Transcripts For CSPAN3 Federal Health Officials Testify On Coronavirus Response 20240713

Education, labor, and pensions will please come to order. I have one goal today and that is Accurate Information. Accurate information that can help americans understand what they should do about the coronavirus and Accurate Information to help members of congress to help decide what else we ought to be doing about the coronavirus. Around the world, the spread of the Novel Coronavirus alarming. 90,000 cases in 65 countries. 3,000 deaths according to the world health organization. But most people in the United States are at low risk. Heres what the New York Times said on its front page two days ago on sunday in describing the situation in our country. Quote, much about the coronavirus remains unclear. And it is far from certain that the outbreak will reach severe proportions in the United States. Or affect many regions at once. With its topnotch scientists, modern hospitals, and sprawling Public Health infrastructure, most experts agree the United States is among the countries best prepared to prevent or manage such an epidemic. Thats from the front page of the New York Times two days ago in describing where we are in our country. Today in our country, while there are 90,000 cases around the world, there are about 100 cases in the United States, maybe a few more. And about half of those contracted the disease overseas and have been brought back here to be quarantined and monitored. There have been six deaths in the United States. In addition to the human suffering, the virus is causing disruption of the global economy. According to our trade representative, more than 20 of everything we import is from china. Medicines, car parts, cell phones, televisions. Chinas shut down factories and locked down 16 cities where 760 Million People live. Now, think about that for a moment. 760 Million People is more than twice as many people as live in the United States. And theyve been locked down in china as china tries to grapple with this. In the shortterm, this could disrupt our american companys ability to buy and transport goods and materials. In the longterm, the production of these materials could shift and there would be implications on jobs and prices there. So the first goal of the hearing is to provide the American People with Accurate Information. Todays witnesses are respected professionals who have a lot of experience in what were talking about today and who know what theyre doing. And i want to take a moment to emphasize their backgrounds. Dr. Ann shuket. She spent 30 years at the center for Disease Control and prevention. Shes the principle the Principal Deputy director there. Her work has been with these kinds of epidemics through democratic and republican president s and Health Emergencies including the 2001 anthrax attack, the 2003 sars outbreak, 2009 flu pandemic. Dr. Anthony fauci. Dr. Fauci has held his position as the chief of Infectious Diseases at the National Institutes of health since president reagans time. Hes work eed for reagan, bush, clinton, bush, obama, and now. Hes led the response to the hiv aids in the 80s and 90s, the west nile virus, sars in 2003, ebola outbraeeaks in afri. For these professionals this is not their first rodeo. 13 years ago congress created the position of assistant secretary for preparedness and response at the department of health and Human Services. Dr. Robert cavlik helped draft the bill and now holds the position that was reauthorized by senator casey and senator burr. Not long ago dr. Cadlik had previous work assisting the United States air force in biological threats. And finally dr. Stephen hahn is the newest to the federal government of these respected professionals. But hes had plenty of experience before becoming commissioner of the United States food and drug administration. The fda. He was part of the university of texas m. D. Anderson Cancer Center with 21,000 employees. The reason i go through that is because were looking for Accurate Information. These four ought to be able to provide it. Now, in addition to getting Accurate Information for the American People, we wanted ourselves to know what else we should be doing to limit the damage of the coronavirus to the American People and the american economy. And before we talk about what else needs to be done, i want to briefly summarize what weve already done. Lets start with congress. Its not the first Public Health threat weve faced. Theres some senators and Staff Members here today who were here 20 years ago when the anthrax attack happened. Sars. The flu pandemic killed an estimated 151,000 to 575,000 people worldwide. Then there was the Ebola Outbreak in 2014 and 18. So following the anthrax attack in the bush administration, congress created the task force bioshield. After 2006 also in the bush administration, Congress Passed the pandemic and all hazards preparedness act. That guides the federal government in how it prepares for and responds to Public Health emergencies. It gave the department of health and Human Services the authority, for example, to prioritize funding for the development of vaccines and treatments for Infectious Diseases. It improved our Public Health Emergency Fund. The senate as i said earlier passed the most recent update of the pandemic law led by senator burr and senator casey. Senator blount and senator murray in their work on the committee helped fund Public Preparedness programs. We all know that president s and their budgets and this includes all the president s i know about sometimes underfund these programs. But last Year Congress gave 4. 5 billion for Public Health and Preparedness Programs. When a crisis occurs, we often need money quickly. Thats why congress has created two funds. The Public Health Emergency Fund and the Infectious Disease Rapid Response fund. For example, secretary azars already used 105 million from the Rapid Response fund. And using Authority Congress has given him, hes transferring 136 million from other programs in his department to respond to the coronavirus. And the Trump Administration has requested an additional 2. 5 million billion. Others in congress have made suggestions and were likely to vote on that in the senate this week. In addition to what congress has done to get ready for pandemics like this, both democratic and republican president s over the last 20 years have used their executive authority during Public Health emergencies. President obama sent the military to west africa during the Ebola Outbreak. President bush send cdc experts around the world to investigate and respond to the sars epidemic. President trump similarly appointed a task force on january 29. He put the Vice President in charge. He moved ambassador burke from the state department whos had years of experience in dealing with Infectious Diseases to be a Principle Deputy in leading that effort. On january 31st at a time there were six cases confirmed in the United States, the administration for the first time in 50 years announced they would quarantine americans whove been exposed to the virus while in china. And impose travel restrictions on foreign nationals who travel to china in the last 14 days. The same time the state department warned americans not to travel to china. And the cdc recommends americans reconsider in asia. They added italy and south korea to the list. The administration said foreign nationals who have travelled to china in the last 14 days cant enter the United States. On saturday the president updated this to include travelers from iran. Dr. Fauci who is testifying today said if we hadnt taken these steps, we would have had many more cases right now. A third example of executive action is developing a test to diagnos diagnose the coronavirus. Its been made available to 46 labs in 38 states and washington, d. C. Two days ago the fda authorized a new test developed in new york and is working with 65 other private Sector Developers including Academic Medical Centers and commercial labs to increase the availability of these tests. Fourth, dr. Fauci has said that were developing a vaccine for coronavirus more rapidly than weve ever developed any other vaccine. And drug manufacturers met with the president yesterday to see if treatments and vaccines could be made available more rapidly. Finally scientists at our National Laboratories oak ridge, livermo liv liv livermore are using their capacity to understand this better. Of course the additional exact on us and our individual lives, theres the impact on the global economy. The trade representative says about 20 of what we import comes from china. As people get sick and cant go to work, that slows down whats sent here and has an impact across the board. 13 of the facilities that make active ingredients for drugs are in china according to the fda. Some people have said that 80 of the ingredients for drugs are produced in china. We should evaluate that figure carefully. It appears to be based on a 1998 report that may not have a source. Ive discussed on how to inquire and whether we should explore the dependence we now have on other countries not just china for medicine and health supplies. Most businesses in the United States that need supplies have more than one source for what they do. Perhaps we need to take another look at that. And its not just medicines affected. In tennessee we have eastman chemical. They have nine manufacturing plants. The ceo said that the recent phase one china trade deal caused orders to go up in his company, but the coronavirus problems in china have caused them to go down. And that has an effect on jobs in tennessee just as it does to jobs in other places. So todays hearing is an opportunity to listen carefully to four respected professionals who have decades of experience and are the right people to give the American People and members of congress Accurate Information about the coronavirus. Both what individuals can do and what else the federal government needs to do to respond. Were going to finish by noon today so that dr. Shuket and dr. Fauci can join the Vice President in briefing senators at our respective lunches. Senator murray. Thank you very much, mr. Chairman. Thank you to all of our witnesses today. I just want to say at the top that im really grateful to all the women and men out there who are working now to keep our country safe and i hope you pass it along to your teams as well. Mr. Chairman, this is really a frightening time. At least six people in my home state have already died from the virus. I am told we should expect more. We expect the number of infections to continue to grow. And the people across my state and im sure across the nation are really scared. Im hearing from people who are sick who want to get tested, are not being told where to go. Im hearing that even when people do get tested and its very few so far, the results are taking way longer to get back to them. The administration has had months to prepare for this and it is unacceptable that people in my state and nationwide cant even get an answer as to whether or not they are infected. To put it simply, if someone at the white house or in this administration is actually in charge of responding to the coronavirus, it would be news to anybody in my state. And ive been on the phone with all of our local officials for days now. This is unacceptable. We are now seeing Community Transmission of this virus. Families deserve to know when testing will actually be able to scale up. What they, the families, should be doing. And most importantly what we are doing. And unfortunately i have to say that while i am profoundly grateful for the work Public Health officials are doing, im very frustrated at the steps the president has taken from repeatedly contradicting experts advice to down playing the seriousness of this threat. And to appointing a politician to lead the response. So im really glad today, mr. Chairman, that we have the opportunity to hear today directly from the experts and get answers to the questions that i am hearing at home. I know people want answered. One of them is when with are we going to scale up the testing especially now were giping to see Community Transmission in the United States . After all, its only after a long, frustrating delay that we are finally able to Start Testing patients for this disease at state labs across this country. And the last few days seemed to confirm what experts have been warning. That this is likely to continue spreading. We now have more than 100 cases of coronavirus that have been tested in this country including repatriated cases. Well, theres a lot we are still learning. There are few things that are abundantly clear about how we need to respond. First of all, we do need to be listening to the experts and making sure facts and science drive our response. In particular, the public needs to be able to trust the information theyre hearing from exper experts. And the federal government is in no way influenced by ideology. And the policies being put in place are based on evidence about how to keep our families safe, not fear or prejudice. I was very heartened to hear your assurances, dr. Fauci, that contrary to reporting youve not been muzzled by the administration. It is essential that that continue to be the case. We cannot have an Effective Response without Accurate Information and transparency from the administration. And i will continue to be very focused on this. Secondly, weve got to provided a vat resources to meet the needs of our federal, state, and local Health Officials. We know researches that come through Public Health Emergency Preparedness program are absolutely critical. But also were never envisioned to be sufficient to respond to a threat like this. Congress is working on a supplemental Funding Agreement that will reimburse our state and local Health Officials for costs theyve already incurred combatting coronavirus. It will guarantee resources are available to respond to outbreak hot spots. It will support development of vaccines and therapeutics to prevent and treat this virus and invest in public and Global Health programs to keep us prepared to respond to future emergencies. I do want to thank and recognize all the democrats and republicans who came together to work quickly on this package and i urge the senate to pass it very quickly. Im very dplglad were working that agreement that goes well beyond what president trumps inadequate request for 1. 25 billion in funding. And i surge the senate to take this up as soon as the house does get it passed and get it to our local communities dealing with this. Im also very encouraged by this committees strong bipartisan record in responding to Public Health emergencies as well. This committee strengthened so many of the research were see deploying today. I want to thank you, mr. Chairman, for our work together. Senator casey and burr for their efforts on that. Third, we have got to be a sure we arent just responding to the latest developments but staying ahead of this crisis by planning ahead. Because this is not likely going to end any time soon. We are already seeing some of the challenges that will come next. Like the strain this will put on our Health Care System. Were seeing that in Washington State. We need to make sure our hospitals have the capacity to address this virus without overwhelming their ability to provide other care that people need. We need to make sure that those Health Care Workers caring for coronavirus patients are safe from infections themselves including by making sure we have a sufficient supply of protective equipment. We need to manage our nations drug and medical device supply especially considering we expect demand for some supplies to skyrocket. And how many drugs and devices are manufactured in countries where an outbreak could cause an interruption . Also something were seeing. We need to give adequate attention to the education. In an age as we all know faster than ever we cant let your to spread dangerous misinformation. We need to take steps to prevent and respond to bullying and harassment that is motivated by stereotypes and fear. And we also have to account now for the ways that some of the Harmful Health care policies have undermined our responsibility to Public Health threats. Our uninsured rate is going up again. Junk plans are expanding. And those actions make it much harder for people to get the care they need to keep this crisis under control. So we have to make sure that everyone who needs it has access to diagnostic testing Going Forward. And while a vaccine is still likely over a year away, we have to make sure cost is not a barrier for that as well. Its not just our Health Care System we need to be considering as we work to stay ahead of this disease. Communities and families right now are facing difficult decisions. What measures should our schools take to keep our students safe . What can parents do . When should schools close . Employers and workers in my state and im sure others are facing similar questions about whether their employees should go to work or whether they should stay open. I will be pressing secretary devos more later this week about how her department is helping to prepare for these issues and ive written to secretary scalia about this as well. And as is so often how this will have higher costs for those who are low wage work who are dont have affordable child care, health insurance, and are experiencing homelessness. In my home state people are being told to stay home for two weeks if they are sick. There are not tests so they cant get tested. Guess who cant stay home. If you dont have child care, if youre a low wage worker, if you dont have sick leave. When those peoples basic needs are not met, they cannot make choices to protect themselves. Which means they cannot make choices to protect others too. Situations like this remind us we are all a community in a real sense. We all have a stake in one anothers well being. When we talk about this threat, i want to be clear this is not just about changes in the stock market. But we also need to develop plans responser to the daytoday experience families actually have. And that is something i plan to raise today and will keep raising. I look forward today to hearing from all of our witnesses about how we can best prepare our communities and i will continue to work with all of you and our Health Officials to keep families in my state and across the country informed about what they should be doing, what were doing, and to keep them safe. And ill keep pushing to make sure as this situation continues to develop, we keep listening to the experts planning for the longterm. Thank you. Thank you, senator murray. And thank you for your cooperation which is typical of the way you work in dealing with this issue. Weve hosted four briefings for senators, several briefing for staff. We had one of our Senate Briefings in a classified setting. So senators could be sure that there werent any secrets that what we were saying in private is the same thing were saying in public. And i agree with her that we should listen to our four professional respected expert who is are here today. Each one will have five minutes to give his or her testimony. Then well go to a round of questions. I gave each of them a pretty good introduction earlier so ill shorten it here. Expect to say dr. Schuket is from the centers for Disease Control and prevention. And shes had a variety of roles dealing with responses to sars, anthrax over the last 30 years. Dr. Tony fauci is the top person at the national stutes of health and Infectious Diseases. Dr. Robert kadlec is from the department of health and Human Services. As i mentioned earlier, he spent time as career officer and physician in the air force. Special assistant to president george w. Bush. Working with senator burr, he helped write the legislation that makes our country better prepared for pandemics. And finally dr. Stephen hahn who is the commissioner of the u. S. Food and drug administration, he was formerly the executive at the university of texas m. D. Anderson Cancer Center. All of you are not getting much sleep these days. We thank you for your willingness to serve the American People in the way that you do and we look forward to your testimony. Thank you so much. Cdcs role in this whole of government, whole of Society Response is built on decades of our Infectious Disease preparedness planning. Our response is dependent on support for core Public Health capabilities at cdc and at a network of dedicated front line Public Health workers at the state and local level living in your communities. Two months into this response to a novel virus, cdc has learned a lot. We have acted nimbly in the United States and around the world, but we do so with humility about the work ahead. There are many things that each of us can do as individuals, businesses, communities, and organizations. And were thrilled to see the website posted behind the senators. Cdc is responding with the following strategy. Our goal has been to slow the spread of this virus through a multilayered aggressive containment. And as needed mitigation effort. Were using evidencebased Public Health interventions that have included early case recognition, isolation, and Contact Tracing. Weve issued travel advisories and dealt with travel restrictions as well as the use of quarantine for individuals returning from Transmission Hot zones including through funneling of flights from Hubei Province and Mainland China to 11 airports. Weve worked with the cbp to get data to ensure that appropriate followup could happen through the state and local health departments. And weve supported the repatriated citizens from the cruise ship. Underscoring our leadership in global Public Health and the power of our investments in International Influenza surveillance. More than 1500 staff at the centers for Disease Control and prevention have been responding to this outbreak. The situation today is evolving and dynamic. In just two months this outbreak has grown from a cluster in china in one city to infecting over 70 countries and territories around the world with more than 90,000 cases and about 3,000 deaths. We are now in the United States seeing in addition to the very small number of travel associated cases or close contacts. We are seeing Community Transmission in a few areas and tragic outbreak in a Health Care Facility or longterm care facility in Washington State. Our hearts go out to the people affected by this virus and to everyone working so hard to counter it. There are steps each of us can take. I want to recognize that people are concerned about this. As always, our number one priority are the health and sate of the American People. Americans are taking this seriously and continuing to seek information about how they can prepare. While the immediate risk to the general American Public remains low an the u. S. Government is doing everything we can to keep it low, risk varies by exposure and some areas of the country are now experiencing Community Spread. State and local jurisdictions where Community Spread of the virus is occurring are intensely investigating and asesing potential community interventions. Cdc has got staff on the ground in washington and california and elsewhere to provide Technical Assistance. Our role in this type of Community Measure is to develop principles and tools based on our updated pandemic planning playbook and based on what weve learned from other areas that have been experiencing the outbreak including in singapore where theyve done a very good job of managing it. A key planning principle is to protect the most vulnerable. I trust you as Senior Leaders in your communities to help us with our mission to provide clear information to you and your constituents by urging people to get the facts from cdc go. Gov. I look forward to answering your questions. Thank you. Dr. Fauci, welcome. Thank you very much. I appreciate the opportunity to spend a few minutes talking to you about one of the aspects of the allgovernment response to this emerging outbreak. And that is in the realm of what we call interventions. Both with regard to therapy namely treatment of a person who was already infected and the other is in the area of vaccines or prevention of infection for those who are not infected. And its important to point out that the timelines for each of these are fundamentally different. And id like to just take a minute to kind of explain why when you talk about and the American Public and the Global Public understandably want to know how quickly we can get interventions to them. So lets start off, first, with therapy. As we know from the data that have come out predominantly from china. If you look at the now 90,000 people infected and the number of deaths that have occurred, about 80 of individuals who get infect infected do quite well without any specific intervention. Namely they spontaneously recover. However 15 of those usually those who are elderly and in risk groups wind up getting serious disease requiring supportive care. That could be oxygen. That could be intensive care. That could be intubation or more dramatic interventions. So we want desperately to have a therapy for these individuals. There are a number of candidate therapies had that as i speak to you today are being tested in random control trials. One of these is called r eed r s desivir. It is being tested in china and also here in the United States in an nih sponsored trial in collaboration with gilead. We should know within a period of a few months, several months whether or not this particular drug works. If it does, the implementation of that would be almost immediate. Now, i cant guarantee it will work. But the timetable for treatment is different than the timetable for a vaccine. And thats why i want to see if we can clear up any misunderstandings that are sometimes out there. Right now the technology that we have has allowed us to go from the time, the sequence of the virus was put in a public data base, to the time we actually stick a candidate into the arm of someone has gone down to literally be the fastest weve ever done. I expect that at least one of those candidates and its not the only one will likely go into Clinical Trials in a phase one study within about two months or maybe even six weeks. That would be a record. However, that is not a vaccine because it will take three months or more to show that it is safe. And then if you show that its safe, youve got to put it into whats called a phase two trial to show that it works. And the reason is that wed be giving this to normal people to prevent infection. So you must be sure. The edict of medicine, first do no harm. So we need to make sure its safe and we need to make sure it works. That entire process will take at least a year or a year and a half. So when we hear talk about a vaccine is going to be ready in a couple of months, it wont be ready for being deployed. Its going to take awhile. So were going to have a multistep process. We have the Public Health measures that youve heard about from dr. Schuchat. And youll hear from dr. Hahn and dr. Im sorry kadlec. Excuse me. But the issue is in addition to those Public Health measures, interventions are going to be critical. So we hope well get good news to you and well be able to say in the next couple of months well have candidates. But there will be no guarantee of that. And the only way to know that would be to do the clinical testings im talking about. So hopefully well have the opportunity to update you on a regular basis about where we are with that. Thank you. Thank you, dr. Fauci. Dr. Kadlec, welcome. Thank you. I really appreciate the opportunity to testify. I think you heard from dr. Sc schuchat about how rapidly evolving situation. This morning youll take a couple of minutes to give you an idea about how were trying to address this problem from a point of strategic anticipation. To senator murrays point. A fourpronged approach to basically manage and support the domestic preparedness. To support the states and other entities. Supporting the Health Care System of the United States and also medical countermeasure development. In the medical countermeasurement, were working closely with dr. Fauci and nih and our d. O. D. Colleagues to see what kind of therapeutics we can rapidly bring to bear to this problem. And see how quickly we can field additional capabilities that cdc has already fielded with commercial activities. Specifically were looking at areas that would allow us to do point of care diagnostics. And we have some very promising candidates that will take several months to bring online. But we also identify therapeutics. Dr. Fauci has talked remdesivir. And looking at two potential vaccine candidates. One that was a product of the investments that congress made in pandemic influenza, with a vaccine that is licensed by the fda made by sanofi. And another one that is a product developed for the ebola crisis. So those are very important and very active activities were moving on first of all. Through the hospital Preparedness Program working in coordination with the Public Health Emergency Preparedness program that cdc administers, we look at how we can basically work better to improve collaboration amongst hospitals and the Public Health sector and other entities like emergency medical services. I want to highlight one area again that congress was very crucial in developing and deploying during the ebola crisis which is the National Ebola treatment network. That has proved to be vital in terms of our ability to manage this. Not only through the repatriation of american who is were taken from wuhan, but also from the diamond princess. That capacity and that capability and that as well as i think spokane, washington, actually housed a number of people through the treatment network. And that was vital in terms of how we could do that. The other issue is how were doing incident management. Since this started, weve been working with fema to put in place and activated formally as of yesterday an Incident Management Network that really is based on a National Response framework. How can we bring the whole of government to respond . This is the first time weve done that formally. Weve done it under exercises, but its a means by which we can leverage fema and all the Emergency Support functions that may be necessary by states when asked to basically employ responders to a system in dealing with this crisis. And the last area ill just highlight is really around the direct support to state and other entities. I mentioned our repatriation efforts. 1100 americans brought back under very difficult circumstances from wau han and from the diamond princess. First time that was ever done. But wed been working two months in advance across hhs and with our japanese colleagues to actually prepare for such an event. So we executed that. But were more importantly focused on how to provide direct state aid. And so with the state of washington, weve used the strategic stockpile to deploy personal protective equipment, to protect Health Care Workers, to highlight what dr. Schuchat has said. About how to work proactively with entities like longterm care facilities, like elder care areas where we know the most vulnerable populations reside. And how do we shield them from the effects of this potential virus . An lastly were looking at our medical system personnel as well as other pirn el to assist at the evergreen longterm care facility. Were doing all of these things really as a team to respond to this. So with that, ill pause and yield back the rest of my time. Thank you, sir. Thank you. Dr. Hahn, welcome. Thank you, chairman and members of the kmcommittee. Really appreciate the opportunity to speak to you about fdas efforts. First of all, on behalf of the 15,000 fda employees, our hearts go out to those who have been affected by the coronavirus and those who have lost their lives. Thats why we had deployed thousands of career men and women to address this and look at aspects of diagnostics as well as the medical supply chain. I will focus todays update on areas where fda has communicated new information, supply chain impacts, and expedite iing test. Please republican some of this i can share now does change quickly. But it is my hope that this will help members of this committee as well as the American People. Have better visibility into the emerging situation. Regarding the drug supply, we have been and continue to be proactive in contacting manufacturers. Not only to remind them of the applicable recording requirements but to assess their entire supply chain. And much of what were asking manufacturers, they are not required to tell us. Since january 24th, fda has been in touch with more than 180 manufacturers of drugs to ask whether they face as a result of this outreach, one manufacturer did tell us about a shortage related to the Novel Coronavirus. That was reported and immediately disclosed to the American Public through our drug shortage list. The good news about that is that were working very closely with that manufacturer and we expect that to be resolved in a very short period of time. The other good news is they are available to providers and patients. I know there is interest surrounding this drug but i cant provide the name because its confidential commercial information. I think this also highlights what weve put in the budget proposals regarding the authorities at the fda here. We do not have the authorities to actually require manufactures of devices to tell us about shortages. Again, theyve been very cooperative with us. As have the Drug Companies with respect to giving us the information that we need. Please be assured if other potential shortages and medical products are identified by the fda, we will be very transparent about this and we will quickly share that information with you. A Fast Breaking bit of information that we just found out this morning is that the india has restricted the export of 26 active pharmaceutical agreements for export which represents about 10 of their export capacity. We are working very closely to look at that list to assess how that will affect the medical supply chain. Regarding devices, we have been in touch with 63 manufacturers of essential medical devices. Weve been aware of no weve been told of no shortages of the devices although we understand on the demand side on personal protective equipment and masks that there is significant pressure and demand particularly domestically. But were working very closely with those manufacturers. What we have found is that some of the manufacturers in china have reported disruptions in the workforce as you might expect particularly in wuhan province. In an effort to mitigate any potential shortage of anything, rest praters, other personal protective agreement for health care, fda as you know issued an emergency authorization to allow the use of niosh approved filtering face piece rest praters, so masks basically. And to increase the supply within the nation. We have a lot of information were communicating to hospitals and Health Care Workers about that, but that should increase the capacity for the Health Care System. Regarding diagnostic tests on february 4th as was mentioned by chairman alexander, the fda issued to eliminate Immediate Use of a test developed by cdc and the ability of this test to be used in cdc qualified Public Health labs. On february 29th, we also issued to authorize testing for the covid19 at two Public Health labs in new york. And since that time, additional labs on the west Coast Washington and california have also notified theyve begun testing using this approach. Weve had a lot of contact with both private and public and Academic Centers with respect to the development of these tests. As i mentioned yesterday, weve seen in cooperation with cdc a significant expansion in the ability to perform those tests. We have one manufacturer who is working closely with the cdc to expand that over this upcoming week. And we expect that to be available. Those kits to providers by the end of the week. And that expansion will continue. Thank you for the opportunity to update the kmae on the fda agencys response to this crisis and i look forward to answering your questions. Thank you, dr. Hahn. We have very good attendance by senators. Were going to continue the hearing until 12 30 in hopes that every senator will have a chance to ask questions. I know that the witnesses have been asked to go to senators lunches with the Vice President , but thats us. So wed like for you to stay here until you answer our questions and then go to lunch with us. And answer our questions further. And i think we can complete that by 12 30. Im going to ask senators to keep the total amount of time for each one on questions and answers to five minutes each so every senator has a chance to ask questions. Dr. Fauci, im going to ask you a series of questions within my five minutes. These are the kind of questions i get at home. Or sometimes here. Senator roberts asked me yesterday and i couldnt give him the exact answer, whats the what do we mean by Community Transmission . Community transmission means when there are cases that are in the community in which the original source is not known. If you get someone who travels, lets say, from wuhan to the United States and you know theyre a traveled case and one of their contacts gets infected, you know the source. Whereas if all of a sudden talk about pearn to person. We know who it is. Persontoperson but you dont know the original source. In the state of washington no, thats i thought there was a difference between persontoperson and Community Transmission. Every transmission of an infection is from a person to a person. What if you do know who it is, what do you call if youre them, that is not socalled community. If its community, you have a cluster in the community. I understand that, but what do you call it if senator murray has it and gives it to me, what do you call that . Thats persontoperson transmission. And if i get it and we dont know who caused it, thats Community Transmission . Exactly. You dont know what the original source is. Well, what are we at the peak of the flu season . Well, the answer is likely, and maybe even on the way down. If you look at the curves were just over the peak . It went up, it went down, it went up and starting to come down. Were talking about the ordinary flu we have every year. Yes. How many americans, if estimated, have the flu this year . Probably 30 million infections, couple thousands of hospitalations. In the United States . In the United States. How many people die every year from the flu . In 2018, we had 70,000 plus people. In one of the worst years . Yeah. The flu is a respiratory disease like coronavirus, correct . That is correct. How do you know if you have the flu as opposed to coronavirus . Well, the definitive test would be to get a test for the flu or a test for the coronavirus. So you need a test . There is overlap in symptoms. The situation with coronavirus is predominantly fever and a lower respiratory infection as opposed to an upper respiratory infection starting off with and then you might get a pulmonary involvement, which is flu. Whats a lower respiratory infection . As opposed to sore throat, sinu sichlt tis, sneezing. When you have lung involvement you can get that with flu but usually its upper respiratory and then lower. Fever and a cough . Fever and a cough could be for either of them. What should you do if you have fever and a cough . Well, it depends on the circumstance. I mean, if youre in the middle of a flu season right now and you have fever and a cough, obviously, if you have a cough, it could be a pneumonia. You should see a physician. Certainly, if youre a person in a risk group, elderly or underlying condition, during the flu season you should see a physician, because we do have antivirals for flu. And you could be helped by doing that. Should we all be Wearing Masks . No. Why . Because right now there isnt anything going around in the community, certainly not coronavirus, that is calling for the broad use of masks in the community. Why do Health Care Workers wear masks in the hospital then . Well, because a health care worker, who is taking care of someone who is known infected with a trancemismissal virus, ts different from Walking Around the streets. Are children getting the coronavirus . To a much lesser extent than adults. For reasons that are still unclear, it may be that they are getting infected but their symptoms are so low, theyre not being recognized. In a number of reports that have come out from china, there are very few cases less than 15 years old. Youll always find the exception but most of the cases are a mean age of 50. What can we or our families do to protect ourselves . Whats the most effective . Right now, and i think the question you asked about flu is important. Right now, we are still in a flu season. What you can do to protect yourself against the possibility of coronavirus is the kinds of things you would do to protect yourself against flu. Now, obviously, you get a flu shot. You can at least protect yourself against flu, but also things like we always say it. It sounds simplistic, but its true. Washing of hands if possible. Staying away from people who are coughing and sneezing. If you, yourself, are infected, stay out of work. Dont send your children to school if theyre infected. My time is up. Senator murray . Thank you, mr. Chairman. And im going to yield the first questioning to senator jones, who has to leave for a flight. I will take the second round. Thank you, senator murray. I would like to follow up on that real quickly. If somebody right now in alabama presents and they didnt get the flu shot. All of a sudden theyve got a fever and a cough, they go get a flu test. Will that test, if they dont have the flu, but have coronavir coronavirus, will that test come back negative . [ inaudible ] they should be concerned if they present symptoms for the flu and that comes back negative. Followup the question on that is about testing. I didnt hear a lot about the testing. Weve had some concerns in this country about testing. Its inadequate, to say the least right now, but i know theres efforts. What capacity do we have to do the testing, as you sit here today and how are we working to expand that and when will that all happen . Yeah, thank you. The cdcs piece in this is to supply the Public Health labs with tests, and we are rapidly doing so. We develop the test very quickly and then detect ed some problem after the Quality Control steps were measured. So by the end of this week, really, all of the state labs, Public Health labs should be able to do testing. I think for context, its important to understand what the Clinical Labs do in respiratory testing. Last week in the United States, Clinical Labs tested 42,000 respiratory specimens for influenza and 11,000 of those were positive for influenza. So far this year, Clinical Labs have tested almost a million specimens and about 200,000 were positive. Public health labs, as opposed to a million so far this year, tested about 62,000. Public health labs are a tiny piece of the testing world. That said, most people with influenza dont actually get tested. We have about, you know, 30 Million People with influenza so far this year and, as i said, about a million tests. So i think the Public Health issue is to detect early when there is emergence of this virus, recognize it in travelers or throughout the community as we said and right now were really keen with the fdas assistance to get those Clinical Labs up and running. Thats an fda and barta issue. How about the testing how much more capacity will we have at the end of this week versus two, three weeks from now . Yes, senator, we work with the cdc on their tests. Were using their outside manufacturers, private companies are using their platform right now to further develop the test. Our expectation in talking to the company thats scaling this up is that we should have the capacity by the end of the week to have kits available to the laboratories to perform about a million tests. All right, great. One thing i would urge, to please continue, as i think both senator alexander and senator murray said, please get information there. Were about to head into the allergy season as well. I can tell you, people are so scared out there right now that the first time they sneeze with an allergy, theyre going to think theyve got this. We need to make sure we educate folks so that the tests we have, the limited ones, are for the right reason. We have hospitals, another rural hospital closing this week in the state of alabama. Are there specific things that you guys are doing to make sure that rural hospitals, who are living from paycheck to paycheck almost, have the resources that they need, the Financial Resources and the tools that they need to make sure their communities are protected as well . I thank you for the question. Frankly, weve been monitoring that situation carefully with our Health Care Coalitions that are funded by the hospital Preparedness Program. And we do recognize there is a possibility in some areas of resources as well as areas of staff. Were looking at telemedicine and how we could make that available. Dr. Fauci said the majority of individuals with the coronavirus dont need care. The critical thing is identifying people who can, and that is something that cdc has been working on messaging to kind of identify guidelines. One, individuals who may be at risk, particularly for severe disease, should seek hospital care. And there needs to be a longterm solution to that challenge. In that regard i appreciate that. I had a question on that. I would encourage you to get with cms and allow them to have for reimbursements for telemedicine. They dont do that right now and that could be an important factor. Were in confessions with them on that. Perfect, thank you. Thats all i have. Thank you. Thank you, senator jones. Senator burr . Mr. Chairman before my five minutes starts can i ask unanimous consent that i enter a statement into the record and ask on behalf of all members if they want to enter a statement into the record that they can . And just remind members in 2005 when senator kennedy and i pass ed papa, it was with this day in mind, that we would be faced with a pandemic and we are close to that determination. The temptations to do legislation are great. Before you do it, read what the statute says. Read what the latitude is that our responders have. Let them do their jobs. Dr. Hahn expressed he just did two emergency use authorizations. Thats part of the work of this committee. So lets not be too quick to go out and encumber them with micromanaging what they do. So ordered. Well go ahead and make unanimous consent to put that in and look forward reading it. Thank you, mr. Chairman. I heard you say youre rapidly trying to reach testing. As of march 1st, cdcs website had total tested up on their website, it was 472 even though secretary azar said last night 4600. Im not sure which is right. What im curious about is why on march 2nd did you take the total number tested off the cdc website . Thank you for that question. Let me clarify. Theres a lot of numbers out there. Theres a difference between persons under investigation who have been tested and all of the tests that we have run. For instance, individual case, the first 12 cases we saw, we did serial testing on them to understand how long the virus was present and when it was safe for them to leave the hospital or when they no longer needed isolation. We collected multiple specimens so we understand with this very new virus, is it the upper respirato respiratory, lower respiratory . Weve collected other specimens from them. Over 3,000 tests run is correct. Weve tested way more than the 500 some persons under investigation. Weve also tested some of the hot cohorts or hot risk cohorts like the repatriatation from the diamond princess. Early january, if not in december with what were looking back at now, diagnostics had to have been one of the things we were looking at. Weve got to be able to do this, and we devote, through papa, 150 million each year to strengthen the surveillance capabilities at the state level. How can we have a situation Like Washington state where weve known for up to six weeks, reaching possibly 1,500 individuals, yt we experienced what we have with this longterm care facility and clearly a cluster that we dont know the magnitude of. How can that happen when weve invested so much in being there early on and understanding it and being prepared . Cdc very rapidly developed a new pcr for a completely new virus. We posted the instructions for that pcr on the website so other labs, academic labs, commercial labs, research labs, could similarly develop tests. Barta has the responsibility to work with the private sector to get commercial labs up and running. And the cdc has supplied the Public Health labs with the ability to do the testing. The situation in Washington State is tragic. An outbreak in a longterm care facility is one of the things we have been worried about from day one. We learned from the sars experience in 2003 that super spreading events or super spreading individuals could cause very large amplification rapidly. The concern about Health Care Settings has been foremost in our mind. Dr. Schuchat, i believe you. My question is, were we better prepared for this happening . It doesnt appear that we were. Papa required direct hiring for 30 new employees at cdc for development of a bio system. Of those 30 slots, how many have you filled . I dont have that information. I can tell you that the Laboratory Activities for the coronavirus are not one of the larger parts of our program. We have really built our response around our influenza capacity which has really grown with the generosity of the American People through congress. So, our coronavirus capacity is relatively small. We built it up a little bit after mers, but were not able to sustain that. So we really appreciate the support from congress to strengthen that Public Health infrastructure, both at cdc and the state. I personally was shocked and i would like to think that im fairly knowledgeable of everything that we instruct and provide for agencies. I was shocked to find out that in the normal appropriations, this 150 million, that that can also be used for cdc facility construction. You know, its a little misleading to say this went for surveillance when the flexibility exists for some of it to go for facility construction. Do you know what portion of the 150 did not go directly to Fund Surveillance . Im not sure what the 150 million line is. I think im going to need to get back to you on that. Our construction renovation appropriations are separate. So i will need to get back to you on that. If you check the appropriations in all appropriations go to cdc, theres an ability to move money from that to construction facilities, and i would encourage appropriators on this committee, especially as we look at Emergency Funding. For god sakes, lets make sure it goes to response and not construction of a campus at this time. I yield back, mr. Chair. Thank you, senator burr. Do you have Something Else . No, just well follow up for the record with the Accurate Information. Senator murray . Thank you. Dr. Hahn, as you heard, im very concerned about the delays in testing. I have people in my state who may have been exposed. They cannot get answers about where to go and Health Officials are telling us that they fear that this virus has been circulating for weeks undetected. We were relieved a month ago when cdc began to ship diagnostic tests to our state and labs but within days many labs reported validation issues with those tests, leading to inconclusive results and cdc worked on remedying that. February 27th cdc began distributing new test kits and at the same time academic, medical Centers Across the country were raising concerns about the lack of ability of diagnostic testing. For example, fda asked labs to at a time when only 15 people in the u. S. Were known to be infected. Fda has worked with labs but press reports indicate the publication of this guidance was delayed within hhs. I was glad to read last night you now believe youll be able to do a million tests by the end of the week but frankly im hearing from professionals that that is unrealistic. So i wanted to ask you, first of all, what happened at the department that created these delays and how can you clarify that that estimate of a million tests is accurate . Thank you, senator. So, first of all, with respect to the timeline and the development of the test, cdc obtains the sequence of the virus. Thats where it starts. And theyre able to develop a test based upon the identification of that sequence. They moved rapidly to develop this pcrbased test as it was just described. We received the validation information around that test on february 3rd and on february 4th we issued the emergency use authorization to allow that test to be used. During the scaleup process, which occurred in the week or so afterwards and sending it out to the Public Health labs, as you mentioned, it was identified at some of the Public Health labs, not all of them, that they werent able to reproduce and validate the test. Cdc heard that information, came to fda and we worked to correct that issue. At the same time, simultaneously, we were working with the private sector to actually scale up the use of the cdcbased test and thats where we came into the most recent estimate to how we can scale up. I understand that. What is the publication delayed, guidance delayed within hhs . Was it, yes or no . No, it was not. It was not delayed . No. Do you really believe 1 million tests will be available by the end of this week . Senator, let me just explain that one. The companies were working with on this, they have the capacity to develop enough test kits to send out by the end of the week. This is a dynamic process. Every day were hearing from additional manufacturers that they can do this. 2500 test kits by the end of the week. That should give us the capacity in the hands of laboratories. Once they validate to perform up to a million tests. 2,500 kits . Kits, and 500 tests per kit. I heard it said the point of where someone goes in to get a test on a rapid we are months away from that, correct . Yes, maam. Im hearing from a lot of people in my state that are really concerned about what they should do if they are infected or if they know they were within range of someone with coronavirus. Right now, the cdcs website says if you suspect you are infected, you should, quote, stay home except to get medical care. Well, right now we know that 27 of private sector workforce in the u. S. Do not have the ability to stay home from work without losing pay or if they have a loved one who is sick. In fact, the u. S. Is only one of two countries that doesnt provide paid leave for personnel illness. If were telling people to stay home, just think about the facility thats been impacted. Its a senior center, lowincome workers there. All of them are being told to stay home for two weeks. Dr. Schuchat i have to ask you, would it be beneficial for a Public Health reason right now while we combat this to have policies in place that make it possible for people to stay home from work without losing a paycheck . Yes, absolutely. Okay. Well, i think thats something we do need to consider with this. Dr. Schuchat i want to ask you also, im very concerned by news reports of hhs staff who are deployed to assist with potentially infected passengers returning from abroad and, despite facetoface contact with passengers, the staff were reportedly not appropriately trained to handle this type of Public Health emergency or in how to wear protective equipment. They were not quarantined, monitored or tested for the virus and some have since taken commercial flight and returned to work. Its not clear to me that hhs took necessary steps to protect staff and the public to, either during this time or after concerns were raised with Senior Leadership about what happened. I suppose dr. Schuchat, what should have been done . I can speak for cdc. We take the health of our workforce very seriously, health and safety, and have predeployment, deployment and post deployment guidance. This is a totally new virus. What i described to you, is that consistent with the protocols . I dont have the full information of that. I believe dr. Kadlik can expand. In particular, woor evaluating what may have been an issue and we owe it to you as well as identified by the whistleblower report to report back to you on that. Mr. Chairman, i would just say that we need people to speak up when they see this situation. It is unacceptable if any of these workers on the front lines are intimidated into staying silent or believe theyll be retaliated against these issues. We have to keep the protection of public first and foremost in our minds and i want this looked at and want to make sure anyone who speaks up is protected. Thank you, senator murray. Senator paul . Dr. Fauci, you mentioned remdesovir. Im interested in that they say its effective against mers in animal models. Do you take that as a good sign it may work in humans, too . I do. With regard to the children its fascinating there arent many cases and i would suspect that it would be improbable theyre not being ininfected, that they have some sort of blanket immunity. One important thing of maybe putting this into perspective, maybe putting a better look on the overall outbreak is if we had numbers. I dont know if someone would suggest to china that they do random testing of kids in a hotbed to see if theres a huge number. If we have 10,000 kids not getting sick or 100 of kids. Rates may not be zero in children but they may be asymptomatic. There are data from a few places that are looking at that. It seems more likely theyre asymptomatic or less symptomatic. I think were going to get some data from the chinese. They actually have been now quite cooperative in sharing data. We had a froop under the ausp auspices of w. H. O. That went to china, individual from cdc and nih, who have now returned and will soon get a good look at the report of what theyve had. And that was one of the questions we asked. As you mentioned, senator, that is a very important issue. With regard to treating the severe and potentially fatal cases in bacterial or viral infections, it seems sometimes its trying to fight off the cause of the infection as well as the bodys response to that. And some bacterial infections, steroids, like with the flesheating strep, sometimes you give massive steroids in the setting of an infection and some of these people survive. In the fatal cases, are they finding that steroids, in addition we dont really have an antiviral treatment. Are they using some steroid treatment in real severe cases and having some success . Theyve done it in an im pchpimpi impiric, noncontrolled way. If had you an antiviral plus steroids might be a different scenario. Thank you. Thats all i have. Thank you, senator paul. Senator casey . Thanks very much. I want to thank the chairman and Ranking Member for the hearing and also, obviously, our witnesses and the expertise and the work by each individual here for many years. I think ill start today with what is the obligation of every elected official in the federal government . Weve got members of the house and the senate, both parties and two in the executive branch, the president and Vice President. The obligation is real simple here, by every elected official. Every one of us is charged with working constructively to at least do the following. Slow the spread of the virus, taking steps to do that, working with all of you, folks you work with. Number two, to support state and local preparedness efforts and, three, provide complete and accurate, always, always Accurate Information to the public to address their concerns about this challenge. I know this committee has worked in a bipartisan fashion on a range of issues for years. Were continuing that today. I appreciate, especially, the work that senator burr has done, working with him as i have for the last number of years in the pandemic preparedness act and the reauthorizations. But weve got to make sure that we do our job, even as were indicating what should come next. I want to start with dr. Kadlec and dr. Schuchat with regard to the tragedy unfolding in the state of washington in Nursing Homes, as senator murray outlined. I guess i want to start with just that venue for this challenge. We know that the early indications suggest that the virus poses a significant and even deadly risk to, number one, older adults, number two, people with disabilities and number three, folks with Underlying Health conditions. The risk is obviously heightened in Nursing Homes where workers dont have the option to distance themselves, residents in particular. Theyre in their home. So theres no staying home to avoid it. And, obviously, the workers have a challenge. So, dr. Schuchat or dr. Kadlec, depending who wants to go first, tell me two things about what the administration is doing. What is the administration doing to protect both, number one, the residents and, number two, the workers in longterm care settings . So ill start and turn it over to dr. Schuchat. As we learn more about this outbreak, and last thursday the chinese posted a fairly significant report on epidemiology that included a record of 44,000 confirmed cases in china, which gave us a pretty good understanding of what are the relative risks, to dr. Faucis point earlier, people over the age of 70 in particular and comorbidities are at risk. From that, saturday ewont steal dr. Schuchats thunder, they released how we could warn and inform people with vulnerabilities and work with them to inform them of those risks and guidelines they can follow, cdc guidelines. Weve been proactive in aggressively trying to respond to this in a way that would ensure we could warn proprietors of those facilities. Its not just longterm care facilities. Its potentially dialysis clinics and other areas where we have Cancer Therapies given where people who are immunologically at risk can be taken care of and shielded from this virus. Dr. Schuchat . Cdc has issued a number of guidance documents and theyve been doing outreach with clinicians and health systems. Through the weekend i spoke many times with cms and the full assets that cms has to help us with this. Those in nursing facilities and acute hospitals have lots of other things going on and the best we can do to protect them from infections acquired there. Its really our responsibility. Just to make a comment, then i have one question for dr. Hahn. You know, weve had a debate about health care and ive been working, as many have, to combat the use of these socalled junk plans. We got a report where a guy got tested for the flu to make sure he didnt have coronavirus. He finds out that his insurance is one of those shortterm limited duration plans, doesnt cover basic testing. You get the picture these junk plans are a problem. I hope this challenge were facing will convince the administration that junk plans or the advancement of junk plans are really dangerous, especially when we face this kind of a threat. Hope they would rethink their regulatory strategy Going Forward. Senator casey, were over time. Just one quick question. Trying to keep you under five minutes. One question on testing. How many people this week can be tested in the United States of america, this week . Senator, that depends upon the deployment by the manufacturer to private companies, Academic Centers, et cetera, and their ability to validate it and do the test. The capacity will be there by the end of the week, but those are the necessary steps to actually get that deployed to the American People. I hope you can get a number on people. Thank you, senator casey. Senator cassidy . Thank you, all. I have several questions so ill ask you to be succinct in your answers. If i interrupt its not to be rude, just to get through them. Cdc, we discussed beforehand. I discovered that the canadians have not been as strict on those returning from Hubei Province. If youre febrile, they quarantine you. If youre not febrile, god bless you, go home, dont infect anybody. What percent of those folks coming from canada, in say Washington State, are actually being screened, either by a questionnaire as to travel history, exposure and or temperature, et cetera . Yeah, i dont have the percent, but weve worked closely with dr. Kadlecs team, u. S. Public Health Service and cdc. Can you give me a ballpark . 10, 15 . A protocol in assessing everybody who is crossing at the keyboarders to alerted to where the flights are coming in and so forth but i cant give you a percentage. It could be as low as 5 . Theres it could be. Are you using cdc using google location data or something similar in terms of tracking contacts . Not for contacts. We are for travel patterns and other means. Go iing to this nursing homen seattle, clearly somebody came who had been exposed to the coronavirus. Law enforcement at the scene of a crime will get a warrant, will ask google to give this data. Weve been reviewing the statutes. So, just to be clear, cdc is not currently using that same sort of thing Law Enforcement is to track contacts . You have to recognize that right now the chances that a person with a fever and cough have coronavirus versus influenza are very low. No, no, my point is if somebody wept to that nursing home and you can follow their location data and it turns out they had a contact with somebody who had traveled to hubei, perhaps in canada, they had gone back and forth, theyre obviously a candidate for being the infector. I would encourage, because i think the answer is no, that you do use that location data. It seems as though that would expedite the epidemiology of how this is being spread throughout the community. Dr. Hahn, those 26 apis that india is not allowing to be exporter, are any of those the ingredient for any of the therapeutic drugs . Senator i dont know the answer to that question. Were going through that list right now to assess the affect on essential medications. Okay. Next, one of the recommendations that senator murphy and i had requesting a drug shortage report that was released last year, recommendation number two, was to establish a Quality Supply chain rating system. Now, should Congress Enact this quickly . Clearly if weve got supply chains overseas that we cant inspect and or they are interdicting the flow of that ingredient to the u. S. And it could be one of these candidate drugs, again, should we now enact that . Senator, we stand behind and are working on the development of this rating system. We also have had some legislative proposals to the president s budget that relate to this. Next, as with regards to the we have a problem with antibiotics in which if you had a really expensive antibiotic for some terribly resistant drug its difficult for us to currently pay for them with capitated payments or dogs to hospitals. We could have the same information with antivirals whereby the antiviral might be very expensive and that would blow the lid off. You see where im going with this. Again, i would Like Congress to act upon this quickly to create some sort of carveout for these essential but expensive drugs to develop. Your thoughts . So, we have implemented the authorities given to us in the gain act and cures act to help with this and we are very much facilitating the development of antibiotics. This would be at the heart of cms. I think we would have to give them the authority. We have a Pilot Project to bridge this gap to the payment side. I defer the payment questions to cms, sir. Dr. Fauci, looking for quick diagnostics, obviously a pcr takes longer than a swab or blood test for igm or igg. How close are we to having an igg or igm blood test that could be quickly turned around in a Community Hospital . I think pretty close. Thats clearly one of the things we want to get. In fact, it would be very important for broader surveillance in the country of exposed people who never come through medical care. I want to finish up by saying this we need to know from yall what authorities we need. We need expanded telehealth with expanded use authority. We need to give appropriate reimbursement. Granted thats all cms. We also need home health. Miss murray was saying how wave got to send people home. I think we need to do something there. And i think thats my question, if you need authority from us, let us know t may be expanded authority that senator burr already referred to but we need to know what else you need. I defer back. Thank you, senator cassidy. Senator murphy . Thank you so much for your service. Thank you for being here today. Dr. Fauci, thank you for your very clear, i think, arthrit articulation this morning for a vaccine. Its pretty extraordinary we have to have our medical and Health Professionals counter message the president of the United States, they have to spend their time trying to correct the record. Weve become normalized to this administrations, this president s Loose Association with the truth, but it becomes particularly dangerous in the middle of a pandemic response. Thank you for being here and sharing facts with us today. We all have lots of questions. Ill try to get in as many as i can. Dr. Hahn, let me follow up on senator cassidys questions about new authorities. One of the things you said in your testimony was that while you feel youve gotten good cooperation from medical device and equipment companies, theyre not required to tell you when theres a shortage. Senator rubio and i sent you a letter, thank you for your response, trying to catalog the shortage areas. Seems like it would be had helpful to have a simple, easy legal requirement that they alert you ahead of time when they see a shortage coming. Senator, thank you for the question. We sent several related proposals as part of the budget and one thing weve learned from this and other shortages, its a very complicated supply chain. The most important thing is redundancy and an effort around advanced manufacturing. Weve had great cooperation. This is complicated. For example, the one drug currently in shortage related to this isnt actually related to an api or the final drug form. Its related to a chemical thats before the active farm suit iccal agreement. The whole supply chain is complicated. More information would be better. Great. I think senator murray asked you a question that you might not have gotten around to answering and its an important one. The right information is key but also setting realistic expectations is key as well. In your estimate by the end of the week there will be a million tests out there does sound a little aggressive, given the fact that weve only tested 3,000 people and new york state is saying their goal is to do 1,000 a day. Tell us why you think by friday of this week were going to have a million tests when thus far weve only done 3,000 . I want to distinguish between the ability to get the test kits out to the laboratories with the ability of the labs to actually do the tests, but we have been working very closely, senator, for the last three or four weeks with all manufacturers, private, economic, et cetera, to build on the platform that cdc has developed. Weve been in touch with this particular manufacturer the last three, four days, reiterated this. We know them well. Theyve estimated theyll be able to scale up to deliver 2,500 kits by the end of the week to providers of the test. Dr. Schuchat, and others can let me ask you, how do we know those are in the right hands . Yeah, thanks. Cdc has been providing the Public Health labs with kits and expects by the end of this week there would be sufficient for 75,000 people to be tested. As you say, not Everyone Needs a test and we dont want to go through all of our tests on low risk situations and not be able to address the care and context that will be critical. We have guidelines for influenza, who needs to seek care, who can stay home, and we broadened what we call person under investigation who needs to be tested not just travel to china but all the other areas and people with severe respiratory disease who dont have an obvious diagnosis should be tested. Many of the cases in Washington State are detected through that or because there was an outbreak being investigated. This question of where these tests end up, and making sure theyre in the right hands will be an important one for us. And you would have oversight. Dr. Schuchat, let me ask you a question about protocols that were recommending to School Districts. One of the biggest disruptions that can happen in a familys life is the closure of a school and, as senator murray pointed out, given the fact that many families have two parents working, thats really difficult for a day, never mind a week. What are the recommendations and protocols that we are telling School Districts about what they should do if they have a child who tests positive, a family member, a teacher who tests positive . Whats the best protocol today . Yeah, thank you. We absolutely recommend a child who is ill should stay home. Whatever they have. So they dont spread. But we have worked closely with local and state Public Health on this issue and essentially decisions about School Dismissals or changes in policies are pretty much locally driven but we provide guidance. What do you use as athe guidance, though . The general principle is to minimize disruption. You have this balance between the earlier you act, the more impact it can have in slowing the spread and the enormous disruption we see with school closures. You may remember in 2009, we saw hundreds of thousands of students sent home in the first couple of weeks of the pandemic. As we learned more about the virus and its spread, we realized that was too disruptive. The virus was relatively mild compared to what we were expecting and we dialed that back and instead to shift from staying home when youre sick, canceling assemblies, changing the patterns of whats done in class but trying to keep classes going because so many depend on School Lunches and other services that are at schools. Its a local decision. If theres too many people sick, of course, you cant keep going but trying to protect the vulnerable and rerus the spread but not affect all those families if their children are home. Thats such an important answer. I hope everyone will try to stick to five minutes so we can allow all senators to ask their questions. Senator roberts . I think i can do that. Right off the bat you asked my question and got a pretty good answer. And senator jones stole my rural question. Bob casey sumed up where we ought to be. The distinguished Ranking Member said look, we ought to get this money appropriated, get it to the president. The president , by the way, said whatever figure you give me, ill take it. Well work with it. And i just want to thank you both. You indicated we needed information that exists. I think were doing that in this process, largely because of the wonderful job that these witnesses do. And i want to thank senator murray for that. This is a very unique committee, along with the sometimes powerful Senate Agriculture committee. We are bipartisan. Theres a lot of partisan elbows out there right now. We dont need to politicize a pandemic. I would recommend that we monitor what people say and i would yield to the chairman for that decision, along with the Ranking Member. And maybe we ought to quarantine people for 14 days if they just shut up about the politics. We can do better. I think we need to get the funding to the president and lets get these kids out. A million at the end of the w k week, thats good progress. Dr. Schuchat and dr. Kadlec, i do want to underscore, again, our rural areas. We have 83 critical access hospitals in kansas. Probably that will be reduced simply because of whats go iin on. Were older. Lot of Nursing Homes. Lot of longterm care enterprises. Thats just ripe for this kind of thing. I might point out in the senate quite a few people have reached that age as well i hope we can follow the chart that the good senator has suggested. I think thats an awfully good thing. I want to say one other thing. Part of our job is to stand with you and stand behind you when youre taking the bows. All of you should take a bow. And i think we ought to have this situation where we have your back, not so much criticize. Were trying to work with you. Were going to get this done. We are going to get this done. I would say, mr. Chairman, that in todays wall street journal last summer for seven bucks, 7. 85 where is that . Get this for 7. 85. If you want to go to amazon today its 114. 97. Ill give it to you for 50. If you bought a litter a litter. A liter of this it was 14. Now its 229. Thats ridiculous. I guess thats the supply demand situation that amazon thinks would be the case. I wanted to ask one other thing. The term that i was a lot of people are confused about is Community Spread. Spread is a verb, but it doesnt say that the whole community that this disease will spread throughout the community. It just indicates theres one person where we dont know where the source was. Is that correct . Yeah, thats right. Were really differentiating it from spread from a close contact or travel associated. It doesnt mean the whole community is affected. What it really means is that if we threw enormous resources at it, we could probably map out each of the listeningnks, but ie important to go from mantoman to zone to see that community recognition, to put the most effort where it can be the most impactful and perhaps less on the individual Contact Tracing and more on the readying the Health Care System, readying the schools and so forth. I thank you very much. I yield back. Senator roberts, you did a better job of asking your own question than i did. So, thank you for doing that. Senator kaine . Thank you, mr. Chair. I express condolences about the tornadoes in tennessee yesterday that were devastating. Thank you. I want to thank the witnesses and thank the chair and ranking. This committee has had a number of round table sessions, and these witnesses have been here and presented to us. The first one was on the 24th of january. Thats positive. I will say when we had that briefing on the 24th, and weve had briefings since. And when the white house appointed the special committee on the 29th, it made me surprised when i looked at the president s budget that came to us on the 10th of february to see that in that budget there was a 52 proposed cut to the world health organization, and cuts between 5 and 10 to the nih, cdc and overall hhs budget. It does not seem to me to be a wise time to take a scalpel or a meat ax to the Public Health infrastructure. I hope as were looking at what we do from an appropriations standpoint, not only coronavirus, but looking at the pieces of the budget that fund the Public Health structure, so we dont do damage to that at this time similarly. The budget contains significant cuts to medicaid. Although its described somewhat euphamistically, its clear that people in states that have adopted medical expansion or the Affordable Care act, it will affect those. The Supreme Court announced yesterday it will take up a case later this year. It is not a good time it is not a good time to take a meat ax or scalpel to the Public Health infrastructure. It is not a good time to scare people about whether or who the theyre going to have health insurance. Im not sure there is a good time to do that, but you could not do it at a worst time as when people are concerned about a pandemic. Senator fauci, i was looking forward to your presentations at the senate lunches. During this meet iing, i got a notice, i dont know if its accurate, that you will no longer be presenting at the democratic lunch. Is that accurate . To my knowledge, no. Im planning on leaving here and being at both lunches. This is what my right . What . Im just told its changed but i dont know why. So i just want to be clear about this. It was notified yesterday that you and the Vice President would be presenting to the democratic and republican lunches. I got a note from the democratic leader that came into all of us around 9 25 that said you would no longer be presenting that ambassador birch would be presenting. Thats the first of what you just heard of this right now . What you just mentioned is the first ive heard. Any idea why youve been disinvited to the lunches . I dont know. I will say that is not a confidence builder. It is not a confidence builder when the person who let me finish when the person who we have a lot of faith in, in really knowing this stuff, who has done it for president s, for both parties for decades, who has advertised is coming to advise us to lunch, were now notified were not coming to lunch. One question but im sorry. You took me by surprise. Am i going . Im going. I thought your staff told you, you werent going 30 seconds ago. What is the answer to this . I am . I am invited, yes. So, why did your staff tell you that you were not invited and then 30 seconds later change it . Am i that persuasive . No, i dont well see what happens. Yeah. Its not a confidence build er, i will say. Its not a confidence builder. Let me ask about a population that is significant in virginia, which is the military. We dont have a d. O. D. Person here but i know you must be working in tandem. A lot of virginians are employed in vincenza, italy, in sicily, italy. Two other countries where theres significant coronavirus. My understanding, at least at the vicenza base, families are being urged to stay on base. Let me talk about your interaction, any of you who deal with this, interaction with the d. O. D. , are we likely to see more of this . Is there a quarantine or stay on the base in south korea, are we likely to see it in germany . Thats the last question i have. First of all, my interaction with d. O. D. Is daily. We basically have a call at 12 00 with the entire enterprise, Office Secretary of defense, logistic agency. What theyre doing is basically abiding by cdcs rules and guidelines in these circumstances. Obviously base circumstance is different, particularly overseas, where you have the means to basically isolate the population on there. Are we doing onbase please stay on base other than in vincenza right now . I dont know the particulars of that, of that base. We can certainly get ill ask. They do conform with cdcs guidelines and what should be done to protect their members. My time is expired. Thank you, senator kaine. Senator romney . Thank you, mr. Chairman. I appreciate the work thats been done in our Public Health community and in our country to delay the arrival of covid19 into the United States. While so many other countries have seen so many cases, whether its italy, iran, south decreea japan, that weve been able to delay t clearly you cant keep it away forever and we have the Community Transmission, which you predicted. I want to turn to whether we as congress and the administration, republican and democrat, have done enough to prepare protective equipment for medical professionals and our public at large. I wont point it at anybody. This isnt you. Its us responsible for funding. Given the fact that our medical professionals need masks, gowns, gloves and so forth, what percent of what would be needed by medical professionals if we were to have a fullblown pandemic . And i hope we dont but if we were to have one, what percentage of what we need for medical professionals is in the strategic stockpile . I can give you a rough idea. 10 of what we need right now if it were to be a severe event yield need 3. 5 billion in respirators. We have about 35 million. So about 10 . 10 and were working actively in that. Thats the area ive been most concerned and it strikes me we should have substantially more than 10 of what would be needed for a substantial pandemic. We should have that in stock. I cant believe we congress. Im not blaming the administration. This is congress, in appropriating, and prior administrations as well, that should be in place. Do masks help for the general public . Say we have a major pandemic and people are concerned. Theyre going to the grocery store. They know other people there might be infected. Do masks actually help . Do they prevent or reduce the likelihood of being exposed to the disease, dr. Fauci . It depends on the mask. If you look n95 masks are better than those sort of floppy masks. In general right now the question youre asking im really asking if we were to have a major outbreak of some kind. The most important thing for a mask would be if someone is infected, to prevent them from infecting others. The other is the health care provider, to protect them. Of course. The general public who could wear them, that could certainly prevent gross droplets from going when someone sneezes and coughs on you, but it doesnt provide the kind of protection that people think it does. So, therefore, there are some down sides because people keep fussing with the masks. Better than nothing . Yeah. Do we have masks in our strategic stockpile for the general public . We do not, okay. Turn to aircraft. If someone on an aircraft is infected and sneezes, how many people are going to be exposed to that disease . Is it just a couple of people, people sitting next to them . Is it the whole aircraft . For this kind of virus, were thinking just the couple rows around it. For other types of infections, it might be broader. Should our flight instructors tell them if you cough or sneeze you should cough into fabric or your sleeve . I keep going into an airplane. Someone coughs or sneezes and i hear it barking out. Its like my goodness in a condition like this, just the general flu. The fact that we have the flu going on and colds, should we not be telling people on airplanes, you may not cough and sneeze unless youre covering your mouth . I think i know the answer to that. And let me ask this, another question. Lets say we do get a vaccine that tests positively and so forth and goes through phase one and phase two Clinical Trials. What does it take to get a major production done . How long does it take to actually kick the production up and how long does that take and who does that . Who is doing the manufacturing once we know this is a vaccine that works . Very good question, senator. That was one of the things that was discussed yesterday when the president and Vice President brought in the ceos of a number of companies. And thats really important, because what i was talking about a year to a year and a half, if you dont have the Production Capacity to make tens and tens of millions of doses, it may take even longer. And the ones who can do that, essentially, are the pharmaceutical companies. The federal government is not going to be able to make hundreds of millions of doses. Its going to have to be partnership with the private sector. Do we have that capacity in the United States . Is this capacity outside the u. S. . I guess the question im looking for is whether legislatively or from an appropriations standpoint we should provide funding to have the capacity to make large numbers of vaccines. We should have that capacity in the u. S. And have it ready at the go in case if this isnt the pandemic were worried about, if another one comes down the road. Is this something we should have ready to go . Yes, sir. Right now the only capacity we have is a production which wouldnt be relevant to the vaccine candidate or candidates we at barta are pursuing. We would have a longer than a sixmonth wait to produce vaccine vaccines on scale. Okay. I want to underscore that that is an area we ought to consider making an investment in. Thank you, mr. Chairman. Thank you, senator romney. Senator smith . Thank you very much. I want to thank, again, all of you for being here today and extend my thanks to your amazingly hardworking professional staff who i can only imagine have just been going nonstop for months now. So, thank you. I want to start by asking a question about sort of the misinformation and flatout falsehoods that have about the coronavirus that has been circulating and amplified. You know, i worry that its being amplified for political reasons to the point of senator roberts and others, that we dont want to politicize this. What is the impact of this misinformation and what should we do about it . Im looking at dr. Sc huchltchat and dr. Fauci in particular. Its embarrassing to go through all the things that have been said on National Media including, honestly, by our president. Dr. Fauci, its not true, is it, that this is just like a common cold and that we can expect this is going to be gone when the weather warms up. Is that true, or not . Let me explain. In general, respiratory illnesses, such as the prototypical influenza virus, are seasonal. Had when it gets warmer in march, april and may, youll see a mark, diminution. The same holds this could happen with this but we dont know. This is a brand new virus with which we have no experience. Even though the concept when warm weather comes many respiratory virus diminished, we have no guarantee that this is going to happen this large. It may come back again. It is conceivable given the degree and efficiency of transmittablety of this virus that we may have a cycle. It may come and be seasonable and come back. Thats quite possible. We dont know that but thats possible. We heard so much misinformation and it has been said this virus is developed as a tool to develop an economic tool against the United States. It has been said this is part of a strategy to bring down the economy, it is ridiculous. Can you as public official comment why this makes it difficult for us to address this epidemic and what we should do to combat this kind of misinformation. I think we need to speak out often and loudly about how n nonsense this is. This is not new with coronavirus. There are also new theory of disease. I am thinking back now of 37 years ago i sat in this room trying to explain to the committee then that hiv was not a virus that was developed by the cia to eliminate certain population. It is crazy, this is what happens when you have outbreaks. There is a lot of misinformation. My point is there is consequence that makes it difficult for Public Health officials to respond and take care of the population and the ways that we need to. I am asking another issue thats extremely important at home. Theyre worried of whats going to happen that theyre going to be experiencing as they try to address the coronavirus on top of Everything Else theyre addressing. My question is it is not only a question of getting the diagnostic tests out so people can respond but also these labs need to have people in order to do the testing. Because it is not like they are sitting around with nothing to do right now. Public health labs are short staff on a good day. You bring out the point it is not just Public Health but all the things they do. They are busy with Contact Tracing and following up on the people who travel and who they are supposed to follow. This type of evolving situation we really need to put the most effort where we can do the most good and not get distracted with small things. It is also why it is so important as we work in these emergency appropriations making sure these department are doing the work they already have done. Absolutely. They have sufficient dollars so they have not dipping into money they would have gotten any way to do the work they dont have the fund to do right now. Great, thank you senator smith. Senator scott. The one thing i am not concerned about is whether or not congress will provide the resources in a timely manner facing with the coronavirus. What will happen if i do think we have not had a lot of conversations about putting this virus into context. Context where the average person in this nation can digest quickly and understand the actual risks that are associated with the virus. Whether it is 2003 sars or 2009 swine flu or rather flu season of the number of people have died because of the flu. I appreciate if you take the time to help us and put into context, 80 of the people would experience if they were infected by the coronavirus that seems to be a fever or the cough. If it is, please let me know. The 20 folks who are elderly and may have disabilities that may be at a heighten risk. If you would just use my three minutes that i have left by the time i finish with my opening comments help me and the rest of the folks in South Carolina who are seeing this issue on every screen and oftentimes see it from my perspective hyped up in a way that it is not helpful. I will close with this. I think there are those who are alarmists and who are really painting a picture thats very difficult to digest and those who are acting with a sense of urgency. Can you help me understand this situatio situation . Senator scott, i can address the regulatory issue. We have worked with agencies and help with diagnostics in support of these terrific Public Health colleagues. Sir, i am going to yield my time. My job is to think of the worse case so i will let them talk about the real case. Senator scott, you bring up a good point. It has to do with what you consider relative risks and how that relates to the unknown. The thing about whats going on now is that since it is a new virus we dont really know where it is going to go. If you look at the disease burden, morbidity and mortality, every single year influenza does a significant amount of health damage, not only to our country but to the rest of the world. The thing about influenza is that although there are many things that are unpredictable. We kind of know the bracket of how many people are going to get sick and how many people are going to die. It is tragic, it is death and suffering, we dont like it. We kind of know. When you are in the area of unknown, you have to walk in the delegate bound. It is not under shooting and being in a situation where you dont respond as aggressively as you should. A sense of urgency. Just to add while in a Large Population most people who get infected will probably have very mild symptoms. Some will have severe illness, pneumonia and be critically ill. Whats unknown is what the full total will be. Will we have many more cases a year than we have with flu which would be difficult to handle or will we be able to slow the spread and protect the Healthcare System. It is this balance that doctor mentions that not over reacting but not under reacting. The risk of under reacting could be that we have second and third order complications. We dont want the Healthcare System flooded of people who dont need to be there. We need to build it up. If this is a bad flu, we need to build up that Healthcare System. Out of the 90,000 cases, how many deaths . Right now in the 3,000. I would send my comment with mr. Chairman. I think 3,000 deaths should get everyones attention and we should act a sense of urgency but not buy into the hysteria thatll make it more difficult for Healthcare Providers to have the resources for those folks to walk in the hospitals and giving assistance. Thank you, chair member murray. Thank you to the panelists and your entire team. You have all been working tirelessly and we know that and we are grateful. I want to get the issue with diagnostic Testing Capacity. What is clear at this point is that the domestic Testing Capacity has been significantly lower here in the United States and what we have seen in countries like south korea and italy. So doctor, are you confident that the policies put in place by the cdc and fda over the past few days will allow states to test for coronavirus at a level of what this rapidly evolving outbreak requires . I am optimistic but i want to remain humble. We see an emergiing Infectious Disease surprises. They tell me they have to do two tests per patients because if you get a negative, you are going to retest the next day. We are still having to send tests into the cdc for confirmation even when we do them at the state level. That should be very soon. State by state as they verify their procedures and we work closely with fda to expedite that. What appe in order to meet the demand of diagnostic testings across the country. Not to my knowledge. I am concerned that the delays in test kits being available means we dont have a full sense of the scope of the problem. I mean if we cant test everybody who has these symptoms yet, we may not know what the full scope is. Having an accurate accounting of problem we face critical for your ongoing preparedness. How has our limiting diagnostic Testing Capacity impacted your response efforts and what steps are you taking to mitigate those challenges . Thats not something that i am involved with but i am happy to give you an opinion with that. You would want to have as many tests as you need. Thats what the cdc is ramping up in collaboration with the state and local health department. The first level is to get individuals and multiple states, they started off with six and there would be more if i am not mistaken to be able to test people who come in with symptom that is would be suggested of respiratory illness or flu or coronavirus, if they dont have the flu it is determined tsa coronavirus. What have we improve and get better at that capacity, well have a much more accurate assessment of whats going on in the community. Thank you. I think the thing is one is a trigger in terms of action how do you respond in early warning. One of the things the cdc have been doing is using its Influenza Network and the test they do there to test broadly deceased surveillance. In terms of understanding whats circulating of this virus, in terms of being able to detect antibodies in peoples blood to understand whats in the denominator of people who may be syst symptomatic. Basically trying to develop a diagnostic to advance it. I have another question to get to. We are doing that Community Surveillance in the six cities and hope to expand it broader so we see what the tip of the iceberg really is. I want to turn to commissioner hahn for a moment. The fda has an Important Role to play. As you know your announcement regarding an unnamed and now you said you could not name it and for those of us who ourselves or have loved ones who have multiple medications of a shortage but we dont know it is ours. Yesterday you stated that the u. S. Labs could perform up to 1 million tests this week while Public Health experts hope to see u. S. Labs complete 10,000 tests per day and tests take time and they take staffs. I understand it is fast moving but it does seem to me like fdas messaging is confusing and at times contradictory over the past few days. I am overtime, i wont ask you to respond right now. I would urge you and perhaps we can have this conversation to get a process in place so that you are making sure that your communications are clear to the public and that theyre integrated and i look forward to have that conversation with you. Thank you, chairman alexander, Ranking Member murray. Chairman alexander, i want to express my condolences in your state for the loss of the tornado this morning. I know we are monitoring that situation. Thank you all for your time today. If you look at where we are right now in terms of capacity of preparedness for response. We come a long way. We need to continue to innovate. Your agency taken significance strive to improve our health capacity. What can we do however to ensure that the private sector supports the response and in these situations Going Forward they can quickly reach the American People . Sure, i can start. We have been taking steps to reach out the private Sector Community and just yesterday i was on a call with over a thousand companies about what this epidemic means to them. A few of us met with the pharmaceutical industry yesterday and a number of Big Companies about both drugs that are therapeutic and knowing that you are from georgia, we have a phenomenal collaboration with georgia tech and they help us modernize the challenges that plagued the Public Health. I was encouraged by the enthusiasm of the ceos of the pharmaceutical companies yesterday when we met at the cabinet room in the white house. It was gratifying to see they were really wanted to do anything they could to help with us. As i mention in response of the previous question, we are not going to get the kind of production of interventions unless we partner with pharmaceutical companies. I want you to comment one thing. Two things they are looking specifically innovations around medical counter measures. We met with 1500 Companies Looking for particular things, diagnostics to work on this and looking for the supply chain issues as it leads to pharmaceuticals. We have been working with pharmaceuticals and vaccines, the development of products to address this outbreak. Thank you all. Senator baldwin. Thank you, mr. Chairman. I want to start with the idea that we have the emergency spending bill going into congress quite rapidly and some of the issues have been raised, i am hoping it wiing well prop address those in this appropriation bill but also being able to follow up and make sure the right policies are in pla place. So i want to start with a discussion that we have been having about domestic production, things that are essential in fighting epidemic. I remember in my former life as a member of the house of representatives, an instance where one of the manufactures flu vaccine in england was shutdown and there was a shortage. There was a lot of worries and we ration the flu vaccine that year and changed the standards of who should seek one and who should not. I remember also in the year that i believe we were fearing of a serious strain of flu inquiring about our domestic protection capacity for the flu vaccine and we had none. Should we assume if we have put in an order with foreign manufacture for however many doses but there is a huge break out in that foreign country that they would come and do that for their own health purposes. The answer i got at the time was yes. That would be a safe assumption on policymaker. As we move forward, i hope appropriation funds to address this. I hope we assure that we dont make those mistakes again. I think i heard all of you testify that having domestic capacity is very crucial in this. Am i correct . The second thing i want to get into is we talked about lab and Testing Capacity in the u. S. I am not sure we are all agreeing on the meaning of the words and things. When i heard the interchange from senatorsenators, igg to immonglobin and igm and iga, he was talking about can we have that test soon. Thats a blood test if i recall. Cdc is using a threesample test, is that correct . It has a nasal swab, threoat swb and a nose swab . We have been developing logic tests for those antibodies that dr. Cassidy was talking about, igg or igm. Thats the population level to understand whos already immune and how much diseases there have been. I want to get in a couple of questions. Can i assume that we are going to have a pcr test for a while . Pcr is a key tool for a while with private sector and Public Sector and potentially a point of care somehow. I want to get into the lab capacity. We talk about Public Health labs and Clinical Labs and epidemic labs and private labs. I dont know if those are four separate classes of labs. If they are. I want to add one other idea if we need to surge our capacity for testing. That is i am aware of veterinariveterinary labs that look at the same sort of tests but theyre not looking at humans. Theyre looking at pest at veterina veterinary clinics, the fish and Wildlife Service also study infections. If there were an emergency, i dont know if you ever thought of tapping into that capacity. I am thinking particularly of the skills work force that deals with you know level three labs and etcetera, that may be a crazy idea or if it is not. I hope you discuss it and think about it if we need to have a surge in our capacity to surveil the transmission of this disease. Thank you, senator baldwin. Senator collins. Thank you, mr. Chairman. Dr. Hahn. I am going to follow up the first question that senator baldwin raised with you. The fda reported its first coronavirus related drug shortage last week and this morning you indicated that india has restricted a number of active pharmaceutical ingredients. The fda has testifiieied previoy that only 28 of the manufacturing facilities making apis to supply the u. S. Market are located in our country by contrast the remaining 72 of api manufactures supplying our American Market are overseas and 13 are in china. You and i have discussed previously the legislation that i have introduced with senator smith, mitigating emergency drug shortages which have been endorsed by more than 50 organizations since our bill contains new reporting requirements that would help fda gain greater disabilities into the drug supply chain including where certain critical drugs are manufactured and pharmaceutical ingredients and manufacturing con t contingency and redundancy plan. Do you believe the concept including in our legislation, our drug shortage bill that i have introduced with senator smith would be helpful . Senatsenator, thank you for question. We appreciate your leadership on this issue. This is an ongoing problem prior to the coronavirus and continued to be highlighted by what we have seen over the last few weeks. Tl agency tot the agency totally shares your goals of mitigating, we look forward to working with you on that. With respect to your particular bill, you know well be generating written response for that so we can provide Technical Assistance and we look forward to working on that bill with you senator. With respect to the one drug that you mentioned that we last announced was in short supply because of the coronavirus outbreak. We have not mentioned this before and again this morning, we have listed that on our drug shortage list, thats available to the American Public and the american providers and have done so since the beginning of the time when we identified it as a shortage. Thank you, i am hopeful that we may be able to move that bipartisan bill. In Mainland China, the coronavirus case fatality rate among older patients is significantly higher, the estimate that i see is 15 of patients 80 and older do not compare compares to just over 2 in the general population of patients. In addition to the figure from china there is a tragic situation evolving in Washington State regarding the spread of the virus and a longterm care facility. This is a particular interest maybe because i represent the state thats the oldest in the nation by median age and i share the senate age in committee. I know senator casey brought this up generally with you as well. My question for you is what is the administration doing and what is the cdc doing in all aspects of response to ensure that we had best practices in assisted living facilities and nursing home of longterm care facilities. Thank you so much for that question. I can speak regularly to the administrator who are extremely concerned about this as well. They are using their field staff to make sure our practices around the country are best practices suited for this. Infection control is always an issue of the Different Levels of healthcare. And elderly are vulnerable to respiratory viruses. We see it the same in influenza as well that the elderly are very vulnerable. Thank you, last round of questions so our respected professionals may go have lunch with United States senators and well be able to finish at 12 30. I will call on senator murray for any questions or comments. Well wrap up by about 12 30 so you can leave. Senator rosen. Thank you all for bringing this hearing here and thank you for your roundtheclock work on this. We are grateful for lifetime of work and care in this avenue. I want to speak about the issue of access and capacity and how we can use telehealth. Many of our constituents are worried of the spread of coronavirus and they are questions of their own health. The symptoms can present like a cold or the flu, i can only imagine what people see in the news theyre foing going to see care. In nevada we have large area of rural population far away from city centers and an increase in those seeking care and having to travel is not only hard on them but creates a burden on the system. So depending on how easy this fire spread. How can we use telehealth to help people in their own home. What are your recommendations . I have a twopart question addressing telehealth . Do you have plans operating hotlines or screenings through a telehealth hub so people can be referred to their care places if needed. We had more lawyers than we had Healthy People trying to figure out how to do that. Most of the health men have been worked out. We have been contacted with a number of people that are adapted there. The nurse triage line for their state or clinically covered individuals. We have been working with telehealth with other parts of the government to understand what kind of approaches are appropriate in the rural area and what the coverage will be. Thats one of the things that cms has been looking for. We funded two programs, Disaster Response system. In nebraska looking at the nuances of how we can use telehealth to expand outreach and evaluating whether it is illegal or practical limb natio limitations to that. Considering this could be Global Pandemic or we have other regional issues or rural issues. I would not want insurance to be a barrier for someone being able to access telehealth hub or get the care. Democrat or republican or old or young and etcetera and etcetera, how do we address this issue of people feeling they could not call or use this because of insurance limitations . I can say the strategy that we are thinking through at cdc is really trying to identify the right level of care for the right situation whether it is telehealth or nurse health line. The circumstances that we could see keeping people out of the Healthcare System physically could be in everybodys interests to preserve it to people who need it most. The insurance issue in pandemic would be some what different. I would like to add in in declaring disaster, we had the opportunity to declare individuals as National Disaster medical system. Patients get reimbursed or providers getting reimbursed to 110 medicare rates. It would be interesting to see how you can evaluate of pandemic or something of this sort. These are conversations with cms to understand that could be utilized in this way. It would be impactful negatively or positively if we dont address it in the right way. Understanding that, what Additional Resources or what should we be looking at as we are going to be voting on some funding or resources hopefully this week or next week that you would need to to address this issue. Can i get back to you on that . Thank you. I yield back. Thank you very much. Senator rosen. Senator murray. Mr. Chairman, thank you for having the hearing. I do have to ask each one of you because this is a serious challenge. We are seeing impact of my state and even though it may not be a serious illness for each individual that has had it, they can come into contact with somebody thats medically fragile so containing it is critical. I think it is important right now and i am concerned that people trust the information that they are hearing so they do the right thing for themselves and the community. Where do you turn for trusted information, experts like all of you and thats who people need to be listening to. I think you have heard the concerns expressed here that the president has made some statements contradicting all of you and the media covering this. I think it is important for us to hear all of you yes or no. Can the American People count on you to be 100 transparent on this virus and the governments response even if you have to contradict a tweet or something someone says . Yes. Absolutely. Yes. Yes, senator thank you. And we need to count on that because this virus is moving quickly and we are seeing it in my state and well see it in another. Families across the country watching the latest news and worried of the threat of this coronavirus. I am really glad that we are taking the opportunity in this committee to ask some of these urgent questions that i have been hearing from home. Well talk about what we are doing as well and how we can prepare for this. We have now learned of the first full closure of a federal facility due to this virus, it is a dhs center in Washington State. It was closed a short time ago. It really is clear by the minute just how serious this is for people in my state of washington as well as the rest of the country. This administration as you all know some answers of the coronavirus and theyre going to keep hearing from me until i get the answers including from Vice President pence shortly and several of you. This is critical and we need to stay on top of it. I want to say again thank you, senator alexander, he says he and i have been holding bipartisan meetings on this. We want to continue to work together, having that information, i cant tell you how important it is for the people of my state in washington. We need to get these tests out. People need to know answers. There are realtime decisions being made right now in my home state about school chllosures a whether to go to entertainment and what businesses should be telling people and these numbers are going to grow and more intense. We are counting on all of you. Thank you, senator murray. At a time when we are not in a middle of now, i want to have more discussion about the extent on what we rely on our countries for our medical supplies and medicines of what we should be doing about it that we are not. It is an interesting twist. We have importing prescription drugs. I have often thought that the way we talk about that is all mixed up. We import a lot of drugs as we now see. The difference is theyre manufactured under fda supervision and they have a supply line to make sure they are safe. When we do that, we have a lot of drugs that are made overseas. So maybe the National Academy should do a study on this. I have talked to some other senators who are concerned about it. One of the areas this committee should look at and several senators have mentioned it is the extent of which we rely on other countries and soul sources of supply. Chickfila sells mac and cheese, it does not have one source of mac and cheese, it has at least two to mistake sure ak does not run out. We certainly should do the same. I want to endorse what senator murray says about our appreciation for years, telling us the truth and giving us Accurate Information of whats going on. We believe you do that. Thats why we have such respect for you and your professionalism. Thats why you are here today, this hearing is all about how we provide Accurate Information to the American People so they can no what to do and how we provide Accurate Information to congress so we know what else we need to do. We expect you to tell us that whether it is unpleasant news or not. We thank you for your professionalism and your extra hours during this period of time. Thank you for coming today. I read at the beginning at the front of the New York Times on sunday, most experts agree the United States is among the best country best prepared or managing such an epidemic. Your Performance Today suggests why it is true. Members may submit additional questions within that time they would like. Thank you for being here. The committee will stand adjourned. Tomorrow the Senate Commerce and science and transportation subcommittee will hold a hearing on Infectious Diseases. Listen live on our free cspan radio app. You can access all of our recent coverage on the cspan home page. It includes hearings and briefings and regularly updated to. Go to cspan. Org and click on the virus link. Watch our Live Campaign 2020 super tuesday coverage of the president ial primaries and caucuses from 14 states including alabama, california, colorado, maine, massachusetts and minnesota and north carolina, oklahoma, tennessee, texas, and utah and vermont and virginia. Candidates speeches and results, coverage begins today live at 7 00 p. M. Eastern on cspan at c span. Org or listen to where you are. During this election season, the candidates beyond the talking points are only revealed overtime. Since you cant be everywhere, there is cspan. Our campaign 2020 Program Different from all political coverage for one simple reason. It is cspan. We brought you your unfiltered view of government everyday since 1979. This year we are bringing you an unfiltered view of the people seeking to stir that coverage this november. In other words, your future. So this election season, go deep, direct and unfiltered. See the biggest picture for yourself and make up your own line. Campaign 2020. Brought to you as a Public Service from your television provider. Also last week house leaders participated in the dedication ceremony of the oversight and Reform Committee hearing room as the elijah e. Cummings room, in honor of the late chair passed away in october. Go