nursing Homes i discussed in my Opening Statement. To ask you about Nursing Homes, but before we get off of this, we have seen on the economic side, and you touched on this in your Opening Statement that the economic shut down has had moments of negative health consequences. People are not getting their cancer screenings and mammograms and some of the other things they would do to take care of themselves physically. Thats not happening, as well as Mental Health issues. Are you seeing that disparity in the African American community as a wrecked result of the economic shut down . If your question is what is the data around Racial Disparities in terms of declines in screenings and treatment of heart attacks and things like that, we dont have enough data to make firm conclusions, but based on what we already know, we can be concerned because Heart Disease, high Blood Pressure, diabetes are more prevalent in the Africanamerican Community and the lack of ability to manage those chronic diseases and acute conditions is problematic. So im concerned about that. Thank you. I know we are putting Additional Resources and hopefully they can be directed properly to address this. Homes. Touch on nursing we talked about this in last weeks briefing where you saw a high disparity, i think 42 of all covid deaths in the country are amongst nursing home patients which only represent 6 of americas population. But not all states are doing this the same way and some states are doing it well. Florida, the mayor of jacksonville was talking about success they had because they put good protocols in place. The highest incident was in new york where the governor, for whatever reason, mandated nursing home patients, covid positive patients had to go back to the Nursing Homes, even if they couldnt possibly take care of them in a quarantine situation and that lead to tragic deaths. You studied that, have you seen that as well . New york problem is not the only one, new jersey did this, michigan is doing it still. At least in new york, they reversed course in midmay. New jersey and michigan are continuing these policies and michigan, we dont even know what the death rate is because michigan refuses to publicly disclose the death rate for People Living in assisted living facilities and Nursing Homes. That is unbelievable and that is something maybe we can address because people are dying for no reason. We know enough to know now theres a better way to take care of nursing home patients, especially covid positive. That is completely senseless deaths that we can hopefully focus on confronting. I will let you finish up. Note is cmsositive is requiring Nursing Homes to directly report a talent the statistics to cms, starting with may 5 data. We will not have data prior to may 5 unless Nursing Homes have voluntarily reported. But from may 5 onward, we should have more consistent reporting across geographies on this. Thank you, i yield back. Thank you very much. The chair recognizes [indiscernible] thank you very much. I thank you for holding this hearing. This is extraordinarily get very upset with this constant talk about Health Disparity because we have been talking about Health Disparities for years stop all of these minority populations are dying from preventable diseases. This has been going on. So it is no surprise that minorities are dying in this pandemic because of preexisting conditions. We talk about what Nursing Homes can do for example. If you have been to Nursing Homes, you know what the problems are. First of all, you are correct. The poorest people with lots of preexisting conditions, there are a lot of blacks and Nursing Homes. By the time they get to a nursing home, dave had diabetes, theyve had amputations, on and on and on. When you talk about what we can do, they cannot do social distancing and Nursing Homes. They cant do a quarantine in Nursing Homes. They have the lowest paid workers and the turnover is very they get people coming off the streets, etc. When you talk about what we can do in Nursing Homes, you have to be talking about resources. Money ino invest more the care of these patients in Nursing Homes. Whether we are talking about Nursing Homes or africanamericans, latinos, etc. , we need to be talking about in some shape or form, medicare for all, even without the pandemic. The pandemic is here and much of what has been talked about is ways to respond to it. If you really understand, you know a lot of this is simply speculation about what can be done in order to save these people in Nursing Homes. Of course we need testing, force me isolation, of course made quarantine, but how many of you moneygree we need lots of and the government should spend the money to do what is necessary for medicare and protection for all, even when there is not a pandemic. Spend the money that is needed to access additional spaces so we can take care of people properly. How many believe we just need to spend the money in america. With missrt blackstock. I agree. The solution is sustained commitment at all levels of government to address living and working conditions in black communities. Atther that is looking medicaid expansions, funding Community Health centers, because health care is moving out into the community. Let me go down the line. Are you willing to indicate that we just need the resources, the money to deal with these problems . Absolutely. We need to spend whatever we need to spend. Do you believe that . Yes, absolutely. We know what works, we just need the funding to get there and target the area of greatest need. The foundation for research on equal opportunity president . We need resources but we need way better infection protocols and wed much better oversight over Nursing Homes because weve seen a lot of problems where a nursing home is not actually doing what they are legally required to do. They cant do it. You know why . They are doing it on the cheap. Whether we are talking about feeding lunch in a nursing home, theres no place to go except in this one place where they all gather. They dont have the rooms, they dont have anyplace to isolate, so what are we talking about in terms of we have allowed Nursing Homes to develop on the cheap and we are not putting the money into Nursing Homes that it takes. We cant protect these patients from the way Nursing Homes are constructed and the amount of dollars they have to spend on them at this time. Have to spend on them at this time. Are you aware of that . Yes, im aware of that than i and i do agree that resources are part of the problem. What i would say, madam chairwoman, is we need to do a better job of making medicaid more flexible so that people are not required to get supportive care, longterm care in a nursing home. It would be much better if medicaid were more flexible so that people could get that supported care in their own homes instead of the facility. But medicaid does not always allow that flexibility. Rep. Waters we got to stop dumping our elderly into these Nursing Homes that cant deal with it. Thank you. I yield back. The chair now recognizes congressman thank you, mr. Chairman. Let me thank our witnesses for being here today. Dr. Roy, why did we shut down the American Economy three months ago . There are a lot of reasons people supply, but the reason that was most persuasive was that we were worried we would overwhelm the hospital and icu capacity because of the endemic. We had to shut down the icus in hospitals from being overwhelmed. Was there harm associated, the shutdown for the American People . Catastrophic harm. When you cant operate business, there is an opportunity cost, all kinds of costs, but you said there is also Health Concerns for americans because of that shutdown. Yes, and it will take us years to unravel exactly what those costs are, but they are significant. I think you said in your statement the Health Concern cost to americans, there was a disproportionate impact on the africanamerican committee. Is that accurate . Yes. Is now time to reopen our economy . It is way past time. Let the ask you this. In states that have largely opened up and did so early on , what has been a Health Concern has there been greater contraction of the coronavirus in those states relative to those that are relatively still closed . By and large we are seeing no difference between the states that are continuing to lockdown and those opening up in terms of , overall on average declining death and morbidity. Rep. Jordan so why in the world are some states still closed and some mayors still adopting the policies we see in place in some of these areas . I suppose mr. Jordan, youll , have to bring them before the committee and ask yourself, but theres a wide range of the rep. Jordan from a health standpoint, there is no data that supports remaining closed and certainly from an economic standpoint, theres no data that supports remaining shut down. The evidence is overwhelmingly we should have a targeted approach where we are focused on whats going on in Nursing Homes, focused on at risk populations, people with Heart Disease, the elderly, etc. But we should absolutely be reopening schools. We should be letting younger people back in the workforce who are at much lower risk. Rep. Jordan i appreciate it. I want to read you a letter that was sent to the president on march 19, 2020 about the Health Concerns that exist when you have a shutdown. 500 physicians sent this letter. Millions of casualties of continued shutdown will be hiding in plain sight and they will be called alcoholism, suicide, stroke, kidney failure, unemployment, drug addiction, unplanned pregnancy poverty, and , abuse. Do you think that statement is accurate . Yes. Rep. Jordan all the more reason why we need to open the economy yesterday in my judgment and get back to normal as quickly as we possibly can. One thing we talk about in our major paper on reopening is the average Small Business has less than 30 days of cash in reserve. They have no customers. We are seeing hundreds of thousands of Small Businesses , many minorityowned by the way, permanently close because they dont have the cash reserve s to reopen once we get out of lockdown. Rep. Jordan that is where we can hope help all americans, africanamericans, to open up the economy and let people go back to doing what they need to do. From a Health Concern and an economic concern, that statement is true. Absolutely. Rep. Jordan thank you, i yield back, mr. Chairman. The chair now recognizes ms. Maloney. Thank you, mr. Chairman, thank you to all of my colleagues and all of our panelists. We are suffering from any quality in our Justice System and in our Health Care System. As in many places across the country, communities of color in my home of new york city have been hit the hardest by the coronavirus pandemic. In new york more than 6100 black and africanamerican residents are estimated to have died from the coronavirus, and more than 6300 hispanic and latino areidents residents estimated to have died. According to the centers for Disease Control, black new yorkers are dying from coronavirus at twice the rate of white new yorkers. And a lack of testing, which has been one of the deadliest missteps of this administration has disproportionately impacted , the Africanamerican Community here in new york city and elsewhere. So i would like to ask dr. Blackstock, how did lack of accessible testing affect infection rates in new york city and who was left behind . Thank you for that very important question. I will say even from my own personal experience caring for patients during the pandemic, we were unable to test them for weeks. I was probably giving two swabs for probably about 100 patients per shift. When i think about all of the patients that we missed because we were unable to test them and they went back out into the community, not knowing if they were infected, contributed to the high rates that we saw. If we rush to reopening, we are going to get into the same predicament we got into the beginning, and it may even be worse. The people that will be the most disproportionally impacted are the same communities, black communities and other communities of color are going to see even more devastation. What we need to do to be able to support these communities and individuals, Small Businesses through a shutdown so we can get this virus to die out and then we can reopen safely. Right now we dont have the testing infrastructure Contact Tracing, infrastructure in place to do so safely. Rep. Maloney new york is launching a testing and tracing program that recommends testing for every single new yorker. But even when testing is available, it may not be accessible. For instance many people in the africanamerican committee have a distrust of the Health Care System and may not seek testing, as some of you testified. Dr. Blackstock what is the root , cause of this distrust and how does it affect Health Outcomes for the Africanamerican Community . This distrust is very real. I had a patient a few weeks ago who she couldnt see me under my layers of personal protective equipment. A young black woman with covid19 symptoms. She whispered to me are you , black, doctor . I said yes. She said ok, i want to make sure i being listened to. Am this is not just a onetime thing. This distrust is a result of the historical legacy of racism in this country, where, especially in terms of black communities interacting with the health care tuskegeehere is the experiment, there is henry in many instances in history. This distrust is important to repair. I would say we would not just need resources but reparations to black communities in order to in order for them to not only survive but thrive. Rep. Maloney thank you. Now for the Latinx Community, we have seen a language barrier to testing when information on the coronavirus is only released in english. Galvez,like to ask dr. How has a lack of Public Information in spanish contributed to testing disparity in the Latinx Community . My Community Health center, in oregon, what we notice we noticed in early march when we were just finding out about covid19 was that the information that was being provided was primarily in english. You have to remember the patients i see, they are primarily hispanic and some of our patients dont speak spanish. We tend to forget that we have many that are essential workers and migrant farmers that are speaking indigenous languages as well. We noticed early on that this lack of information in spanish and other languages was contributing to decreased knowledge about how to mitigate spread of the virus. In my community, we immediately began to create Public Service announcements in spanish that were both given on the radio and written. We noticed within a couple of weeks, the public began to have a better understanding of how to mitigate covid19. Many of my patients in late march, they did have the information they needed to prevent spreading the virus , but they do not have the support systems out of work. Information and knowledge but do not have the , support systems in place that at their worksite, they will not be able to implement these healthy behaviors. The same goes for housing and labor camps. We can give them ppe when they are on the field. When they go home, they continue to live in these crowded camps. They will still spread the virus, so im asking that we really Pay Attention to the conditions that work, but also to the Housing Conditions that my patients are living in. [indiscernible] thank you very much, ms. Maloney. The chair now recognizes congressman luetkemeyer. Thank you, chairman clyburn, and Ranking Member scalise. For putting this hearing together today and the interesting panel that we have here. As we go through the process of trying to look at the effects of the covid on our entire population and you look at the groupsties between those that are being more or less impacted and economically the same impacts, dr. Roy, have you done any studies with regard to vaccination . Some governors believe and mayors believe we cant get back to work until we get a vaccine. Latenow, they believe fall, early winter we may have a vaccine, but we cant be shut down until then. They have discussed the fact that i think in one of the publications a week or so ago, the number now is 65,000 people as thedie from result of a covid effect, not from the disease itself but the effect of focusing on covid the at the expense of the rest of our society. If we dont focus on those folks pretty soon, we have already withpast the covid deaths those deaths we have not been paying attention to health wise. It can be devastating to the economy. But believing we have to have a vaccine is a false sense of security. There was a recent study that came out that said 50 of the people, if a vaccine was available, wouldnt take the shot. How do you address that issue . How do you incentivize those people . How do you get past this issue, and then because of that, it would seem it is even more imperative we reopen the economy . Dr. Roy i appreciate you bringing this point up because its one of the most reckless policy postures to say we are going to wait for a vaccine before we reopen the economy. The reason why is theres absolutely no guarantee that we will have a vaccine in the next 12 to 18 months. We have been working for nearly years on a vaccine for hiv. 40 we still dont have one. We have been working for even forer for a vaccine hepatitis c, and we still dont have we have drugs that treat one. Active infections for hiv and hepatitis. We have never developed a vaccine for coronavirus before. The land speed record for an novel virus vaccine was ebola, and it took five years to develop a vaccine. They are very talented and brilliant people, and lots of entrepreneurs trying to solve this problem, and maybe they will succeed where others have failed. There are no guarantees and we cannot keep the economy locked down until a vaccine may or may not ever come. Rep. Luetkemeyer i know you have a lot of statistics with regard to unemployment. The relationship between employment it is something i have been doing a lot of reading on. Suicide, drug abuse, death from drug overdoses, domestic abuse, all of those things. It was seem that an active and ongoing economy would take care of a lot of these things. Does your Research Show that windows things pick up, those other things slow those slow down . Dr. Roy there is a lot of research now, about the negative Health Effects of an employment of unemployment and poverty. The one thing is no one is getting in a car accident. Everything other than a car accident is negative. Huge problem. Thats why its very important i think a false dichotomy that is been sometimes put out there about if you care about reopening the economy, you only care about money. Now it is essential for Public Health because people should not be afraid of leaving their homes. They will not see the doctors. They will not get mammograms or treated for a heart attack. That is really important. Lastluetkemeyer in the committee hearing, someone made a comment with regards to masks. The new england journal of medicine letter article, i presented it to some Health Officials in my district. And they all agreed that wearing a mask outside of a Health Care Facility offers very little protection and is not worth your money or time to do that. It seems to me that these false things that people are putting out, to give to try to control people seems to be backfiring. I think people are getting the information out there to show that they can live their lives in a very productive way. In a very normal way. I think that is the message that we should be sending. Thank you very much, mr. Chairman. I yelled back. Rep. Clyburn thank you very much. Recognizes mr. Foster. I too had to look at that new england journal of medicine. The article that was referenced in the last thing, it was an opinion piece, not research article. There was not a number. It made qualitative statements. It is not useful. We need numbers here. It did not address the core issue with masks. They protect other people. But they were talking about is if you go into a patients room, sick, you are wearing a mask, you will need a hazmat suit to guarantee you will not be infected. If you are in a choir, singing, talking loud, you are a threat to other people and that is made better if you are wearing a mask. Its really important to give the correct information. Sorry about that. I am getting off the subject of this hearing. When you talk about Racial Disparities, one of the things that concerns me is there may be a genetic component to this, that there are apparently differences in one receptor that is the entryway, the doorway through which the virus enters human cells. If it is true, and theres a policy difference theres a difference in the policy response. For example, we could be in a situation where we have a vaccine that works better or an anti body treatment that works better in one racial group than another. I was wondering how we should stay on top of this. This is a very tough thing to even study because of the huge Racial Disparities in the provisioning of health care and the initial health conditions. I was wondering if the mds here have any opinion on what the state of understanding whether or not there may be a genetic component to this. I think that it is too premature to make any assumption on that level. What we do know is that there is no biological basis for race. We know that people of different 99. 999 tually have genetic similarity. I dont even i think bringing up the topic, perpetuating racebased medicine is potentially very dangerous. But as you alluded to, there are factors such as social economic social and economic policies that have left black communities and other communities of color more vulnerable and predisposed to this virus. And i think rep. Foster our office has worked for years trying to get a sickle cell treatments based on event genetic engineering. That is a very race linked thing. Dr. Blackstock no rep. Foster racially linked. Dr. Blackstock it is geographical ancestry which is very different for race. Race is a very social construct. We need to make sure that we differentiate those two. Rep. Foster genetically ok. Statistically south asians, south and east asians and africanamericans that are the predominant bearers of this disease. If part of this ends up being me having a genetic basis, i think we have to make sure we put effort into understanding whether or not we want to respond to that. Because part of the you know it cant be used as an excuse to maintain the disparities and in provision of healthcare. That is not the argument is was making. The question is whether we have to keep our eye and whether the treatment may work equally well depending on things like the details of the receptor which can be important. Dr. Blackstock i agree with you, but i think we need to focus on those social determinants of health which is what we know are greatest predictive factors and Health Outcomes. If i could pipe in here youre right that there are genetic variations about the a2 enzyme and the interaction between various strains of the Novel Coronavirus and the receptors. It will be interesting. We are fortunate to live in a golden age of genetics wrote a genetics where a lot of this biology can be understood. So im optimistic that as we continue to sequence of different strains of the sars virus and sequence of various alleles in the enzyme we , will be able to come up with tailored therapeutic approaches were needed. People are aware of the research. I think it is important we do a good job that research. I know one person brought up in the Armed Services committee the possible use of the Armed Services data, because that is a population where you control for health and age and so on, Housing Conditions. So you could get up use that data to get a real idea of whether theres a genetic component to this. And anyway, i have used up my time. Thank you, mr. Chairman. Rep. Clyburn thank you, mr. Foster. Thank you, mr. Chairman. Thank you to our witnesses as well. I want to begin by much my heart aches for the family of george floyd and our country right now. Theres no place in our society for police brutality, nor the violence and destruction that we seen in some cities. But even as americans we have the right to protest peacefully, we see countless others being denied their right to pray for peace and justice and understanding. I think this is inexcusable at a time when our nation needs prayers for unity and healing. I call on every mayor and governor who are still barring the faithful from gathering to reverse course immediately and open up our churches. That is what this nation needs. Every single state needs to have access to their churches. Thecoronavirus has impacted world, and it has been disproportionate in some populations. Mr. Roy, you spoke about this, that showed nursing home residents make up. 6 of the u. S. Population but 42 of all coronavirus deaths. Those with underlying condition such as diabetes, hypertension, obesity and asthma are also at high risk for complications. We know that africanamericans are more likely to have some of these conditions. So on this point in particular, there is no Simple Solutions or instant fixes but we have to , start somewhere, such as exploring ways to improve social conditions of health. The conditions in which some social and economic environment shapes their health. I am a proud cosponsor of the accelerator act which would help states and communities better leverage existing programs and authorities to improve the health and wellbeing of medicaid participants. It would also provide planning grants and Technical Assistance to help state, local and tribal governments to take innovative evidencebased approaches to , coordinate services and improve outcomes. Economic opportunity is a major role. It can help incentivize public, private investments. Most immediately we need to continue to open, reopen and defeat coronavirus. Safely reopening businesses doesnt just put money in peoples pockets. It boosts their wealth and wellbeing. Joblessness has negative results. Indeed many Mental Health experts have said prolonging these lockdowns could result in a wide range of problems such as suicides, Substance Abuse and Mental Health. Mr. Roy, do you agree that the financial effects coupled with isolation due to these lockdowns have affected the physical and Mental Health of minority communities . Dr. Roy yes, and if i can emphasize one particular point, which is social determinants of health, the most important social determinants of health in terms of correlation with Health Outcome other than income, is educational attainment. And what have we done . We have shut down the schools even though children are at one in a rate of death from million covid19. We obviously have to protect their parents and their grandparents and elderly teachers. We have to be careful about how we reopen schools and strategic , but it can be done. We are doing it in florida. We are doing it texas. We are doing it in europe. Reopening schools is absolutely essential. The longer the schools are closed, the worse Racial Disparities will become in all sorts of dimensions. Rep. Walorski yeah, could you just elaborate on that . I totally agree. Is there anything else that you see in this wide spectrum of reinvigorating economies other than schools . What else can you see that will reinvigorate these communities . Dr. Roy i mentioned in my written statement, schools. The other one is hourly workers. People who are on hourly wage earners, they are disproportionately low, disproportionately minority. Their jobs have been cut by 5270 percent and farquharson lockdown states. Rep. Walorski thank you very much. Mr. Chairman, i yield back. Rep. Clyburn thank you very much. The chair now recognizes congressman ruskin. Thanks, mr. Chairman. Do you hear me ok . Rep. Clyburn yes, i do. Ok. The last thing we want to do is spread misinformation. I recommend everyone go to the centers for Disease Control website about the remarkable number of infectious transmissions that have taken place at religious assemblies , at rural arkansas. Onethey inspected attendees, 92 chief Justice Roberts handed down a decision saying there was no religious discrimination going on. Religious offerings are just dangerous under the covid19. Secondly i want to say is the Public Health and economic consequences of the covid19 pandemic and president trumps lethal mismanagement of the response to it is devastating for our people. I dont think we have mentioned casualties,107,000 people who have died, in the crisis. Nearly 2 Million People sickened by it. We have 4 Million People who have been thrown out of work. So the Public Health and economic consequences together have been devastating ever since this began just four months ago. Democratic and republican governors alike issued Public Health orders for to stay at home because we dont have the treatment, and we dont have a cure, and we dont have a vaccine. So my republican governor, larry hogan in maryland issued a , stayathome order. I would like to ask the doctor, would we have higher death camp count today had we not acted as we did, number and number one, two, does a successful reopening require continued aggressive Public Health action such as steppedup testing, Contact Tracing and quarantine for sick people . Thank you very much for the question. First, absolutely. If we had not imposed the stay the orders, we would Research Found if we had shuts down and imposed shelter in place even one week earlier, we would have saved 36,000 people here in the u. S. Another publisher found that if we did not put in place the shelter in place orders, ten times the number of inspection infections. Ten times the number of minorities that we would also see. I just wanted to address your second point, the white house issued their own guidelines about reopening. Specifically the guidelines and said we had to have a 14 day decline in the number of cases and also that there must be testing, Contact Tracing and isolation available. No public expert would argue that we need to close down until we get a vaccine. They were saying we need to find the cases and also that these capabilities are there. Unfortunately the federal government has not had a National Strategy for testing, for Contact Tracing, for developing the Public Health infrastructure. Governmente that the had bias was squandered. We are reopening before we are ready. I wanted to add it is not just the elderly nursing home who get ill. Its also young people who die. There are children, this multi system inflammatory syndrome that causes multiorgan failure. That has landed children in icus. Kids have died from this. Healthy people in their 30s and 40s have gotten strokes. We need to take that into consideration. Rep. Ruskin thank you. We need real data to talk about the inequality, which is why we have the law requiring an administration to provide specific demographic information on the rates of case spread, hospitalizations as a result of the covid19. The administration filed its first report, if you can call it that, to congress on may 20. Its really is a joke pretty joke,oke, and a front an affront to everything we are trying to do. 3. 5 pages. Page one is the cover page. Page two is a copy of the law and three is the collection of links to the cdc website. Doctor, why is it crucial for congress and for the people to get racial ethnic data on the coronavirus epidemic, and what should the administration be doing to improve this performance in collecting the reporting of this data . Thank you for that question. I will say that the hasnistrations response been quite anemic. Picture to get a full of the degree of devastation to these communities of color. Without the data, we dont know how much resources these communities need. That is why we really need every state and locality to disclose, not only hospitalizations and deaths, but we also need to know testing. We have seen that black americans are less likely to be tested. And then when they go to the hospital, they are more likely to be admitted. So that points to significant structural factors that we need to understand better. By having the full data that will allow us to equitably allocate resources to the communities that need it most. Rep. Ruskin thank you very much. I yield back, mr. Chairman. Rep. Clyburn thank you very much. The chair now recognizes congressman green. Thank you. This is an important topic especially in light of Critical National conversation we are having as we continue to mourn and seek justice for george floyd. Plus years working in the 20 innercity rural ers, suburban ers, i know that when a patient comes into the er, doesnt matter what race they are. We treat them all the same and having been a special operations Flight Surgeon in the army, ive seen firsthand that our soldiers whatever race they may be, blood , on the floor of the black hawk helicopter is all red when you wash it out. I would ask all americans to look in the National Guards in their communities right now, caucasians, africanamericans, latino americans, Asian Americans and together united they are protecting americans. Thats unity can be an example to us all. The data on covid19 has shown clear disparities and it is important we get some followup, but we need to be careful misinterpreting the data because the numbers can be misinterpreted. For instance in louisiana, people with covid19 deaths were 53 africanamerican even when white people make up 63 of the state. However when you look more closely at that the vast , majority of the deaths were concentrated in urbanized areas which is over 60 africanamerican, and we had the most disparate. However, other majority africanamerican parishes in rural areas such as east parish in Madison Parish combined, so only two deaths. We know coronavirus is spreading in various ways, droplets, aerosols the key factors in , every transmission as in common proximity. The coronavirus appears to be hitting those in dense urban areas the hardest, and minorities are more likely to live in dense urban areas, as no surprise that they can increase the risk of covid19. Not only do we have denser Living Conditions in urban areas. Consider other differences predict between say new york and lawrenceburg, tennessee. Tight transportation, corridors. Maye draw conclusions, we miss the need to sterilize public buses or subways. Since urbanization is a clear variable, we need to do that. Another dependent variable is the disparity in high morbidities. High Blood Pressure is more prevalent among black americans. As the chairwoman, said, we have been studying this disparity for 50 plus years. One study found that the population attributable to risk for hypertension and 30year mortality among white men was 23. 3 compared with 45. 2 among black men. And 19. 3 were white women compared to 39. 5 for black women. There are studies to suggest that is because the way africanamericans dissolve salt in the kidneys but honestly, no , one after all of these years of studying is 100 found the medical answer to this disparity. Seems to be lots of variables there as well. A study published in american association. 57 percent of those who had covid19 had hypertension british africanamericans are also in a higher rate for diabetes. 11 of black people have diabetes versus 7. 5 of nonhispanic white. The paper in the general diabetes science noted the risk of death from covid19 is four times greater than in those with diabetes. It is clear that the number of different factors contribute to greater rates of infection in higher numbers. Hit state of sao paulo, black resilience are 62 per brazilians are 62 more likely to die from the virus than white brazilians. And according to the u. K. Office the national since statistics, four times more likely to die from covid19 then white people. Thats higher than in america. U. K. Has universal health care, government care for all and the disparity between blacks and whites there is higher than the United States. Because of numerous factors, covid19 is hitting disproportionately our Black Brothers and sisters across the globe. We must tackle this issue using a sciencebased approach that will truly help them. Only when we understand those interlocking variables can we get to the bottom of it. Hopefully we will with hypertension. Hopefully we will with covid19. We have got to continue studying it. We have got to make sure we look at the data fairly. Thank you, mr. Chairman. Rep. Clyburn now we recognize thank you so much chairman. , i would like to address questions to dr. Wen and ms. Sharp. This briefing is about reopening. I will start by saying i want to get things reopened as quickly as we can in a responsible way. My home state of new jersey has been hit particularly hard by the virus, and i know a lot of Small Businesses are struggling and a lot of other folks are struggling. When i think about reopening, theres a discussion already this something that comes , to mind is what you said about the White House Coronavirus task force. They say data driven conditions in each region and states should satisfy before proceeding to a phased opening. I wanted to ask you if all states in our country have met the conditions that the white house and the Trump Administration has laid out. Dr. Wen no, they have not. In fact many Public Health experts including myself have argued that no states have met these criteria. Many have not met the criteria consistent of their number of cases the states have met the capabilities. The widespread testing that we need. That is because we need national leadership. A National Strategy to get there. Rep. Kim i appreciate that. I wanted to make it clear where things stand with the Trump Administrations guidelines on reopening. I want to turn to the Asian American, Pacific Islander population. As i have gotten a chance to speak with a. P. I. Communities across the country, a couple of things have come out that we have not talked about necessarily in this discussion so far. P. I. ,and foremost with a it is not just about the effect on patients and those that are getting infected, theres also a are number of api that essential workers, a high number of api that are physicians and nurses. Apie are over one million considered essential markers right now. 20 . In addition to this, i have mentioned before a colleague of mine, carolyn maloney, about communication. Ae api community has had tremendous amount of difficulty getting this information about the coronavirus due to language barriers. I have heard a lot of people especially in north jersey where incidents have been rampant Asian American communities not , knowing where to go for testing. As i looked into trying to whether or not this is a disparity by race and ethnicity, i have learned only four states our country actually tracked data for those that are getting tested, breaking that down by race and ethnicity, which makes it hard to know whether the data about deaths and those percentages falling ill is manifesting in an accurate count and representational count. I want to get your thoughts on some of those issues affecting only api communities but all communities when we dont have that data. Dr. Wen that is right. We need far better data for infections deaths and critically testing so that we know whether we are targeting our resources to communities that actually need it. We also need better data in general. We actually have very little data on api overall. The data we have show there are disproportionate numbers of covid19. In south dakota it is six times for api faced on Demographic Data alone. We need that also about outreach. We need to have people who speak the language, who are culturally competent, who are the most credible messengers. The more testing we have, the better surveillance we can have too. Often we find when there is one case, there are dozens or hundreds of others, and actually protesting and daily surveillance will offer the road to reopening. This is what we need to do. The particular targeting to minority communities including the api community. Rep. Kim that is right. When we are talking about Contact Tracing, if you are not able to communicate in that language, it makes it all the more difficult. I was moved by your statement and the challenges facing Services Even before this pandemic. I want for you to paint a picture for me how the lack of funding affected the health get the Health Funding even before this pandemic happened. And the foundation for which the response occurred. Thank you. I really appreciate the followup to that question. Long before the pandemic hit this country, we were already in a crisis. We suffer in some areas of boards of 80 on it upwards of 80 unemployment. We suffered at largescale economic impacts. Some of the questions that were surrounded around reopening, we already faced those prior to the pandemic. So what we found is not only do we have an inability to protect ourselves during this pandemic, but we have notable, every sector of the funding that we receive from the federal government is chronically underfunded, whether that is Law Enforcement, healthcare, education. Every part of our public is been is deeply impacted. But also the ability to raise our own revenue for taxation has has been limited. Even with Economic Relief the cares and, we were disallowed from using that really to support our economies that we built. Failed, we have commercialise through resorts. That is severely limited. Not only do we not have a trustee that is funding us, we have an inability to raise our own revenues area when we do, hijacked by state and local government. When this it, we saw there was no National Strategy. We went to the World Health Organization for the four pillars and we began immediate Rapid Testing trying to see how we could get testing to our community. We saw that the fda was approving emergency use authorization for some companies. We found that if we were able to have those companies under tribal law for tribal citizens within our areas that would be a , start. But all of those things have left us in a place where when i saw images coming out of italy and spain, it became clear if we dont protect ourselves, then there just left wont be any left. Rep. Kim thank you, chairman. Rep. Clyburn thank you very much. Before closing, any closing comments you want to make. Thank you, chairman. Thank you to all the witnesses. I think a lot of things came out. We have seen data that shows where the disparities are and how covid19 is affecting our country. Its not affecting the country equally. It doesnt affect age groups the same. It certainly doesnt affect people, different backgrounds, minorities are the most impacted, seniors in Nursing Homes are the most impacted. Points weregreens so poignantly made, when you look at our different parishes in a state like my home state in louisiana, the Africanamerican Community in a city like new orleans is very adversely impacted differently than an Africanamerican Community in a rural parish in louisiana like west carol. I appreciate you making those points. Jackie was talking about the need to reopen our churches. We need to be praying right now and coming together. It is communities in those places that we go to to gather. We know how we can do it safely. Dr. Roy pointed out the protocols. States are already showing us how to do it the right way. Well be following the states. Like with Nursing Homes. Some states are doing it right. Some states are doing it wrong. For the state like michigan, must keep doing the wrong way. As we share this information, it could be helpful. If we use the data we are getting and the knowledge we are gaining to share with others who need it the most who can help us , save lives. And then get our economy back opening, which we have also seen in the testimony. I appreciate, mr. Chairman, your focus and again, and we extend our prayers to George Floyds family. Lets all keep working to make this better. Thank you, mr. Chairman. I yield back. Rep. Clyburn thank you very much. In closing, i want to thank all of our panelists for the rock the remarks here today. We are grateful for your leadershipd your during this time of great crisis, both in our nation. I want to thank mr. Sillies and all of my mr. Scalise and all of my colleagues for their participation in the panel. It is clear from todays comments that the coronavirus pandemic has imposed an unequal burden on communities of color. But its also clear that this burden has been building for centuries. As black and brown americans have faced numerous barriers to Higher Quality healthcare. I want to thank dr. Blackstock. She mentioned the tuskegee experiment. I always say that we ought to be informed by our districts. Mentioned ms. Henrietta lacks. She should be a doctor for all she has committed to healthcare. I want to ask my colleagues know aboutu do not henrietta blacks, please google her. I think you will see why her name was mentioned here today. We need the federal government to respond to this current crisis. Minority communities getting testing, testing commitment and the treatment they need. We also need to sustain investment and structural change to ensure racial equities in the future including universal access to highquality health care. I often quote dr. Martin luther king, jr. Who back in 1966, speaking at a medical conference said this. , of all the forms of inequality, injustice in health is the most shocking and the most inhuman. He did not say inhumane, he said inhuman. Because it often results in physical death. End of quote. We are seeing too much unequal and unjust physical death from multiple shocking and inhuman causes. Directare now seeing action and creative nonviolence. The conscience of the nation is being raised, and its my hope that racial inequities in health and other areas will be addressed. Thanks once again to all of you. This meeting is adjourned. [captions Copyright National cable satellite corp. 2020] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] announcer 1 tonight on q and a, Peggy Wallace kennedy, daughter of George Wallace, talks about her fathers controversial career and what inspired her to write her recent book. In 1996 we took our younger son to the Martin Luther king museum, historical site in atlanta. And we went to his church and to his grave, and then we went over to the museum. It was being newly constructed at that time. We were going through the exhibits and we came to the exhibit, alabama exhibit. And it showed the Edmund Pettus bombing of the church, fire hoses and dogs, birmingham and George Wallace standing in the schoolhouse door. And burns looked up at me and said, he was so sad. To did poppa do those things other people . It broke my heart. And i said poppa never told me why he did those things to other wrong. But i know he was maybe it will just have to be up to you and me to help make things right. Announcer 1 watch tonight at 8 00 eastern. Trump er 2 president toured Puritan Medical Products in maine. He delivered brief remarks. And im proud to be an american where at least i know im free and i wont forget the men who died who gave that write to me and i gladly stand up next to you and defend her still today aint no doubt i love this land god bless the usa pres. Trump thank you very much, appreciate it. You have a lot of