Who are supposed to protect them. My prayers go out to the floyd family and other families, a long list of other victims and their loved ones. I stand in solidarity with all those who are protesting and patriotically challenging the status quo. These protests are about more than the pigment of africanamericans at the hands of police. There about the systemic changes or gears. They are now magnified by the coronavirus that we are here to talk about. This racial inequity in healthcare, it has been laid out by this pandemic. Africanamericans, latinos, native americans and other people of color have tested positive, being hospitalized and dying from covid19 at alarming rates. Americans are dying at a rate that is double what would be expected given the population. Latinos have been infected every state. Native americans who represent just 4 of the population in arizona are 21 of the coronavirus deaths. They went under, the recent by this crisis, the national conversation. The Coronavirus Infections and deaths among americans and undermine disparities. People of color, they are greater risk of contracting the virus. Diagnoses and Chronic Health conditions such as diabetes. Heart and lung disease which increased the risk of death from coronavirus. Black and brown communities also adequate healthcare facilities. The federal government needs to address these disparities now. We will have access to coronavirus testing including mobile testing as well as healthcare to address these chronic conditions. Essential workers have the protective equipment that they need and receive decent pay and paid leave so there not forced to work when they are sick. Immigrant communities and lifesaving people without being targeted by immigration officials and the need to ensure American Communities and federal investment that needs to thrive. These Racial Disparities addressed, we also need good data. In april, Congress Passed a law to provide Coronavirus Infections, hospitalizations and deaths. Unfortunately, the first report did not divide the comprehensive data we need. Todays briefings is to examine Racial Health disparities in the coronavirus pandemic and we can ensure response. Witnesses are qualified to give us and we hear from Public Health experts positions were coronavirus patients and Community Activists who are seen firsthand by the virus that deepened inequities. I hope this committee will approach these issues respectfully. First provide partisan solutions. Thank you, mr. Chairman. As we start this hearing, are country is facing two different crisis. We are facing the shutdown of our country and economy with covid19 and the pandemic 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 follow and also the violet writing and burning down some of our cities. My prayers with george floyd and his family, and his david dorans families. Senselessly murdered trying to stop looters. They were trying to protect their communities from senseless violence about spread out of us. This committee should be focused on following the facts and working on solutions to these very Serious Problems and challenges. The covid19 pandemic struck suddenly, its taken over 100,000 lives in this country and its caused lockdown resulting in 40 million jobs lost. Sadly, that is not the only story. Covid19 hit minority communities disproportionately. Its hit lower income americans, especially hard. Its targeted the elderly, its taken a cruel talk americans with underlying Health Conditions like diabetes and cancer. We face an evil enemy we face it of the 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 from weve lost over 1300 of our friends and neighbors. More than 400 nursing home residents have died from covid19. Our largest Hospital System reported this week that 77 hospitalized covid19 patients were africanamerican. More than half fatalities have been minorities. Names and faces of victims include people like a friend of mine, a legendary, an educator, patriarch of the marsalis family. Through his fame, and death draws attention to the impact of musicians, artists, particularly in the Africanamerican Community that represent so much of the culture and diversity and vitality of our city. Florida tried to take them she spent six months on a ventilator. Immediately after birth giving birth, she was tested positive. After 72 days, she was finally able to hold her infant son for the very first time. His delivered when she first went into the hospital, who was immediately separated for his safety. Her doctors called it a symbol of hope during time of death and defeat. Nationally, covid19 deaths are nearly two times greater in minority communities than other communities. Navajo nations, the countrys largest reservation now has a higher death rate in any u. S. State except for new york, new jersey, connecticut and massachusetts. New mexico native americans are dying every 19 times that of all populations combined. Were going to do something about the disproportionate impact, we have to ask and answer why this is happening. This is not an american problem alone, all over the globe minorities and lower income people have suffered disproportionally. In america, you know Nursing Homes and assisted living facilities happen places where covid19 has spread into many have died including minorities. We can take immediate steps to reduce the suffering by learning hard lessons weve seen. Lastly, the subcommittee heard from mayor of jacksonville who laid out specifically and cured Nursing Homes, things like new york. Lets hope the rest of the states follow those paths and learn from mistakes, mistakes like new york. Mortality and diabetes are highly correlated. Africanamericans have a disproportionate rate of diabetes. President trump recognizes and the cost of insulin 35 a month for seniors. Last july, the president watched the advancing american in the Health Initiative with stated the goal of reducing americans developing renal disease. Perhaps congress should look at what we can do to help speed up achieving 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. My home state, almost 45 of the comedy Food Service Workers have lost their job. This is an industry dominated by low income families. Alcohol and drug abuse and leads to people delaying these medical care. Many people back to work is critical to improving healthcare outcomes especially in minority communities. Some of the Solutions Take time. Operation warp speed which the president kicked off will hopefully bring the vaccine we need soon but we know it wont be today. We need to keep working. That shouldnt distract from doing the things we know we can do to help things on the ground and know this administration and Congress Need to continue working together to get this done. I look forward to a good discussion with her when assisted. I yield back. Thank you. Let me think our panelists again and introduce Community Leaders who work with us today. Coronavirus patients in new yo york, the ceo of an organization for Healthcare Providers to give them to each and every patient. A professor at the George Washington university and former Health Commissioner for the city of baltimore. Giving people opportunity. Giving interest of government and communities. Working on the front lines of the coronavirus pandemic, treating workers and other low Income Patients in oregon. I am an emergency medicine physician that im also the founder of advancing health equity. The mission of my resolution is to work with health care and related organizations to close the gap and Racial Health disparities. Irs lane founded this Organization Prior to the Coronavirus Crisis existence by significant advances in health care and technology over the last decades helped the sporty disparities have been profound and persistent but id like to acknowledge the pain and trauma that many black americans are currently experiencing due to the recent killings of George Floyd Breonna Taylor by police and omar arbery by two white civilians. Their deaths like Health Disparities are a symptom of the same deeply rues deeplyrooted disease in this country. Black men have the shortest life expectancy. Black a beast the highest infant mortality rate, black women the highest Maternal Mortality rate in this trend persists despite socioeconomic status and the level of education. Even the chronic stress of living with daily racism results in the weathering effect. Premature physiologic aging of black americans. Living in this country has essentially made black americans sick and over the last three months we have witnessed a crisis layered upon a crisis as black communities across this country have borne the greatest burden of illness and death from the Novel Coronavirus. More than one in 2000 black americans have died from coronavirus. If black americans had died at the same rate of white americans 13,000 black americans would still be alive today. It midmarch with my own eyes and notice the demographics of my patience patients in urgent care clinics where he worked rapidly shift from a racially and socioeconomic diverse population to mostly black many were essential workers bus driver subway conductors Grocery Store workers. Many had underlying medical problems like diabetes can hide Blood Pressure and asthma. Many with no other choice than to use Public Transportation and many displaying typical covid19 symptoms however we did not have adequate supplies at the time to test them. I have been a physician for 15 years and i work in emergency departments. I have never been as scared for my patients as ive been in the past few months. In particular i remember an elderly black man who came in with shortness of breath and fever. His oxygen level was incredibly low. He lived by himself or they was very worried about him and told him i would like to call an ambulance to bring him from urgent care to emergency room. He told me he did not want to go. He did not want to die in the er. He told me he thought he would not receive good care and he felt safer at home. This is not a come on for the Health Care System. Its also based on current and equities. Structural racism or social and economic policies that disadvantage black americans has placed them at risk for illness and death. It has been a Key Driving Force behind the factors that terminate at an individual and Community Health outcomes for the kurds a subcommittee to act urgently and swiftly to mitigate these widespread and appalling Racial Health disparities. This moment must be used for structural change in the form of among other social determinants of health safe and adequate housing gainful Employment Access to quality education and Healthy Foods and health care for all. This country desperately needs a reconciliation process around the racist policies of economic institutions that have left black lives devalued. This is an opportunity to intentionally acknowledge unjustified in ongoing wrongs engage with black amenities and rebuild them and then maybe, just maybe black americans including my patient that i mentioned earlier in my two beautiful boys in the next room playing could have more than a fighting chance against the Novel Coronavirus. Thank you. Thank you very much. Now we will hear from dr. Manny. Chairman clyburn and distinguished subcommittee members thank you for addressing the intersection of Racial Disparities and the covid19 pandemic. I come from the city of baltimore where i am a practicing physician and had the of serving as the Health Commissioner in my city children can expect to live 20 years more or less depending on where they are born in the color of their skin for their Racial Disparities across every metric of health and throughout the United States inequality is years of life in currency. This is what we are seeing with covid19 predicts a new disease that has unmatched longstanding Health Disparities among africanamerican and other minorities who bear the greatest brunt of the pandemic. My written test my outline solutions to address the acute issues and underlying problems and that like to highlight concrete actions. First the federal government must target Public Health resources to minority and other underserved committees but i want to talk about testing not only that it needs to be widespread and free but demographic information must be available for testing as a way to track resource allocation. We see the positive rate in the is 10 but africanamericans ar. That means africanamericans arent attested that my ideal scenario would he a dashboard oe directed to communities most in need. Also our guidance for testing positive at beat a self isolate. Would he you do if you live in crowded multigenerational housing and to have to do something thats impossible while losing at ability to earn income could have joined with other Public Health leaders to call for to be converted into the voluntary selfisolation facilities into place. Second the federal government must ensure they are our clear directive guidelines to protect workers and Health Officials are depended on the cdc for unambiguous guidance. When i dealt with measles and sega. The language in the covid19 guidelines is not what im used to seeing from the cdc. People should not be quote encouraged to do social distancing. What exact standards must be met in meatpacking plants. Mass should not be worn if feasible. They should be required and a clear statement such as if the criteria cannot be mad they cannot be opened. Osha should then enforce these rules as should local and state regulatory entities. Its not just people of color and those whose suffer as system make insecurities is that for the most Big Government needs a National Strategy to prepare for next search. The National Shame we cannot mask another 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 available for doctors and nurses, why shouldnt cashiers bus drivers and nursing home attendants who are disproportionately people of color have production and there must be a framework for equitable treatment of vaccines should they become available. Congress must provide further support for local Public Health. Cdcs findings for Public Health impairments have been cut by half over the last decade. Forcing local officials to make tradeoffs between programs free we can agree treating covid19 should not come at the expense of preventing cardiovascular disease and reducing overdose deaths. Longer term there must be attention to Health Disparities that are inextricably linked to housing ability food deserts and black of transportation access. Racism is a publichealth issue indeed a Public Health crisis in and of itself. Id like to end my testimony today with a quote from the former former chairman of the House Oversight committee delayed representative Elijah Cummings from baltimore. He would talk about the work we havent thought about is bigger than us so much bigger than us and its about our children who are messengers to a future that we will never see. That future is one of which the currency of inequality no longer means years of life one in which where people are born and what race they happen to be no longer determined whether they live. Thank you. We will now hear from dr. Chairman clyburn Ranking Member scalise and house of the members of the coronavirus subcommittee. Policies and ideas can improve the lives of americans in the bottom half the economic ladder. We spent the last several months focusing on the impact of covid19 on low income americans all races and ethnicities and we welcome the opportunity to discuss their research specifically on minorities today. My written statement contains more detailed discussion of our findings to my oral remarks are in three topics per first ill discuss mortality impact of covid19 on major u. S. Group since i cannot discuss their research on the subpopulation vulnerable seniors who live in Nursing Homes and assisted living facilities. Third ill discuss how economic restrictions put in place by states and localities of disproportionally harmed localities that have good reason to believe minorities are at highrisk for covid19. Severe lesson that from covid19 are associated with patients with cardiovascular metabolic conditions such as Heart Disease and diabetes. These conditions are disproportionally the latest covid19 brutality data from the cdc indicates indeed blacks represent a greater share of than they do of the general population even for the fact that covid is more prevalent in cities. What may be surprising is more are dying of covid19 higher predicted rates than the other hand hispanics and asians represent a lower share of covid death rate been implied by a third geographically adjusted share of the u. S. Population. The likely reason for these differences in in morbidity and mortality from covid19 and most common among the elderly are at 81 of all covid deaths in the u. S. Have incurred in people ages 65 or older and the oldest racial group are whites with a median age of 44 predations have a median age of 37 blacks 34 and hispanics 30. As we can expect to see higher fertility rates and asians and hispanics due to their age on the other hand africanamericans are relatively young and we are seeing higher mortality rates among blacks. We will have better data to assess Racial Disparities in covid mortality when the cdc releases the data to break down mortality by race and age at the same time. My understanding is first aid is forthcoming. You may be familiar with research that we produced over last several weeks on the tragedy taking place in our Nursing Homes and assisted living or silly spray 0. 6 of americans live in Health Care Facilities and within the population lives 42 of all u. S. Deaths from the Novel Coronavirus, 42 . As you know Nursing Homes or residential facilities or medically vulnerable seniors who have challenges with the 70s of daily living such as taking a shower or getting rest. My colleagues Gregory Vernon bob dornan hour and i want to see if states with high death rates and longterm care facilities were associated with higher proportions of black residence homelessness and and in my recent written statement details no correlation could once again a more granular analysis at county over silly level data may give greater insight and we expect cms will be producing the data in the coming weeks. There is no such ambiguity regarding the results of economic lockdown 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 3. 9 in late 2019, also a record three today at 18. 9 are compared to asians blacks and latinos less likely to work in whitecollar occupations and said they are seeing their jobs slashed hourly wage work is down 50 on average and even more in places with the most stringent lockdowns. The decision to impose lockdowns in march and we feared our icu would be overwhelmed but within weeks it was clear evidencebased real brains can protect Public Health and restore employment for lowincome americans of all races. Amid april we published a plan called the new strategy for bringing people back to work during covid19 the details exactly how that can be done and im glad to say a number of states have reopened a way to recommend preopening is not just good for the health and be at but also physical health. We can do better and i look forward to working with the subcommittee to do that. Thank you very much. We will now hear from ms. Shaw. Good morning. I served as president of the National Congress of american indians. Chairman clyburn Ranking Member scalise and members of the subcommittee we thank you for convening this hearing. We look forward to partnering with you in the future to address the disproportionate impact of covid19. Like all other government congregations 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 treaty. We have entered into a secret agreement whereby have landed in exchange United States made stricter policies to provide health care for community prefer over 200 years that ive saved as recognized the treaty responsibilities and commitments to provide for our health care. Despite this responsibility denies states is chronically underfunded every sector of our health and socioeconomic light creating a crisis in the 21st century that respects Public Health our economy and our socialize. These disparities have led to the vulnerability of our community during this pandemic and resulted in her committees having a high or cap at a covid rate in the United States. Currently we are looking at not only the impact of underfunding and the vulnerability for her committees to having some of the highest rates in the United States. The rate of infection from covid19 continues to grow in a committee. The Indian HealthService Reports nearly 11,475 positive cases exist in the Health Care System. Over 395 natives have died. In summary the impacts are even deeper. For example we represent only 11 of the population but we are impacted at a rate of 43. 7 . In arizona we are 2 of the population and we are impacted at a rate of 21. 6 . These undercount extended covid19 through Data Collection issues. For example we did not take date on hospitalization and mortality data and the inability of our community for expert testing and their limited resources third 71 of our population lives in urban areas. Health care authorities often omitting this class bias. We have is a force would have rates of diabetes Heart Disease and asthma and Health Conditions that serve to provide a lethal impact to our community. Tribal communities experience overcrowding and homes at a risk of eight times the National Average which makes quarantining and social distancing nearly impossible. The absence of water and sanitation has been a longstanding Public Health challenge for our committee. Over 31 of homes are in tribal lands are in need of sanitation and Facility Improvements while 13 of native homes in contrast to. 6 of nonnative homes black access to safe drinking water. Its a part of the underfunding of the federal government treaty responsibilities. Ihs extended per person. Thousand 779 compared to 9409 for federal Health Care Spending nationwide. In 2018 the commission on civil rights released a report containing federal funding shortfalls for native americans which found federal programs continue to underfund the health care and the Commission Found two things. First is result of the responsibilities second hunting for Tribal Health is inequitable compared to spending it covers only a fraction title health care needs. Indian country has experienced unquantifiable harm during this pandemic. The death of each tribal citizen has been part of our culture or history or language and devastating many families were multiple members have died. We have addressed Health Disparities. The broken promises rate at the Marshall Plan a roadmap for precovid health and socioeconomic crisis in the tribal committees. Now more than ever such a plan is needed to address this pandemic and the conditions that created it. I urge the subcommittee to aid in the development of the Public Health and economic Recovery Plan by working with the u. S. To supplement the broken promises report and the commissions that led to the impact of legislative and executive branch responses and propose legislation including to adjust the disparities identified in an updated report to nasa urge the subcommittee made Indian Country by exercising its powers to adjust delays in federal funding that would specifically allocate congress for the covid response. Tribal nations have experienced cdc and dhs funding. To date over two months after Congress Passed the act over 3. 2 billion of tribal covid funding has yet to be recognized by the department of education and commerce bridge to the subcommittee to investigate to ensure the congressional public relief immediately reaches our community. I thank you for your time and im happy to answer any questions. Thank you very much ms. Shaw. It seems as if we are having some technical difficulties. The Ranking Member, or you back end, steve . They said there were technical difficulties with the video. Is out working now . Icu. Obviously theres a challenge here. I do not see mr. Galvez. I hear something. This is dr. Gallis as. Can you hear me . We can hear you now. Good afternoon chairman clyburn and members of the subcommittee. Can you see my . Yes. Cant see you but i hear you. Good morning. Good morning. Good morning everybody. Good afternoon chairman clyburn the subcommittee i am dr. Gallis as a family physician at the Memorial Health center and im honored to be here today. Im also the proud daughter of a mexican immigrant seasonal farmworker. My Life Experiences along with the work i do today have provided me with the unique perspective on the challenges faced by the tino immigrants and farm workers. This pandemic has made extensional contributions to democrats and farm workers are making to our country. I have worked on the front lines of the dashes of treating physician. We serve more than 52,000 individuals every year. Over half of our population is latino. 90 live at the poverty line and 20 are farmworkers. Her patients are some of the most vulnerable. Black of Housing Health care food instability and unsafe working environments contribute to their higher rates of diabetes, respiratory illnesses in lower life expectancy. Covid19 continues to expose the heightened challenges of increase for mobility are communities face. It increases the infection rate for the positive rate among latino groups have increased. In oregon latinos represent approximately 13 of the population yet we are 30 of the positive cases. As of june 2 we have tested 1418 individuals. Just over 60 of those tested identify as latino. 92 of the positive cases. Latinos account for 32. 7 of positive testing results but only 18. 2 of the population. What are the facts and committing to this disparity . Latinos make up a large portion of our workforce laboring to keep food on our tables working in agriculture and take place indoors and outside and often require work and Group Standing sidebyside in rows or in factory lines. Most often without ppe. She was asymptomatic and found that her coworker tested positive for the before pic she shared with me she worked with her coworkers and she had not been wearing ppe preterm player told her if she won at ppe she would have to get it herself and they would would reimburse her later preview was not until an anonymous report was made to osha changes and are working in buyer met were made. Even then her player expressed frustration for the required changes and she was told there had be retaliation. Adding to this most latino immigrants and farm workers do not have access to Unemployment Benefits vacation or paid sick leave. As we began they go to work anyway as if they dont work their family does not eat. Three weeks ago i tested a farmworker exposed to covid19. He was a single father of two young daughters with no family in the air. Although fearful the prospect of infecting his daughters even more distressing to him as a lack of income and finding alternative housing if he had to be quarantined. Complicating manners matters contributing to the spread of this highly contagious virus farmworkers have lived in labor camps or house with multiple unrelated individuals. Living in one room no burger than 10 x 10 feet. Youll find a single washing machine for 30 people and one shower shared by 10 people. For those low wages make finding home housing a challenge. This really present a massive barrier to social distancing and making it impossible to self quarantine if someone does fall ill. All of these things lack of basic benefits facilitate the spread of the virus and led to disproportionate on a horrible population. Id like to assess committee to address the things. Worker protection trevorrow to safe and healthy working environment, expands of worker benefits and health care for all and unemployment and improvement in labor for farmworkers in labor camp. Id like you to join me and other Health Care Advocates and Creative Solutions that will ensure safe working and Living Conditions for the full marble essential population. Thank you. Thank you. Thank you very very much. Before i joined with the Ranking Member i want to ask the doctor do you have anys sitake suggestions you would like to make as to what you think we need to do to address the issues that you have raised here today. Absolutely. There are strategies that we can employ in the shortterm and the longterm. Its very clear to me that this pandemic will be with us for some time. I think we can mitigate some of the devastation by doing several things. We need to actively allocate resources to black communities as quickly as possible and we know now that testing and Contact Tracing and isolating sick individuals are some of the key fundamental Public Health intervention strategies that we can do. Terms of testing its not just about testing but ensuring its accessible. Walkup testing, mobile testing needs to be available in black areas. Contact tracing in itself is a very sensitive area because when you Contact Tracing but he they will have to tell you exactly who theyve been in contact with. We need to make sure we are gauging with the black communities. I see a role for Community Health workers to be involved in the Contact Tracing efforts. Messaging and i outreach will be incredibly important because the discrepancy we havent Health Care System is going to be an issue in terms of access and later down the road in terms of and his doctor when mentioned in sure in our essential workers not only have versatile protective equipment but also hazard pay and Financial Assistance for lost wages as well as ensuring food banks are well supplied and we are addressing how meeting of the instability to these committees for longerterm we need are found investment in communities around the social determinants of health that we talked about previously and Housing Education and jobs and ensuring we create policies that we are using a russell equity lends to address these problems. Thank you very much. Theres a question on the floor for dr. When. I wholeheartedly agree with what was said in terms of the access issues. We already know what works when it comes to health infrastructure. We need contract Contact Tracing quarantining and these are the pillars of the well of containing the disease and of course we need treatment as well. All of that needs to be accessible. He cannot its necessary but not sufficient to make these types of things available but wed get the testing and tracing for free but you need to reach people where they are. Communities who are more and are served and my having worked in baltimore many of our residents arent going to necessarily go to their Doctors Office or hospital to get a test. Testing needs to be brought to them ideally to places like churches and Public Housing into the places they are to make a difference for it on top of that we need for there to be data and surveillance that act urgently captures demographic information so that we can tell if testing g is not to committees of color. We can immediately identify the problem in real time. Thank you both very much. I really appreciate what we have heard from our panelists here today and im sure all the members would agree that you have given us a whole lot to work with. With that but my yield to Ranking Member scalise. Thank you mr. Chairman and we are looking at the data grid obviously we are seeing in the United States disparity that africanamericans are more than two times more likely to die from covid19 and white communities. When you look around the world lets say the United Kingdom for example data shows its even worse maybe four times more likely that someone dies in the black community there in the white community. We have done some research on this and while data is not as widely available for all countries from the countries we have been able to get data on their wee sing a similar Racial Disparity all around the world . What is important to remember when you look at the data is that covid19 any Infectious Diseases is going to be more contagious and spread more rapidly in a highly dense community. In other words cities. You have to adjust the statistics are where somebody lives. For example in the United States the tristate area around your city represents more than half of all covid cases and deaths in the United States in the northeast corridor from neubert virginia to new england represent a greater share. If you actually and the cdc does this and this statistic they publish every day. If you adjust the base of the demographics are comparing to that fact reform sample who is a nerc city and was the demographic composition of new york city and compare that to the death rates in new york city based on that analysis to your question that something you do see internationally as well because there is variation of course but environments are part of the equation. If you adjust the geography you get to the statistics imagine where the africanamerican mortality is an outlier relative to a other rates of disease in particular and thats where we will need to adjust more franchise along with the issue of Nursing Homes that i discussed in my opening statement. I want to ask about Nursing Homes especially within the africanamerican committee we have seen on the economic side and youve talked about this in your opening statement. The economic shutdown has had negative Health Consequences they are all populations. People are getting their cancer screenings and their mammograms and some the things they would do to take care of themselves physically that arent happening as well as Mental Health issues that are being addressed but are you saying that disparity in the Africanamerican Community as a result of the economic shutdown . If your question is what is the date around Racial Disparities in terms of declines and screenings and treatments of hard facts and things like that we dont have enough data to make firm conclusions but he certainly based on what we already know are concerned. Heart disease, blood hide Blood Pressure and diabetes are more prevalent in the Africanamerican Community to the lack of ability to manage those chronic diseases and sometimes acute conditions is very problematic trait and buried concerned about that as we are by institution. Hopefully Additional Resources can be directed properly to address that. We talked about this in last weeks briefing where you saw a high disparity, 42 of all covid death rate the country are among nursing home patients which represent 43 of the american population. Clearly thats a problem but as we found out all states are doing at the same way and some states are doing that well. The mayor of jacksonville was here to talk about the protocols in place and we saw the highest incidence was in new york where the governor mandated nursing home patients but covid positive patients have to go back even if they couldnt take care of them in a quarantine situation. That led to tragic deaths. Have you seen that as well . Its a huge problem the fact that certain states and new york isnt the only one. New jersey did this and michigan is doing this and in new york they finally were first course in midmay. New jersey and michigan are continuing these policies in michigan we dont even know what the death rate is for Nursing Homes because michigan refuses to publicly disclose the death rate for People Living in assisted living facilities and Nursing Homes. That something maybe we can address on this committee. Theres a better way to take care of nursing home patients especially covid positive and deaths that we can hopefully focus on addressing. I will let you finish grade i apologize. The one positive note sea of apps is requiring Nursing Homes to direct statistics to cms starting with may 5 data. We wont have data prior to may 5 unless Nursing Homes voluntarily reported. Onward we should have more consistent reporting across geographies on this problem. We should get that demographic data. Thank you to mr. Chairman. I yield back. The chair recognizes Ranking Member thank you so very much and thank you for holding this hearing. This is extraordinarily important and i guess some are very upset with the constant talk about Health Disparities because we have been talking about Health Disparities for years. All of these minority populations have i mean this is thing going on. Its no surprise that more people are dying in this pandemic is a preexisting conditions. We talk about what Nursing Homes can do for example. First of all you are absolutely correct the poorest people with lots of resisting conditions and Nursing Homes, lot of lax and Nursing Homes. They have had diabetes and they have had on amputations on and on and on. When you talk about what they can do they cant do social distancing and Nursing Homes but they cant do quarantine to Nursing Homes. They have the lowest paid workers in the turnover is very high. When you will talk about what they can do a Nursing Homes you have to be talking about we need resources and we need to get more money for the care of these patients in Nursing Homes. Whether we are talking about Nursing Homes or we are talking about africanamericans but tinas immigrants etc. What we need to be talking about is in some shape or form medicare for all. The pandemic is here and much of what is being talked about and the response to it, if you really understand you know a lot of it is simply speculation about what can be done in order to save these people and Nursing Homes. Of course we need testing, coarsely the isolation and of course when a the quarantine but how many of you will agree we need lots of money and the government should send the money to do what is necessary for medicare and protection for all even when theres not a pandemic and if there is a pandemic than the money that is needed to access additional spaces that we can take your people properly. I will start with ms. Hello. Hi yes i agree. I think the solution is sustained commitment at all levels of government to address living and working conditions of black communities spread whether thats looking at medicaid expansion, Funding CommitteeHealth Centers and health care looking out into the community. With me go on down the line. Are you willing to indicate that we just need the resources, the money to deal with these problems. Do you believe that . Yes, absolutely. Doctors wen . Yes, we know that it works. We just need the funding to get there. Okay and foundation for research and opportunity. We need research and we need better infection protocol and way better oversight releasing a lot of problems were nursing home is doing what they are legally required to do. You know why . Because they were doing it on the cheap. There is no place to go except in this one space where they all gather. They dont have anyplace to isolate so what are we talking about in terms of allowing Nursing Homes to develop on the cheap. We are putting that money into Nursing Homes and we can protect these patients in the way that Nursing Homes and the amount of dollars they have to spend on them. Are you aware of that . Yes, im aware of that than 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 people are required to get supportive care, longterm care in a nursing home. He would be much better if medicaid were more flexible so people could get that care in their own homes. It does not allow the flexibility. Thank you. I yield back. The chair now recognizes congressman with me thinker witnesses for being here today per dr. Right thank you to the witnesses. The reason i was most persuasive was that we were worried we would overwhelm the hospital in icu capacity of the pandemic if it spread too widely. We had to shut down the icy use in hospitals from being overwhelmed. Was their harm associated, with their harm associated and that cut down for the American People . A catastrophic harm. When people tell you cant run your this has theres all kinds of costs associated with that. There are also Health Concerns because of that. Yasmina will take us years to unravel exactly what they are but they are significant. The Health Concern costs and the disproportionate impact on africanamerican committee. Its now time to reopen our economy. Its way past time. Let the ask you this. States that have largely opened up and did so early on what has been the Health Concerns in those states relative to those most is to a close. By and large we are seeing no difference between the states that continue to lock down in terms of overall on average declining death and morbidity. Why in the world are some states still closed and adopting the policies we see in facilities there. I suppose mr. Jordan youll have to bring them before the committee and ask yourself but theres a wide range of the kenyans about what to do it we clearly should be looking at this data reopening. Dr. Raj is no data that supports remaining close in from an economic standpoint theres no data that supports shutdowns. The evidence is overwhelming we should have a targeted approach where we are focused on whats going on in Nursing Homes and very lucas on at risk populations that people with Heart Disease the elderly etc. But we should absolutely be reopening schools. The absolute should be letting one younger people back in the workforce who are at much lower risk. I want to read a letter sent to the president on march 19 2020 about the Health Concerns that exist when you have a shutdown. Im quoting and mrs. Millions of continued shutdowns will be hiding in plain sight and suicide protects kidney failure unemployment drug addiction poverty and abuse. Do you think that statement is accurate . The reason we need to open it commonly yesterday in my judgment and get back to normal as quickly as we possibly can. One thing we talk about in our major paper in reopening is the average Small Business has less than 30 days of cash in reserve. We are seeing hundreds of thousands of Small Businesses many minorityowned by the way permanently close because they dont have the cash reserve to reopen once we get out of lockdown. All americans need 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. I yield back mr. Chairman. The chair now recognizes ms. Maloney. Thank you mr. Chairman thank you to all of my colleagues in all of our panelists. As in many races 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 or than 6000 black and american africanamerican residents are estimated to have died from the coronavirus and more than 6300 hispanic and latino residents. According to the centers for Disease Control black new yorkers are dying from coronavirus at twice the rate of white people. Lack of testing which has been one of the deadliest missteps of this event straight and has disproportionately impacted the Africanamerican Community here in new york city and elsewhere. I would like to ask how this lack of accessible testing affect infection rates in new york city and to his left find . Thank you for that very important question. I will give you my own personal experience caring for patients during the pandemic that we were unable to test them for weeks predators probably giving two swabs for 100 patients per shift. When i think about all of the patients we missed because we were unable to test them and they went act out into the community not knowing whether they were in fact did country which did the high rates we saw. We are going to get in the same predicament we got into the beginning it may be worse for the people that will be the most disproportionally impacted are the same communities, black communities and 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 diad in the making reopen safely. Right now we dont have the test tracing of the structure in place to do so safely. New york is launching a testt recommends testing for every single new yorker. Even when testing is available it may not be acceptable. For instance many people in the africanamerican committee have a distrust of the Health Care System and may not seek testing. What is the root cause of this distrust and how does it affect Health Outcomes for the Africanamerican Community . Distrust is very real. I had a patient a few weeks ago who couldnt see me under my layers of personal protective equipment. A young black one with covid19 symptoms. She said are you black, doctor . I said yes. She said i just want to make sure and being listened to. This is not just a onetime thing. Patient distrust is a result of the historical legacy of racism in this country where in terms of black communities interacting with the Health Care System theres henry ate a lax in many instances in history. This distrust is important to prepare. I would even say we need access to resources and reparations to black communities in order to come in order for them to not only survive but thrive. For the Latinx Community we have seen a language barrier where am information on the coronavirus is only released in english. Has it contributed to testing disparity in the Latinx Community . Mike community in oregon what we notice we were finding out about covid19 was that the information being provided was i merely an english. You have to remember the patients i see are primarily hispanic and some of her patients dont speak spanish and 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 which was contributing to decrease knowledge about how to mitigate the virus. In my community we began to create Public Service announcements in spanish there were given on the radio and written. We notice within a couple of weeks the public began to have a better understanding. Many of my patients in late march they had the information that they needed to prevent spreading the virus that they do not have i worked. People can have information but do not have the support systems in place that their worksite raids they are not able to implement these Healthy Behaviors for the same goes for housing and labor camps. We can give them ppe when they are on the field. They continue to live in crowded camps. They will still spread the virus so im asking that we really Pay Attention to the conditions that work would also the Housing Conditions that my patients are living in. Thank you very much ms. Maloney. The chair 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 cope with on our entire population covid in our entire population the disparities between those groups that are more or less impacted and economically have the same and tax, dr. Roizen view done many studies with regards to vaccinations . I know the governors believe in some mayors believe we cant get back to work and took it a vaccine. They believe late fall or early winter we may have a vaccine now and we cant be shut down until then. Some of the members of party discussed the fact that i think in one of the publications a week or so ago the number is 65,000 people per month die as the result of a covid effect, not from the disease itself but the effect of focusing on covid the expense of the rest of our society. If we dont focus on those folks soon we have bartik on past the covid death rate and deaths of people who we have not in paying attention to help twice. We can see it does change our economy but having a vaccine to me 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 because of that its more imperative that we i appreciate you bringing this point up because its one of the most reckless policies to say we are going to wait for a vaccine before reopen economy. The reason why is theres absolutely no guarantee that we will have a back scene in the next 12 to 18 months. We have been working for nearly four years on a vaccine for hiv. We still dont have one. We have been working for even longer in a vaccine for hepatitis c and we still on have lent. We have drugs that treat active infections for hiv and hepatitis. We have never developed a vaccine for coronavirus before but the last records for an novel virus vaccine was ebola and it took five years to did 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 ale. There are no guarantees and we cannot keep the economy locked down until a vaccine may or may not ever come. These things your Research Show that were made from a base of those things started so down pretty. Theres a lot of research now, about the negative Health Effects of an employment poverty. The one annealing thing thing is the direct on the economy, but is getting into 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 but out there about if you care about reopening the economy coming you only care about money. No, is essential for Public Health help because of people are afraid and told they should be afraid of leaving their home, not when we see the doctors. They will get those mammograms running been treated for a heart attack. That is really important. In my calling; committee, last hearing made the comment with regards to masks. Journal of medicine letter Article Health professionals by district and they all agreed that wearing a mask outside of the healthcare facility offers very little protection is actually probably not worth your time or money to do that. It seems to me that these false things that people are putting out, to try to control people seems to be backfiring. I think people are getting the information out there to show they can live their lives in a very productive way. Blaine i think that is the message that we should be sending. The chair now recognizes nests person. I to had to look at that journal of medicine. The article that was referenced. There was opinion piece not research article. It simply made statements. It is not useful. We need numbers here. It did not address the core issue with masks. It protects other people. But they were talking about is if you go into a patients room, the patient is wearing a mask that to be heckuva good basically hazmat suit the guarantees that you will not be infected. That is not the situation. If youre crowd, patio are singing or talking though, your threat to other people. And its much that if your wearing a mask. Its really important to give the correct information. Sorry about that of getting off of the subject when youre talking about Racial Disparities there are some indications, but there aint be a genetic component to that. Barely there are differences. These two receptor the doorway through which the virus enters through the cells. If it is true, and theres a difference in the policy response. For example, we could be in a situation where in the vaccine that works better for an anti body treatment that works better in one racial group than another. I wonder how we should stand top of this. This is a very tough thing to even study because of the huge Racial Disparities. And in the initial health. I wonder if any of the entities here have an opinion on what the state of understanding whether or not there may be a genetic component to this. Theme is too premature to make any assumption on that level. We do know is there is no biological basis for race. Many of the people of different races actually have 99. 999 percent genetic similarity. I dont even, i dont even bring up the topic. Racebased medicine is potentially very dangerous. But as you alluded to, there are factors such as social economic policies that have left black communities and other communities of color more vulnerable and predisposed to this virus. Our office has worked for years trying to get a sickle cell treatment based on event genetic engineering. That is a very race linked thing. Racial a link pretty. Is not race, is it geographical ancestry which is very different for race. Race is a very social construct. We need to make sure that we separate the differences. Students statistically, i believe it is east asians and africanamericans that are predominant bears of this disease. If part of this ends up being me 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, cant be used as an excuse to maintain the disparities and provision of healthcare. That is not the argument is 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 a two receptor. I agree with you. When i do think we need to focus on the social determinants of health which is what we know our greatest predictive factors and Health Outcomes. Here. Youre right that there are genetic variations about the a to enzyme and the interaction between various strains of the Novel Coronavirus in the end to receptors. It will be interesting. We are fortunate to live in a golden age of genetics wrote 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 rent variations in the case 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 it was brought up in the Armed Services committee, the possible use of the Armed Services data. As of the population where you control for health and age and so on. So you could get up use that data to get a real idea of whether theres a genetic component to this. Ive use of my time. Thank you very much. Thank you. I want to begin by much my heart aches for the family of george floyd. Theres no place in our society for pope Police Brutality for the violence and destruction that we seen in some studies. But even as americans we have the right to protest peacefully. Bc countless others being denied their rights together at a church in the synagogue to pray for peace. Injustice and understanding. At a time when our nation needs prayers for unity and healing, i call on every mayor and governor right now who are still barring people together to open up our churches. Thats what this nation needs predict everything a state needs have access to the churches. The coronavirus pandemic has affected the whole world in a question and has been disproportionate in some populations princes, mr. Wright, you just spoke about this pretty they show that nursing home residents make up 0. 6 percent but 42 percent of all coronavirus debts pretty those with underlying condition such as diabetes, hypertension, obesity and asthma are also at high risk for complications. Raymond death from coronavirus pretty be no and africanamericans are more likely to have some of these conditions. So on this point in particular, theres no simple but we have to start somewhere. Such as exporting ways to improve social conditions of health. The conditions in which some asocial and economic environment shapes their health. The act which would help states and communities better leverage existing programs and authorities to improve the health and wellbeing medicaid participants. It would also provide Technical Assistance to help save local governments take innovated, evidencebased approaches to cordate services and improve outcomes. Economic opportunity is a major role. And in private and most immediately we need to continue to open, reopen and reopen, and to beat coronavirus pretty safely reopening businesses doesnt just put money in peoples pockets, impose their wealth and wellbeing. Joblessness has negative results. Prolonging these lockdowns could result in the wide range of problems such as suicides, Substance Abuse and Mental Health. Mr. Roy do you agree that the financial coupled with isolation due to these lockdowns have affected the physical and Mental Health of minority communities. Yes and i can empathize 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. Shutdown schools. In the children asked literally one in a million rate of death from 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 be strategic but it can be done. We are doing it in florida and texas. In his working family 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. Continued to elaborate on that pretty is there anything else that you see in this wide spectrum of reinvigorating economies other than schools. What else you see that will reinvigorate these communities. Avik two things, schools the other one is hourly workers. People who are in hourly wage earners, there just fortunate or pertinently minority and low income. Their jobs have been cut by 527n lockdown states. Thank you very much. The chair now recognizes congressman ruskin. Came to be okay. Okay. The listing we wanted to on this committee is to spread misinformation. So i would recommend that we go to centers of Disease Control website about the remarkable number of transmissions that are taking place that religious assemblies across rural arkansas. Ninetytwo attendees, chief Justice Roberts benedetto decisions and there is no determination going on against the religious right obviously Large Group Gatherings are just dangerous under the covid19. Secondly i want to say is the Public Health and economic consequences of the covid19 pandemic and present trumps mismanagement of the response to an is been devastating for our people. Dont think we mentioned there were now over 107,000 people who have died in the crisis. 2 Million People second 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 like, issued Public Health orders for to stay at home. We dont have the treatment and we dont have a cure and we have a vaccine. So my republican governor, issued a stayathome order. I would like to ask the doctor, when we have higher death camp today had we not acted as we did. This number one and number two, successful reopening require continued aggressive Public Health action such as steppedup testing, conduct tracing and quarantine for sick people. Thank you very much for the question. First, absolutely. If we had not imposed, the state homeowners, we not are more infections death. This is been on research at the Columbia Research if we had shuts down and imposed shelter in place even one week earlier, would face 36000 people in the u. S. Pretty save them. Another publisher found that if we did not in place orders, ten times the number spread best ten times the number of minorities that we would also see. I just wanted to say that the white house issued their own violence about reopening. And specifically the guidelines and we have to have a decline in the number of cases and also that there must be testing Contact Tracing and isolation available. We would argue that we need to close down until we get a vaccine pretty were saying that we need to find the cases and also that these capabilities are there. And firstly the federal government has not had a National Strategy for testing, full Contact Tracing, for developing the Public Health infrastructure. So the shelter in place orders for both bias, squanders. We are reopening before we are ready. I just when asked to that it is not just the elderly nursing home who get ill. Its also young people who die. There are children, this multi system system that causes multiorgan failure. Kids have died from this. Helping people in the 30s and 40s. We need to take that into consideration. We need real data to talk about this which is why we have the law requiring an administration to provide specific demographic information on the race at rates of being spread as a result of the covid19. The administration follows first report if you can call it that, to congress on may 20th. Its really is a joke pretty across to everything were trying to do pretty is three and a half pages, page one is the cover page. Page two is a copy of the law and three is the collection of links that the cd4 websites. Doctor, why is it crucial for congress and for the people to get racial ethnic data on the coronavirus epidemic and why 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 ministrations response to the Data Collection have been quite anemic. Even the cdc, dates at that we have is incredibly incomplete and we need the full day death in order to get the full picture of the degree of devastation to these communities of color. Without the data, we dont know how much resources these communities need are in it thats we need every state and locality to disclose, not only hospitalizations and deaths, but we also need to know testing. If we have seen mass, black americans are less likely to be tested. And then when they go to the hospital, the more likely to be admitted that. 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 community that need it most. Thank you very much. Thank you chairman and recce members and thanks to her witnesses. This is an important topic especially in light of critical conversations as we continue to mourn for george floyd. Twenty plus years working in the innercity rural ers, suburban ers, i know that when a patient comes into the er, doesnt matter what race they are predict we treat them all the same and having been a special operations Flight Surgeon in the army, ive seen firsthand the soldiers, whatever race they may be, blood in the floor, is already when you wash it out. I would ask all americans to look in the National Guards in their communities right now predict in their brains are caucasians, africanamericans, latino americans, Asian Americans and together united they are protecting americans. Thats unity can be an example to us all. The date on covid19 as soon disparities and we will get to the bottom of it. But we need to be careful when we analyze these data. The numbers can be misinterpreted for instance in louisiana. People with covid19 debts were africanamerican. Even the why people make up 63 percent of the state. However when you look more closely to thats, the vast majority of the deaths were concentrated in urbanized areas which is over 60 percent africanamerican and we had the most desperate however, other majority africanamerican parishes in rural areas such as east parish in Madison Parish combined, so only two deaths. We note coronavirus is spreading in various ways. The key factors in every transmission as in common proximity. It appears to be getting those in the dense urban areas the heart is. In 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. Intensity. Public transportation, did we draw conclusions that this is all due to some race bias in healthcare, we may miss the need to analyze how weak sterilize public buses or subways. Its a variable we need to do that. Another variable is the disparity. Chairwoman, said, we have been studying this disparity for 50 plus years. One study found that the population attributable to risk for hypertension and 30 year mortalitys, among white men was 28point percent compared with 45. 2 percent among black men. 19. 3 percent were white women compared to 39. 5 percent for black women. There are studies to suggest that is because the way africanamericans cells in the kidneys but honestly, no one after all of these years of studying is, has 100 percent 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. And black people have diabetes versus 7. 5 percent of nonhispanic white. The paper in the general diabetes science noted the risk of death from covid19s four times greater with those of diabetes. It is clear that the number of different factors contribute to greater rates of infection in higher numbers spirit cases in more deaths. The same factors are trivial not just for black people in the u. S. But across the world in brazil. Hardest hit some follow black brazilians, 60 with percent more likely to die from the virus than the white brazilian. And according to the uk office the national since statistics, four times more likely to die from covid19 the my people. Thats higher than in america. In the universal her healthcare pretty the uk has universal healthcare. Government care for all the disparity between blacks and whites there is higher than the United States predict and partially due to numerous factors covid19 is disproportionately hard bucks brothers and sisters across the globe. We must talk this issue the truly help them. Only when we understand all of those interlocking variables can be seen to get to the bottom of. I hope that we will with his hypertension. Hopefully we will with the covid19. We have but to continue studying it. Gotta make sure that we look at the data carefully. Thank you mr. Chairman. Thank you so much chairman. I would like to address questions to doctor nguyen and ms. Sharp. Its been talked about before about this briefing, about reopening. Ill start by saying i want to get these reopened as quickly as we can and responsible as a way. My home state of new jersey has been hit particularly hard by the virus. I know that a lot of Small Businesses. Our struggling. When i think about reopening, theres a discussion already during speaking about something that comes to mind is what you said about the White House Coronavirus task force pretty and reminded me that actually wanted to look at the question that they say is data driven conditions in each region and states should satisfy to face opening. I wanted to ask you if all states in our country have met the conditions that the white house and Health Administration has laid out. And the havenots. In fact many of like Health Experts including myself have argued that the note 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 for example that we need in this because we need national leadership. A National Strategy to get there. I just want to make it clear the Trump Administration guidelines on the reopening. On turn . Teamed document. About Asian American and Pacific Islander population. In a chance to speak with api communities across the country, a couple of things have come out that we have not talked about necessarily in this discussion so far. First of four months most with the largest about the effect on patients and those that are getting infected, theres also a high number of aci their essential markers, i never of aci that are physicians and nurses. I think over to millions acis are considered essential markers right now. Over 20 percent of physicians in a venture considered aci. So that is to suggest that this is well, that weve had in health suddenly comes to the an addition to the since mentioned by the calling of mine carolyn, about communication. Insight community as well has had a tremendous due to language barriers, for a lot of people talk about especially where incidents have been rampant. Asian American Communities not knowing where to go for protection. As i looked into trying to whether or not this is a disparate seat by race. I learned that only four states our country actually tracked data for those that are getting tested. Writing the temporaries. So whether they data about deaths those percentages neil is actually managed. We dont know if its accurate counter representational counts. So i want to give you or i would like to know your thoughts on that. Especially when we dont have that data. So thats right, we need for better data or 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 predict we actually have very little data. In the data that we have for example shows that there are disproportionate numbers of covid19 for example among Asian Americans. So we need that data specifically. Also outreach. We need to have people who speak the language who are culturally competent and are the most credible messengers. The more testing we have, the better surveillance we can have two. Within that. Avik keep one piece or hundreds of dozens of others in actually the testing under surveillance, will offered the road to reopening. This is what we need to do. The particular targeting to minority communities including the asian community. Also we are talking about Contact Tracing. It makes it all that much more difficult if you dont have it in the language. Weve been moved by your statement he talked about the challenges that we are facing in the health service. Even before this pandemic. I want to to paint a picture for me how the lack of funding affected the health get even before this pandemic happened. And the foundation for which the response occurred. I really appreciate the followup to that question. When the pandemic is this country, we were already in crisis. We suffered in some areas out there, 80 percent. We suffered at largescale economic impacts. Some of the questions that were surrounded around reopening read we face those prior to the pandemic so what we found is not only do we have an inability to protect ourselves, during this pandemic we have notable, every factor of the funding that we received from the federal government, the law enforcement, healthcare, education. Every part of our public has been equally impacted but only that, their own revenues for taxation has been really limited pretty even with Economic Relief the cares act, were disallowed from using that really to support our economy those bills pretty so in the absence of the funding of the responsibility, we tried raise taxes. And when that fails, we tried to rest commercial profits and tourism. So not only do we not have a trustee, we have an ability to economically hijacked. So in this pandemic it, we too started to with no strategy. We began immediate Rapid Testing prior to to see how we could get testing to our community. The fda was giving emergency use authorization for some companies. We found of them or be able this company at the Community Center tribal loss and tribal citizens that would be a start. But all of those things have left us and a place where just coming out of and is clear to me that if we dont protect ourselves, then there just left tonight. Thank you chairman. Thank you very much. But mthank you to all of our witnesses for the steering and the members of stayed. I think a lot of important things them out pretty clearly we have seen data that shows with the disparities are. And how covid19 is affecting our country. Its not affecting the country equally. It affects age groups the same, and surely doesnt affect people who have different backgrounds, minorities of the most impacted british seniors in Nursing Homes, the most impacted. In doctor greens points, i thought were so pointedly made that when you look at different parishes in a state like my home state in louisiana, Africanamerican Community and city like new orleans, is very adversely impacted differently than an Africanamerican Community in a rural parish. In louisiana like wesco. So appreciate you making those points. And the need to reopen. It reopening our churches. We need to be praying right now and coming together as communities in those places that we go to gather. We know how we can do it safely. The protocols were called out. States are already showing us how to do it the right way. Well be following the states. Some states are doing its right. Some states are doing its wrong for the state like michigan, must keep doing the wrong way. We out of the all pushing it to stop them from doing it because its killing people. Other sure this information, would be helpful if we use the data were getting in the knowledge we are getting to share with others who need it most. Who can help us save lives. We get our economy back open. And it also saves lives. I appreciate mr. Chairman, your focus and again and we extend our prayers to George Floyds family. Thank you very much. I want to thank all of our panelists for the rock here today. We are grateful for your insights and leadership during this time of crisis both i in or nation. On think all of my colleagues. The participation in the constitution today. 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 blacks and run americans have face numerous barriers to Higher Quality healthcare read on like to think the doctor, she mentioned an experiment. I always say were also informed by our districts british also mentioned ms. And renta. And regarding to healthcare. Inaudible. And i would ask my colleagues, if you do not know about henrietta, please google per. I think you see why her name was mentioned here today. We need the federal government to respond to the current crisis. The testing and commitments in the treatment they need. We also need to sustain investment and structural change. To ensure the equities in the future including universal rights. I often quote Martin Luther king junior who back in 1966, medical conference he was speaking at, said this. Of all the forms of inequality, injustice is the most inhuman. He notes a inhumane, he said inhuman. Because often results in death. Missing too much unequal and unjust physical death. From multiple shocking inhuman causes. And we are now saying the direct action and nonviolence. The causes of the nation is being raised and its my hope that racial inequities in health, and other areas will be addressed. And thank you once again to all