Officials are asked about the federal governments response to the spread of coronavirus. We will hear from the director at this security meeting. The committee will come to order. The committee is meeting to receive testimony about confronting the coronavirus. Without objection, the chair is authorized to declare the committee in recess at any point. Good morning. Today the committees meeting to hear from medical experts about how our country can best confront the coronavirus. Americans are justifiably concerned about the virus, which has spread around the world and claimed the lives of thousands. Understandably, they have questions about how it might affect them, their loved ones and communities. How concerned do we need to be about the virus . Who is most at risk . What can communities do to prepare . What can americans do to protect themselves and their families . What is the federal government doing . What more should it be doing . When might we have a vaccine or other treatment . My constituents are looking to the federal government for leadership, guidance and i amtise and i share my sure my constituents are two. I am concerned the Trump Administration has downplayed the threat, overstated how close scientists are to developing a vaccine and silenced experts who disagree with them. We must acknowledge the threat and allow doctors and scientists to offer candid assessments of the situation and direct a federal response. We are fortunate to have a distinguished panel of physicians to offer their Expert Opinion today. I look forward to hearing from them about what the federal government must do to stop support state and local efforts and protect the lives of americans. Input like theres will absolutely be essential to confronting this threat and i appreciate their willingness to join us today. Comes,e Ranking Member we will allow him an opportunity to read his statement into the record. I welcome forward our panel of witnesses. Dr. Tom inglesby is the director of the center for Health Security of the Johns Hopkins Bloomberg School of Public Health. His work is internationally recognized in the fields of preparedness, pandemic and emerging Infectious Disease, and response to biological threats. I now recognize the gentlelady from illinois to introduce our next witness. Dr. Ezike. O welcome she is a pediatrician who has dedicated her career for Health Care Access to the people of illinois. She has served in Public Health roles for the last 15 years in my home state in illinois. She received her undergraduate degree from harvard. She completed her internship at rush medical center, where she is a professor of pediatrics. I want to thank her and her team for working aroundtheclock to deal with the coronavirus outbreaks in illinois and to take the time to share her expertise with us. Have dr. Julie g erberding. Serves astly executive Vice President and chief patent officer for a Strategic Communications Global Public policy. She is cochair for the center of strategic and International Studies commission on strengthening americas Health Security. Witnesssjection, the full statement will be inserted in the record. I would like to defer to the Ranking Member for an Opening Statement. I apologize for being late. I have two hearings going on simultaneously. This is a great panel. Our hearts go out to those who have lost loved ones and those currently undergoing treatment. This is a global event that requires global response. Many of our National Partners are working diligently as part of a united effort to understand and address the spread of covid19. Some actions taken by other countries might have hindered a comprehensive response to this virus. I remain concerned chinese officials withheld information from the International Community in the most critical stages of this outbreak. My deepest concern at the moment is the level of preparedness at the state and local level. I have heard from responders and medical profession ares that are dealing with an increasingly concerned public. We have a distinguished panel of medical professionals. I am interesting im interested to hear what we need from the federal government to deal with this crisis. Director of the cdc for most of the Bush Administration is here. She has led an effective response. She has managed more than other 40 Emergency Responses. I am interested in hearing about her experiences. Finally, i am interested in the panels assessment of the risk of the virus. Invaluable ors reassuring the public in times like this. It is important for political leaders to avoid fanning the flames of hysteria. Our job is to support the medical community. That is why i am pleased we will be considering his supplemental appropriations bill today. Hopefully this will help speed along important treatment resources that will alleviate this crisis. I have one request that we enter this into the record. Without objection. Each witness to summarize his or her statement in five minutes beginning with dr. Inglesby. Thank you for the chance to testify today about cobit 19. Covid19. Dr. Inglesby im director for the Johns Hopkins university. Covid19 started in wuhan, china. As of yesterday, it has infected between 85,000 and 90,000 cases worldwide. Patients have become sick with covid19 have cough, fever, and the more serious cases underlying viral pneumonia. In a china, approximately 80 of those with the illness had mild symptoms. 15 required hospitalization. And 5 developed critical illness. The virus has a one to 14day incubation period and spread by respiratory droplets with people in close contact. And elderly and those with underlying conditions are at highest risk. As of yesterday, the u. S. Had confirmed 118 cases of covid19 including eight deaths. The majority of those cases are returning travelers or repatriated persons from china but there is no connection between any known case of covid19 which suggests that in those places there is some level of Community Transmission of covid going on. An emergency supplemental going on between congress and the administration. 20142015, congress appropriated 5. 4 billion for the ebola response. In my view, covid19 will require twice as much or more given its respiratory transmission and the likelihood that it is going to be widespread around the country and so all jurisdictions will need to prepare and respond. Health care systems should be planning to provide care for large numbers of critically ill patients, as weve seen has been required in china and south korea and italy. They will also need very strong Infection Control strategies, including access to personal protective equipment as well as other kinds of engineering and administrative controls and hospitals. The federal government should be engaging at the highest level of industry regarding p. P. E. Manufacturing and maximizing supply of this critical medical material. Steps should be taken to make sure that routine medical care is not disrupted, as it has been in china, where we saw clinics entirely unrelated to covid19 were disrupted, including cancer clinics, dialysis clinics, and other important medical facilities. Public Health Agencies are working to isolate suspected cases around the country and help ensure highrisk contacts. If cases increase significantly, it may no longer be possible to isolate all cases and contacts and there may need to be a shift, probably will need to be a shift in strategy, and at that point, Public Health agencies will need to focus on surveying the population for the overall level of covid19, advising how the public can be tested, and how it needs to be isolated when sick and working with political leaders at the state and local level to consider social distancing policies that will do more good than harm. C. D. C. Has been doing all lab testing until this week, but testing is going getting in Public Health labs around the country. I believe we will see considerably more cases diagnosed around the u. S. In the coming days as weve seen in the last week. Largescale testing at clinical sites around the country will require clinical diagnostic companies to create tests because c. D. C. And Public Health labs were not designed for the kind of high clinical testing that will ultimately need to take place. Vaccine development is likely to take 12 to 18 months. One of the worlds experts is to my left so youll hear more about that. As we develop an effective vaccine, we need to have the means to mass manufacture it, which is not necessarily the normal process for vaccine manufacturing. Ideally that should be occurring in multiple sites around the world. Even if the u. S. Is the country to develop the vaccine, there will be a huge demand for the vaccine around the world. Antiviral or antibody base medicines should be under way should those be successful. One of the themes of our preparedness in this country needs to be Close Partnership between government and industry because industry is the place where diagnostics on a large scale, p. P. E. , medicines, vaccines, hospital equipment are being manufactured so there is no way around having a very close, affective partnership and making sure that those industries are well aware of the support they will receive from the government to do that work. Finally, id say its very important from this point forward for the federal government to be speaking in a single, consistent voice about what is happening. I think a Daily Briefing as we did in the 2009 h1n1 about whats known, whats unknown, how we are learning to fill the gaps and information should come out of the government on a daily basis. And i do think that should come from our Health Officials here at h. H. S. Or c. D. C. Because they are close to the people around the agencies around the country. Thank you for the opportunity to testify. Mr. Thompson thank you. Now to dr. Ezike to summarize her statement for five minutes. Dr. Ezike chairman thompson, vice chair underwood, Ranking Member rogers, and distinguished members of the committee. My name is dr. Ngozi ezike. I thank you for inviting me to speak about the Novel Coronavirus and the preparedness and response efforts of the Illinois Department of Public Health. Even before our first illinois january,identified in a strong federal, state, county, and local coordinated effort was enacted. It enabled our state to be a leader in addressing this rapidly developing outbreak. The c. D. C. Quickly deployed a team to illinois after our first case was announced and was essential in partnering with us through the response. They have been equally responsive with our recently announced third and fourth cases. The illinois congressional delegation supported our request for immediate approval of an emergency use authorization for the covid19 test, which has been invaluable in the effort to containing illness. Illinois was the first state in the United States to validate this test and to begin testing inhouse, a capability we had for the last three to four weeks. We began surveillance testing this week, enabling illinois to better determine how much covid19 is circulating within our community. Our success in testing raises a new concern, however. Will we have enough to maintain and increase our testing . We are requesting that c. D. C. Provide an uninterrupted supply of testing materials. The ability of states like illinois to test samples lessens the burden on the c. D. C. We encourage c. D. C. To expedite additional reagent shipments to illinois and other states. Illinois has utilized and proven its capabilities in the past when responding to the domestic cases of sars, h1n1, zika and ebola. We participated in crimson contagion. This is a National Tabletop exercise that used a covid19like outbreak that was set to have originated in china in the u. S. However, Surge Capacity remains something that is not able to be sustained for extended periods of time. Therefore, emergency supplemental funding is necessary. Illinois encourages congress to appropriate funds enough to reimburse illinois and other states for the costs associated with this aggressive response. Public Health Infrastructure such as data management, information sharing, and Operations Management are essential just for daytoday function, but theyre vital in the settings of Public Health emergencies. For example, during this response, the state Health Department is closely monitoring the availability of airborne infection isolation rooms. These isolation rooms are providing are proving critical in the treatment of these patients by controlling the spread of the virus to the public and Health Care Workers. We inventory these beds daily as an indicator of disease rates and to adjust Surge Capacity estimates. An important support for this capability came from aspers hospital preparedness program. Given the transmissibility of covid19, isolation sites are required to house effective house infected persons. Its challenging to find establishments willing to take on isolation or quarantine patients. When covid19 began in illinois, the city of chicago was given very little time to set up screening operations at ohare and establish a requisite quarantine site. Chicago has continued to maintain both its screening operation and quarantine site at an enormous cost. Without reimbursement and ongoing money for future expenses, governments will likely struggle to maintain these critical Public Health interventions. Additional attention must be given to mitigation strategies for the state. We are also working closely with longterm facilities to implement strategies aimed at protecting what will be our most vulnerable citizens. In addition to these Community Mitigation approaches, we encourage the public to employ their own strategies to keep themselves healthy. We said it over and over. The frequent hand washing, staying home when ill, sanitizing frequently touched surfaces. Individuals should take care to rely on trusted sources of information such as the c. D. C. Public Health Security is Homeland Security. Our country is nothing without the health of its people, and we can all Work Together to ensure that we continue to support this response and decrease the potential negative effect and impact on the people of this country. In closing, i wish to again thank the committee for its invitation and the attentiveness to illinois successes and responsibility in responding to covid19. Thank you. Dr. Now recognize gerberding to summarize her statement. Dr. Gerberding i want to thank you for allowing me to testify with such distinguished colleagues. I am the key patient officer at merc where i served as the president of the vaccine business for a number of years and more recently as the chief patient officer contributed to the development and deployment of the ebola vaccine in the democratic republic of the congo, which is now licensed, even though it was created on the fastest possible track and so far weve been able to contribute to about 300,000 doses of the vaccine. This week, the director general of the w. H. O. Indicated his optimism that that outbreak has finally come under control. Im also witnessing as the cochair of the Csis Commission on global Health Security which submitted this report to the record, the commission is the bipartisan includes bipartisan members of the senate and the house and has the stated purpose to advise the congress on steps that can be taken to improve our global Health Security. The report was written before coronavirus was recognized, but i think many of the recommendations, which are summarized in my written testimony really apply to the situation that we are experiencing today. I would be remiss if i didnt mention that im also on the executive committee of bio, the biotechnology innovation organization. Today, many of the c. E. O. s of b. I. O. Are here in washington to brief members of congress. About 40 of these companies have innovations and molecules and platforms and are stepping up to try to contribute to the prevention and treatment of this coronavirus outbreak. So were lucky we live in a country that has such a vital biotechnology organization. And finally, i am the former c. D. C. Director in the past life where we were dealing with anthrax and sars and many other outbreaks. The first coronavirus outbreak, sars, challenged the United States and challenged the world, and i think we learned many lessons, which are relevant to where we are today. I dont have time to give the full picture of the u. S. Public health situation. I think my colleague has expressed it from a state view very eloquently, but i would say its important to remember where we are in the outbreak right now. From the u. S. Perspective. There are really three main phases of outbreak response. The first is detection, and that happened in china and was reported fairly early in the process, but we dont have full detection because we havent had full testing and we still dont whether the cases were detecting represent the tip of the iceberg and how much of the iceberg is undetected yet because we havent tested or because many patient are asymptomatic which i in fact suspect. The second phase is the phase of trying to contain the outbreak where it starts, and i dont think in the history of the world we have seen a more dramatic demonstration what has occurred in china and what has occurred in countries around the world who attempted to keep the virus out of the country. It was the heroic effort. It wasnt perfect, but it probably did buy us some time. For that, i think we should all be grateful. Where we are now is in the phase of slowing the spread of the virus. Its here. Were doing everything we can on the front lines of Public Health to identify and isolate cases, to quarantine people who may be exposed or incubating and managing the social spread. We need to advance the effort to slow things down by recognizing we also need to sustain our essential services, our businesses need to run, our medical supply chain needs to operate, and our security and safety needs to also be part of our overall response capability. So were going to be seeing a lot of local decisionmaking. If youre looking at it from a highlevel view, whats going on in chicago might look different from whats going on in some other part of the country. But you know that each individual location has to make decisions in the best interest given the state of the outbreak in their particular community. One of the most important lessons that i wanted to emphasize in my Opening Statement is something weve learned in every outbreak and that has to do with the importance of trust. We must have credible leadership at every level credible leadersp at every level federal, state, and local. We must have clear and consistent communication from trusted individuals who are knowledgeable about Public Health, health care, and the science and evidence of Public Health interventions. We must have a spirit of collaboration, combat. A spirit of Health Protection and not politics. Thank you. Mr. Thompson thank you very much. I must add, we hear from a lot of the witnesses on this committee and what youve told us has been quite sobering, to say the least, but quite informative. So id like to compliment you at the beginning of the questions. But one of the things that each one of you talked about was the need in a situation like this to have effective communication. And there seems to be mixed messages to the public from the administration at this point regarding the severity of this outbreak. Many of my constituents have repeatedly called asking for clarity on many issues citing inconsistencies made by the highlevel administrative officials. How would you assess the u. S. Governments communication with the public regarding the risks presented by this outbreak . And what can the federal government do better . Dr. Inglesby, well start with you. Dr. Inglesby i think the state of the outbreak has changed a lot in the last month, and we have a very big federal government with many different people working on this. And so there have been days when within the government there have been different messages issued. I dont think that was necessarily intentional. I think its partly people kind of catching up to where we are in the outbreak. But i do think it will be very valuable for the government to be speaking with as much of a single and consistent voice as they can, as is possible in a big government. And i do think its on the one hand, i think its important to say what the risk is at this moment. I think main of the risk statements have been said from the government, today the risk is very low for any particular american. That may be accurate for today, but i think it will be helpful for americans to understand risk Going Forward. What do Health Officials believe will likely happen in their communities . Not in an alarmist way, but so people can be informed, begin to take measures, as we heard my colleagues talk about, to try to diminish their own risks, to make sure theyre staying home when sick, to make sure theyre washing their hands properly, disinfecting after they touch public surfaces. So i think consistent messages that empower the public will be useful, even though we dont know what exactly will happen next, we expect this disease to continue to spread in the country at this point. It will be useful for people to know that. Mr. Thompson dr. Ezike. Dr. Ezike in illinois, our intersection with the federal government has been primarily with the c. D. C. , and we have had intense communication and collaboration. We are on hours of calls together every day, seven days a week. We have had federal c. D. C. Staff come on site to help us directly with our investigations. And with the f. D. A. , they were the ones that gave us the authorization to be able to test. That ability to test and being the first state being able to do that has been very instrumental in being able to quickly identify our positive versus our negative cases. So we have seen how good communication, collaboration, and coordination between the federal, state, and our local Health Departments, how that integration has been successful in giving us a pretty good response in illinois. Mr. Thompson dr. Gerberding, you have gone through this in another life. Can you kind of talk about the same issue as it relates to communication and the public needing to hear consistent voice . Dr. Gerberding i will share a couple things i think i learned along the way. The one hardest for me, you cant communicate enough. That it really does take, like you said, daily, regular. What do we know today that we didnt know yesterday . What are we doing . What can you expect Going Forward . One of the hardest things being in the early phases of an outbreak like this is we dont really know what to expect. This is new and were learning as we go. So preparing people for change, for decisions that we make today might be different from decisions that we make next week. These are very important things. And to just acknowledge them. People dont panic if theyre given straightforward information. They panic when they hear confusing and conflicting information and they dont know who to trust or who to believe. I think the other important lesson that i learned was the importance of governors in the communication. We tend to think that everything is washington and federal and if we do our job right it will just automatically flow through the system. But as you know, governors have a great deal of authority in their states, and they need to be brought into the communication and information flow, because they influence a whole number of important decisions at the state and local level. So making sure that they are connected to the federal response is critical. Mr. Thompson and i thank all of you for saying that, because yesterday, the administrations Coronavirus Task force held a press briefing that was closed to cameras and audio recordings. And thats troubling in a time like this because information is very important. So if you hold briefings, i think they should be public. Recordings should be made because its the consistency of the message that provides the confidence thats so important during these troubling times. So my theme to the administration Going Forward is, please allow at the briefings to have the press there, have the cameras rolling, have the recordings being made because all this adds to strengthening the level of communication required in a situation that were in now. So i wanted to make sure that the Administration Hears Us so future press briefings will be open from a transparency standpoint to the public and i think all three of you have kind of said thats so important in situations like this. I yield to the Ranking Member. Mr. Rogers thank you, mr. Chairman. Dr. Gerberding, you talked about Lessons Learned in your previous life. What lesson have we most learned from this outbreak given that its in the early stages that we need to take heed of . Can you think of one in particular that stands out . Dr. Gerberding i will say the global lesson is we are going to see Infectious Diseases spillover from the Animal Kingdom on an increasing basis for a number of reasons, and that there are commonsense things that Global Community needs to rally behind like not having wet markets where live animals are congregated together and could create the opportunity for this spillover to occur. I think the u. S. Response perspective, the lessons are summarized in this report and that is that we do a pretty good job of stepping up when theres a crisis. Our response machinery takes time to get in place, but eventually we get there and we do a pretty good job of managing an outbreak, but we shouldnt have to do it in a crisis mode. We need to invest. We need to take our countermeasures across the finish line. We still dont have a sars vaccine. We do not have an mers vaccine. We dont have a zika vaccine. We are partially there, but then the effort gets abandoned, so we need to stay the course and complete the jobs so we can take some of these threats off the table. Mr. Rogers dr. Ezike, you talked about quarantine. What do you think the appropriate facility would be styled like to be a good quarantine facility . Dr. Ezike so thank you for the question. Let me start by distinguishing the quarantine sites versus the isolation sites. Mr. Rogers define those two. Dr. Ezike quarantine, we used to talk about people who dont have symptoms, who are asymptomatic. When i talk about isolating people, maybe we needed some sites for home isolation for people who may be are already showing symptoms. The goal would be for people who are already sick to actually keep them out of the hospital. If they dont require hospitallevel care, i. C. U. Care, we really want to keep those people out of the hospital so that we dont pose that additional risk to the Health Care Workers and sicker people in the hospital. Mr. Rogers do they need to be exposed to any way to people who have no symptoms . Dr. Ezike please repeat the question. Mr. Rogers do those individuals who are starting to show symptoms need to be exposed to anybody else that doesnt have . Dr. Ezike thats what were trying to avoid. So in cases where a person has contracted the virus but they are not sick enough to require hospitalization, wed like to have a space, an isolation location, where that person can be safely housed until they were no longer infected. Mr. Rogers what would the characteristics of a place that is safe . Dr. Ezike if a person lived alone, that is ok. If they have a family, we wouldnt want them exposed to their family. The setting we looked to use or have used, we need a motel where you have individual rooms with their own entrance, where the air is not shared, where theres not a common lobby, where people would have to congregate. So you want individual settings where they can minimize exposure to other people. Mr. Rogers what if somebody had to go to the hospital . What should a hospital prepare for as far as rooms or capacity that does not expose people to other emergency room personnel or patients . Dr. Ezike yeah, again, it comes around coordination. Ideally, if you knew someone was concerned or the clinician who had talked to the person hopefully by phone and identify them as an atrisk for having the virus, that we would have a system in place where they could be safely transported to the e. D. And or whatever location but not be exposed to people, where the initial people who are interacting with this suspected person could already be in full personal protective equipment. We had hundreds of people who were just taking doing business as usual and then after fact found out that the patient they were taking care of had the coronavirus. And that has resulted in them having to be at home for 14 days waiting to see if they develop symptoms. Ideally we would have robust communication, be able to bring them into a safe space. Ideally not into the hospital. If we could create some kind of, you know, drivethrough testing sites that are away from the hospital, if there was some offsite location where you avoid contact with, you know, sick people in the hospital and Health Care Workers, we dont want to do anything to compromise our capacity in terms of Health Care Workers where theyre all home waiting to see if they contracted something and not able to provide front line services. Mr. Rogers thank you. I yield back. Mr. Thompson thank you very much. The chair recognizes the gentleman from rhode island, mr. Langevin, for five minutes. Mr. Langevin thank you for the witnesses coming here today and your testimony. Dr. Gerberding, in particular, welcome back before the committee. You testified before us many times when you were the head of the c. D. C. , including hosting me in a congressional delegation at c. D. C. For a site visit there. We appreciate your leadership. Id like to continue on this line of state preparedness and what states should be thinking about right now. Yesterday, i spoke with the governor of rhode island about the emerging Public Health threat to our state, which has already seen one confirmed case of coronavirus. Any additional thoughts on state preparedness right now, what they should be thinking of in terms of surge or alternative sites, because thats been my concern is that people are sick, they are going to go to the hospital, they could very easily overwhelm the Public Health system in addition to infecting sick patients already that are at the hospital or equally important the Health Care Providers that are caring for people, so any additional thoughts on what states can be thinking of right now preparing for the eventuality this might become Community Spread and we have alternative sites . Dr. Gerberding so thats of course exactly what we are working on. Throughout our agency, were trying to develop were developing guidance for different locales. Were developing guidance for our local Health Departments so they can advise schools. We want schools to start thinking about contingency plans so we cant be overprepared. Dr. Ezike i think the adage is if you fail to prepare, youre failing to prepare. So just thinking through possibilities. Thinking through the options for telework. Looking at your agency, your company and seeing which people in your agency, if this surge could stay home and still maintain the operations of the company or the business, which people dont have to come in, how do we minimize those situations . So going through different scenarios, having top of mind longterm care facilities because there is a highrisk population. And making sure all the longterm care facilities, assisted living, that they are looking at their Infection Control programs, that they are making sure theyre following them, that they teach and reeducate their staff on Infection Control measures. Think how what are the appropriate ways to cohouse people if there is more than one person in the room. Thinking about all the possibilities. Thats the preparedness part. Mr. Langevin of course, we know the workplace is an area of particular concern with respect to viral transmissions. To that end, the c. D. C. And state leaders, including our governors strongly recommend that people stay home to work who are sick which is common sense. However, many people, especially hourly workers staying at home can mean choosing between putting food on the table or paying bills or stopping the spread of the virus. So i know governor raimondo is looking at Creative Solutions to make sure Rhode Islanders are not forced to make this impossible choice. Dr. Ezike, how is illinois addressing this problem, and what should be the federal government be doing to help . Dr. Ezike thats a really real concern. I am thinking of one person in particular who actually wanted to leave the hospital before we had test results because they expressed that exact concern, that i only get paid when i show up to work, and being here is costing me and im the primary breadwinner for the family. So we know in the hospital setting, we have had great collaboration with our hospital leadership and so when they have told employees to stay at home, they know they will be paid. But we need to have some kind of payback for people who are set up to stay home. If we want people to comply with our Public Health interventions, it cant be at a detrimental cost to their family. So making Funds Available to reimburse people for the time they have to be at home to comply with our Public Health measures will help people to follow our Public Health measures as opposed to avoiding being tested because they dont want to incur the result in isolation. Mr. Langevin hopefully that will be addressed in supplemental and we will have the mechanism. Dr. Gerberding, any thoughts before my time is up . Dr. Gerberding i just want to say one thing about schools, because we learned in studying the previous influenza pandemic that Early School Closure was a critical component to help the slowdown in many communities. This outbreak is puzzling because less of 1 of the cases are in kids. So that may be because they have mild disease and they dont get tested or they are not noticed to have the disease or perhaps they have some immunity from prior normal coronavirus, common cold type of exposure. We dont know that until we have testing, we wont understand the whole tip of the iceberg. I think we will see situations where School Closure makes sense in the short run, but we very quickly need to learn what is the role of children in spreading the diseases with this coronavirus, because it makes a huge difference whether or not schools are closed. Closing schools is extremely disruptive. It may be necessary, but we need to, i think, build the Evidence Base to understand how to use that tool. Mr. Langevin thank you, all. Mr. Thompson thank you very much. The chair recognizes the gentleman from new york, five minutes, mr. King. Mr. King thank you, mr. Chairman. Thank you to all the witnesses for your testimony. There was a report from new york which shows the rolling impact of this disease. It was a lawyer from Westchester County diagnosed yesterday. This morning, turns out his wife and two children and the neighbor who drove them to the hospital for the test all have it. And one of the concerns is a student at a university and the school is being shut down because of that. This is the growing impact it can have. In the metropolitan area of new york or chicago, los angeles, boston, any of them, how quickly could this spread . I am not trying to spread fear here because this can be controlled. When you see the one impact of one person, one family, and his neighbor and students, how quickly that can spread, and i assume he may have taken the train or subway to work that day, he works in lower manhattan, going through an elevator, walking through a hallway, he runs into hundreds of people. Dr. Inglesby so in wuhan where this first occurred, the first model was the epidemic was doubling every week. We dont know whether that will be the same here. But we do see most we saw very prominent clustering in families and people who have close contact. So i think we should presume there will be relatively rapid spread in our communities. We are beginning to take measures to try and change that, but i think it could spread rapidly in communities around the country. Fortunately, i think many of the cases that you just described will have very mild illness. They wont have if they didnt have a contact with their father, they may never have been recognized. They may have had the illness and never had it diagnosed. So were going to learn a lot about the illness and what it looks like in america in the coming weeks and we should be prepared to move in different directions. I think the social distancing measures need to be considered in places where we have high exposure and lots of cases recognized, such as the communities in Washington State, which are having a lot of disease recognized. But at some point, i dont believe those measures will some of those measures will scale any further, and we wont be able to quarantine or isolate in the way were doing now. It will be too many people to do that. So well have to shift strategies to things that are more communitybased. Dr. Ezike so in the cases weve seen in illinois, we have seen how a single individual, after being diagnosed, when we tried to look back at the time they could have been incubating, the places they would have been, the different settings, you know, maybe if they interacted with the Health Care System as an outpatient and then was sent home and they came back, one person could have contacted up to i mean, in our case im thinking of specific examples 150 people. And so then those people are all looked at. But if someone happened to have, you know, flown or gone to a mass gathering, the number could be a lot. Absolutely to your point, a single case can spread to many people. But we have also seen, as the doctor mentioned, its been the closest contacts we have seen so far. You know, we have not had any of the Health Care Workers who have been exposed to the patients before they were detected, before they were in full personal protective equipment, none of those people have come back positive. We hope that is a sign that will continue, but the idea is to minimize the number of cases because it does have the potential to spread exponentially. Mr. King doctor. Dr. Gerberding i think about the very first patient diagnosed in the United States who had traveled to china and came back with the virus and was a good citizen and stepped forward when he just didnt feel well long before he had fever or pneumonia, so they were able to sample his respiratory track and learned early on when you might not have recognized you were very sick, his upper airway was full of virus. He was probably potentially quite infectious early even early in the course of his disease. Later, he went on to develop pneumonia. Of course, with pneumonia, if youre coughing or getting airway procedures in the health care setting, you have a risk of becoming a super spreader, which means your respiratory secretions are being dispersed in the air. We can usually minimize that kind of spread. But stepping back and thinking of the transmissibility of this coronavirus versus the Community Transmission of sars, this is a much more transmissible situation. We saw very little Community Transmission. Another way thinking about in sars, in eight months, we had 8,000 global cases. With coronavirus, there were 8,000 cases in two weeks. Mr. King i feel sorry for the guy who drove him hospital for the test ended up no good deed goes unpunished. Thank you for your testimony. Appreciate it very much. Mr. Thompson thank you. The chair recognizes the gentleman from california, mr. Correa, for five minutes. Mr. Correa thank you for holding this most important and timely hearing. January, orange county, my county had the first patients who tested positive for coronavirus in the United States, one of the first ones. Now we have 43 of these cases in california. Its looking at my phone right now, we just reported the second case in orange county. Yesterday, in response to the news report, i wrote to the centers of Disease Control and prevention asking them to please share clinical information on the coronavirus patients with medical professionals to help doctors diagnosis, evaluate, and treat coronavirus. I would presume that right now we dont know how many folks are infected out there, so we really dont know the death rate out there. We dont know if this is worse than flu. Yes or no, am i correct on that . Dr. Inglesby you are correct. At this point in china, the overall number of people whove died have been about 3 , close to 3 . Between 2 and 3 . We dont think that will ultimately be the case fatality rate of this. As gerberding said, those that have mild illness, which will mean the case fatality rate will go down. We dont have any surety about that yet. So we believe its as comparison, seasonal influenza is somewhere in the order of one in 1,000 die from that disease or less, depending on the year. Mr. Correa as we get more information, we have a better picture, and therefore, possibly this is a better evaluation, a better handle on this emergency. Dr. Ezike, are we doing enough at the federal level, Homeland Security with local, state, addressing this issue . Can the communication do a better job getting a handle on this crisis . Dr. Ezike i think at the forefront of what you mentioned, identifying the details and the full picture is the ability to broadly test. We cant know what the rates of infection are if we dont diagnosis the infection. So i think thats so critical. Sentinel surveillance that would be a helpful tool involves looking at people just generally in the community to see if there are what the levels are in te Community Without a known travel history, without a known exposure to a confirmed case. Currently in illinois, were trying to start that process, but we have to tread lightly because we dont want to run out of testing supplies. We need to also test people who are connected to these the last two cases that we just recently identified. So i think making sure that testing supplies are available broadly where people can test without reservation i think is an important thing that the federal government needs to give the states and hospitals the ability to do. I think thats pretty central to the effort being able to diagnosis in the first place. Mr. Correa dr. Gerberding, you said something that really bothered me which is, we had similar crises, similar situations, yet we dont finish the job. We havent developed vaccines, treatments for those in the past. Yet, you said, well continue to have these kinds of situations that jump from animal infections to humans. What can we do at the federal level to compare and be consistent in terms of addressing these crises so they dont turn out to be such a major challenge as we move forward . Dr. Gerberding thank you. You know, im so grateful that the congress is going to provide an emergency supplemental for this, but if we were investing properly for our broad Homeland Security and the issue of health threats, Infectious Disease threats, we would not need emergency supplemental anywhere near the scope and magnitude you are facing right now. We need to improve the support for the c. D. C. s surveillance capability. I think we learned that we also need to make sure that they can scale testing as quickly as necessary to avoid the bottle necks that weve seen. I think we need to make sure that our state and local Health Departments have the capacity. They will soon run out of laboratory, time, space, and people to be able to do all of these tests, and they will need support from the federal government to scale their capabilities. They will be working 24 7, literally. So we havent built into our system preparedness that search capability. It might be fine if this were a rare situation, but lets just think back for a few years. We had sars. We had avian influenza, we had zika. We had to worry about ebola. And now here we are with this new coronavirus. This will be our new reality. We need to upgrade the investment we are making on the front line of Public Health. Mr. Correa thank you. Mr. Chair. Mr. Thompson thank you. The chair recognizes the gentleman from North Carolina, mr. Walker. Mr. Walker thank you, chairman thompson. Dr. Ezike, my home state of North Carolina announced its first case of coronavirus. The patient in North Carolina had recently returned from Washington State where an outbreak had occurred. How is your state monitoring patients arriving from areas that have many confirmed cases . Dr. Ezike so right now for interstate travel within the u. S. , theres not a specific mechanism, a formalized mechanism to say, this person came from california. Where that information would be used if the person developed symptoms and hopefully a very astute clinician is taking a travel history and then would notice in asking questions about where youve been recently somebody would say i was in washington or i was in california and so that would raise the level of suspicion, the index of suspicion, oh, that could be maybe a higher risk. So at that point they would reach out to the local Health Department to get the authorization to test. So we have, you know, more formalized processes that where we, through the customs and Border Patrol and the global migration of quarantine, whether they come from china or iran, certain questions we will get that automatically, but for interstate we dont. Mr. Walker i understand the deaths weve seen in Washington State are senior adults are maybe some respiratory issues, is that your understanding . Dr. Ezike i dont know of all of them. I know for in fact the majority of them are. I cant speak for every single case. I know that the whole state using Hand Sanitizer, washing hands. Youre giving that message ourdly, but i think exceptional surveillance will be helpful so we can identify if there are pockets of the state that actually have circulating virus that we are not aware of. I know that the whole state might not see some kind of surge at the same time. Its going to be local in certain communities. So we just want the ability to identify that as soon as possible. Dr. Inglesby, you discussed the incubation period is five days someone who gets infected has no symptoms. The question is this, what do you suggest the government does to minimize the risk of asymptomatic transmission . Dr. Inglesby i think thats a difficult question. Im not sure there is anything specific. I dont believe any of us are infected with coronavirus, but we wouldnt know. I think ultimately the goal of communities as this virus begins to spread is to try to lower the peak of the epidemic, to slow it down, so our Health Care System is not overburdened with very sick people. Some of the measures that Public Health agencies and local governments are going to start to consider will be should we cancel public gatherings where thousands of people get together for sports event or concert or Something Else . Should we recommend they telecommute if they can . A quarantine time period of 14 days, is that a sufficient amount of time . How did medical professionals come to that number . Should patients stay in quarantine any longer . Dr. Inglesby i think that number was based on what we have seen from china and the World Health Organization and the c. D. C. Its based on the longest we have seen in terms of incubation. When people come out of isolation, their local Health Authorities are working with them directly to make sure they are safely coming out of isolation if they have been infected. Mr. Walker there have been a few reports of people testing positive after having recovered from an earlier infection, which is very troubling, that means that brings in other things we wont get into today as far as concerns, where it was based or how it was created. If you become infected and recover, is it possible to be infected again . Is this a larger issue with testing such as false positives . Being married to a family nurse practitioner, this has been part of our discussion this past week. Dr. Inglesby i think its the latter. I think the numbers are too small to say anything about reinfection. Our judgment is that its probably a testing phenomenon. Test one day, and the next, picks it up the next day but the person was consistently recovering. Mr. Walker last question, yes or no. This is something we are debating at home. Washing your hands is crucial. With antibacterial soap is that better than Hand Sanitizer . Dr. Inglesby i dont think there is any evidence there is. Chair thompson the chair recognizes the gentlelady from illinois, ms. Underwood. Ms. Underwood thank you, mr. Chairman and thank you to our witnesses. Coronavirus requires a whole government response which means federal, state, and local governments must work closely together to fulfill their different roles. But it also requires a Public Health approach, one that prioritizes Risk Communication as youall both all three of you just clearly expressed. It uses smart strategy to minimize the impacts of the virus and keeps communities that we all serve educated and safe. Dr. Ezike, can you tell us more about your departments daytoday work with the c. D. C. In response to the coronavirus . Dr. Ezike we have lots of interaction with the c. D. C. There are hours of calls per day where we get updates, where they will interact with whether its the state Health Officials or the state epidemiologist or state preparedness or response, there are all departments talking. We have onsite support in terms of epidemiologic officers. We have go teams that have been deployed to help us with the actual investigations. They have guidance that they are continually putting out and updating to help us disseminate information to our communities. In terms of ways they can get prepared. There is a robust coordination and collaboration. The calls, they are listening to us to identify what our needs are when we say we are missing a guidance related to this, then they say, yes, well take that back. Then they work with their teams and solicit our input and put out guidance in as timely a manner as possible. Theres been a robust coordination. We are happy to partner with the c. D. C. Ms. Underwood any other federal agencies in this response . Dr. Ezike my level thats the primary point of contact. I know that my governor has been we are in contact constantly, and hes also in contact with the federal government. They outreach directly to him as well to give him the overview and the summaries. Theres communication directly with the governor. As well as with defense parts of different parts of the Public Health department. Ms. Underwood are there any areas where additional assistance would be helpful . Dr. Ezike we cant reiterate enough the need for funding. Both to make sure that we can accommodate all the employee, whether its the overtime, whether its we had to in one instance in our state we had to rent an r. V. Because we couldnt find a motel that would agree to take one of the people that needed to be isolated. We need assistance to pay for the Housing Options for people who dont have it, fund for people who are displaced from work temporarily. Assistance with that. Our lab, to run the lab, the lab equipment, single piece of lab machinery is up to 500,000 or more. Theres a list of resources that need Financial Support to maintain our operations. Ms. Underwood in your testimony you wrote that illinois conducted an exercise last year, the crimson contagion. Can you tell us about those exercises and why its an important part of the preparation to respond to potential outbreaks. Dr. Ezike it in the aftermath of 9 11, we started getting funding for what our office has called the office of preparedness and response. So in that office its gearing up, as the doctor mentioned, for trying to prepare for what are the eventual situations that can arise. Table top exercises where you convene with the federal government, multiple states, local Health Departments, businesses, schools, communities, all we had almost weeklong exercise where the event, which was created, was a novel virus that came from china and was spreading throughout the world. That was the scenario that was played out with all these partners at the table. So thinking through the what ifs, if you will, is part of the preparedness. The more prepared you are, then when you see something similar to that, then you switch into response. Ms. Underwood in your testimony you wrote that responding to the coronavirus has cost the state more than 20 million in the first five weeks. We have heard from a local Public Health officials the importance of stable, longterm funding. We are so pleased to be able to at least have a supplemental to get a down payment. And hope to continue to work with our colleagues to make sure these efforts are well funded. We know that too Many Americans have chosen to skip a visit to the doctor because their costs are too high. Their outofpocket costs are too high. When dealing with an unknown Infectious Disease, that decisionmaking has consequences not only for their patient and family, but the entire community. Its our hope that addressing those outofpocket costs in addition to your Public Health costs is going to be an important solution to this epidemic. Thank you for being here. I yield back. Chair thompson thank you very much. The chair recognizes the gentleman from pennsylvania, for five minutes, mr. Joyce. Mr. Joyce thank you, mr. Chairman. Thank you for the esteemed panel for being with us here today. Of utmost importance it is imperative that we Work Together. As you have stated, on a federal, local, and every level to fight this problem that we are facing with the coronavirus. To briefly review the timeline, President Trump has taken action, Decisive Action to protect americans and to prevent the spread of covid19. In january, President Trump declared a Public Health emergency initiated travel restrictions, and mandated quarantines for those returning from affected areas. He also formed the Corona Task Force to ensure a coordinated response among all u. S. Agencies and experts of the since then, the Trump Administration has expanded travel restrictions, explored innovative medical solutions, and requested additional funding for covid19 response resources. Vice president pence has also been elevated to lead the response and has been appointed a corona response coordinator. Vice president pence also announced just yesterday that medicare and medicaid will be covering the coronavirus testing. Most important questions we need to be asking are where do we go from here . And what can be done to mitigate the future threats of the same nature . Dr. Gerberding, your expertise and extensive experience in this field serving as c. D. C. Director during the anthrax, the sars, which is also a coronavirus, the west nile virus, and the avian flu outbreaks. If you could talk to us about the development of a vaccine, specifically you had mentioned that we have not yet completed the sars evaluation for vaccines, yet that process has been initiated. And sars 2 is a coronavirus. Does that put us steps ahead in the Vaccine Development . Dr. Gerberding one optimistic point of view is science has evolved considerably since 2003 when the first sars outbreak occurred so that the timeline and the ability to have the Molecular Tools and immunology tools to speed up manufacturing has significantly improved. At the w. H. O. Leadership meeting on vaccines for this coronavirus, there were 31 innovators there talking about their approach to Vaccine Development. Unfortunately, all of that development was preclinical. None of those vaccine candidates were in people yet. But the ability to have that much innovation already on the table really speaks to the importance of our biotechnology industry and capability. I think thats a positive perspective. The reality check, and i know this from the experience we have had at merck working on the ebola vaccine, is getting a candidate vaccine is somewhat straightforward. Getting it through the safety testing, through the clinical testing, and frontline conditions, getting the data together, getting it through several regulatory processes, manufacturing it, and in this case not just for a relatively small number of people in a localized ebola outbreak, but for the world, that is a daunting task. There are 7. 7 billion people in the world and im not sure who is going to be left out of access to the vaccine. It is a big undertaking to have the full completed preparedness accomplished in the vaccine arena. What concerns me about our current outlook is that we are seeing some overpromising, and we need not to alarm people when those promises dont actually come to fruition on the timeline people are expecting. We need to be straightforward about the challenge ahead. Work hard, invest, support the people who are doing innovative work, but at the same time be cognizant that this vaccine is not going to be in peoples arms for a long time. I have always been impressed by american know how, innovation, approach to science, specifically to medicine. Dr. Gerberding, could you comment to us what immediate actions could we be taking in congress to assist and to inform our constituents while we are still awaiting the results of negotiations on the emergency funding package . Dr. Gerberding obviously funding is a big piece of the effort in almost any direction you look. But i also think that there is an opportunity here for congress to provide its own leadership and communications front. You are members of state delegations. You do interact with governors and state leaders and really coming together as a unified whole of government opportunity to get on the same page, for youall to understand whats needed at the state and local level. That creates an informed platform for decisionmaking. I think as we have heard from our colleague in illinois, youll learn a lot about whats really needed at the local level. Mr. Joyce i thank all the panelists for being here today. I yield my time. Chair thompson thank you. The chair recognizes the gentlelady from new york for five minutes, ms. Clarke. Ms. Clarke i thank you, mr. Chairman. I thank our expert panelists for bringing your expertise to bear today. Its refreshing to hear facts. Let me start by saying that yesterday in new york it was confirmed that we had a second covid19 coronavirus case. As mr. King has stated, we are now dealing with sort of the fallout and rapid spread of this illness as a result of a gentleman who had traveled from Westchester County into the city of new york. We can expect more to come. But this is not the time for fear. Its time for facts. And thats why im so happy you are here today. This crisis is serious, but we can mitigate the coronavirus if we put science over scoring points. Doctors, not politicians, need to be in the drivers seat as we combat this global outbreak. This is isnt a hoax in the word of the white house, and its not an apocalypse, either. It is a Public Health emergency, but one we can address with funding, resources, and sound science. As of yesterday, we know of 105 cases and a death toll of nine persons in the United States. As testing is expanded, the numbers will continue to rise. The federal government and the state and local partners must also rise to the occasion and give each american not only the care they need if infected, but also the knowledge they need to avoid infection. I look forward to our continued conversation as we guide the American People through this impending crisis. Dr. Gerberding, according to the recent article in may of 2018, donald Trump Administration ordered ncss entire global Health Security unit shut down, calling for reassignment of rear admiral Timothy Zimer and dissolution of his team inside the agency. What were the consequences of this action . Dr. Gerberding thank you for the question. I honestly dont know the answer to your question. Im a champion of the whole of government approach. I know the doctor, hes an amazing leader and served as well first in malaria and then in subsequent Public Health emergencies. He was an extraordinarily effective whole of government leader and i was sorry to see him go. Ms. Clarke its important that we have institutional knowledge. And that as you have stated in your testimony, we follow the course. To its natural end. Unfortunately when we dismantle or disrupt, we dont benefit from that institutional knowledge. A commission was established on strengthening americas Health Security to examine the u. S. Preparedness to responsible Global Health threats. The Commission Published in its final report last year. Dr. Gerberding, you served as cochair of the commission. The commissions first recommendation was, and i quote, to restore Health Security leadership at the White House National security council. Why did you believe that restoring senior level leadership at the national National Security council is so important to ensure our nation is prepared to combat a potential pandemic . Dr. Gerberding let me share my personal experience while we were involved in a very serious whole of government effort to prepare for an influenza pandemic. At the time the second of health and Human Services was secretary mike levitt. Secretary levitt believe we needed to have all of the cabinets of the federal government participating in the preparedness. So he took all of us as leaders of parts of h. H. S. To every cabinet and sat down with every cabinet secretary with the book on the 1918 pandemic and we went through highlighted sections and asked the question, what will your cabinet need to do in the context of a serious emergency . And what that really thought me was that the federal government in every cabinet level has something to contribute, whether its education and School Closures, or commerce and keeping our businesses operational, transportation, whatever the cabinet has authority over, its relevant in a serious Public Health crisis and we need to have the whole of government collaborating. The only way to really do that is to bring an uber leader, somebody who really sits above and has the authority of the president. I will also acknowledge that there is a bipartisan Blue Ribbon Panel in biodefense that secretary ridge, former governor ridge and senator lieberman have cochaired for several years. That panels recommendation sort of paralleled to what csis recommended is that the Vice President should share that whole of government process. I think what that tells you the idea is the same. You need an empowered person to oversee complex intergovernmental agencies and the government strategy, but how you go about doing that may vary from one administration to another. Ms. Clarke very well. Mr. Chairman, thank you. I yield back. Chair thompson thank you very much. The chair recognizes the gentleman from North Carolina, mr. Bishop. Mr. Bishop thank you. Dr. Ezike, you mentioned in your written and spoken testimony the phrase sentinel surveillance testing, what is that . Dr. Ezike thank you for the question. Sentinel surveillance once you have the ability to test involves testing people who dont have a direct connection to a confirmed case, do not have a direct travel to a specific place that would put them in a higher risk as a coronavirus suspect. This is going to your average person with no connection to a case or to a hotbed, if you will, and them developing a flulike illness, influenza like illness, and going to their doctor and the doctor identifying that, oh, you dont have the flu, you dont have any of the other common viruses on the respiratory virus panel, maybe this is coronavirus, despite you having no connection. So testing people with no connection and seeing what the ground percentage of coronavirus, if its there and if so how much. So if you can do that broadly, you can see if there are pockets within your state that have coronavirus and people you wouldnt specifically suspect to have. Mr. Bishop dr. Gerberding, the c. D. C. Effort initially understand in early february released test kits determined there was a flaw in them. I understood from speaking to someone else that those tests are referred to as an rtpcr test and three components what was flawed was the negative control component. Do you have any information about that or how that came to pass . Thats sort of alarming if we need to respond quickly if somewhere in c. D. C. s function this test kit was created and then didnt work because of what i understand to be a basic error. How does that take place . Do you have any insights . Dr. Gerberding i dont have insight into the specifics. I can tell you long before i was part of the c. D. C. The one thing i understood and saw from my frontline at San Francisco General Hospital was that the c. D. C. Is the best at testing. Their diagnostics are gold standard. So this seems to represent a highly unusual and exceptional situation. Im sure theyll get to the bottom of it. I know they had a great deal of consternation about their inability to be out there with the not just an accurate test but with the volume of tests that people need. Mr. Bishop following up on that, dr. Gerberding, or whoever else wants to comment. My understanding is there a is question about who had access to a test. Could an emergency room doctor decide to administer this test, it was limited at some point to public labs, perhaps because of supply, now the Vice President has made it clear that anyone will be allowed to order a test, any doctor. And that there is a distribution going on like 2,500 or 25,000 kits that enable testing up to a million people. Can you speak to those details . Dr. Gerberding this is not unusual at the very beginning of a situation with a new pathogen we have never seen before. We dont have a test on the shelf for it. Its being invented in real time. This is does not surprise me that early on there was a limited number of tests that were available. We typically used whats known as the Laboratory Response network because those people are highly trained. They have the standardized equipment. Part of our public system. Best able to judge in their own communities who should be tested. The state Health Officers also contribute to the decisions about what is a Case Definition and who should be tested. Its not just an order from above, its a collaborative process. When we are sitting in the u. S. And the disease is in china and we are not suspecting large number of cases, it made sense that you would focus your testing, your limited testing on a traveler who had just come back from china. Obviously we are in a different situation now where we are seeing Community Spread. Its normal that we would expand the indications for testing. I completely agree with the notion that if a doctor suspects coronavirus, they ought to be able to order the test. Mr. Bishop given the limited time, my friend, ms. Clarke, made the comment that the president called the coronavirus a hoax. Since that was said in public i want to say he didnt say any such thing. I dont want to alter what i think has been a very good tenor of this hearing. My last question having said that is i understand that for the testing to be done rapidly enough, we need to be able to empower or bring in private Lab Infrastructure into that picture. And i dont know who met, dr. Gerberding, not to pick on you, if you could comment on whats needed to make that happen. Dr. Gerberding i think i thats well under way. Im going to be spending time this afternoon with colleagues, including the c. E. O. Of one of the important diagnostic companies in the United States. Ill have a better answer by the end of the day. The first thing is f. D. A. Through the years has liberalized the process for getting an emergency authorization for new tests to get out there into the community. And compared to 20 years ago, our ability to do this fast has significantly improved. Once we know what we are looking for, its a simple matter for diagnostic companies to pick up on that. They have the scale and the capacity to ultimately build a much larger capacity than the Public Health system. But they do have to demonstrate the sensitivity and specificity of their testings. When you dont have the disease its harder to do that because you dont have enough case material to know if you are accurate in the results that you are receiving. Chair thompson thank you very much. The chair now recognizes the gentleman from staten island, mr. Rose. Mr. Rose mr. Chairman, thank you. Thank you all so much for being here. I want to start off with what im seeing some Business Leaders making decisions around employee travel. Halting international flights. Halting domestic flights. Getting ahead of unnecessary or necessary, my question here, ahead of guidance from the federal government. What should our Business Leaders be doing . People running Global Companies . Dr. Gerberding i can share what our philosophy has been. We are a Global Company and we have 1,200 people in china. Many of them are on lock down for an extended period of time. Im so glad our offices are back open and our systems are operational there. But we recognize when we have people in several of the hot spots, where Community Transmission is occurring and we are responsible for essential medicines and vaccines, that we have to keep our supply chain open and running. So people need to be coming to work. Those critical employees are especially cautioned about nonbusiness essential travel and to selfquarantine if they have travel to a hot spot and not come to work when they are sick. We dont have a decision that you cant travel, we are just simply saying, while we are working on slowing spread and understanding whats going on here, lets err on the side of caution. Mr. Rose what about Domestic Travel . Dr. Gerberding Domestic Travel is more in the spirit of the slowing down the spread that dr. Inglesby was talking about. If we are in a situation where we cannot quarantine each individual and we are trying to reduce the peak of transmission, it does make sense that we begin to think about avoiding crowds and minimizing our movement flying as well . Flying as well. You are trying to use common on flying. Emphasize now is a good time to be more comfortable using Digital Communication and being thoughtful about how we travel. Anyone else would like to speak to that . I think the cdc guidance on travel seems logical. It is describing countries where they think there is elevated risk and making recommendations on where americans should travel. Is we havechallenges seen things change rapidly in a week. 10 days ago, italy had zero cases. Now it is among the countries with the highest cases. It is challenging for Business Leaders to think about think ahead when things can change quite a bit. I think the best recommendation is to follow government guidance would also be aware that something could change in a day or two as countries begin to Start Testing. Understood. Echo what are saying. This is an emergent situation and advice given today may not be applicable tomorrow. Continuing to follow the most recent guidance. I want to move on to our lower wage, hourly workers. I am concerned that they will not rightfully or rationally responded to quarantine suggestions because of the economic concerns. What can the federal government due to stepan two step in to support people so they respond to quarantine . One thing that can be done, which is being discussed here, is to make sure there are no barriers to testing or getting medical care or isolation. I think that sounds like that is beginning to occur through discussions with insurance companies. That is important because we have seen evidence of people who had 3000 bills after they went to get a test and people will potentially avoid getting tested. I think it is a harder challenge could we consider expanding Unemployment Insurance . Way of helping people in the gate economy or lower wage workers make good decisions, i think that should be considered. Anything else . I would agree that there should be a mechanism for people who would be economically disadvantaged if they dont have any benefit time, any kind of paid leave, that there should be a way for them to be compensated so they dont have to make the decision between following Public Health measures that will help the entire Community Versus being able to pay their next months rent. I want to add something. In the context of this conversation, we have to be mindful of stigma. This happened during the sars where the Chinese Community was stigmatized and i think it is an opportunity for leaders and house members as well to stand up and make sure that we are including everyone in the benefits that we can provide to protect americans but also that we speak out against the stigmatization that often follows in the wake of an outbreak. Thank you very much. The chair recognizes the gentleman from tennessee, mr. Green. Thank you to all of you for being here today. I appreciate your involvement in this process. Very quick, by questions, i have lots of them. Appears to be, it about 3 in china. Outside china, it appears to be about 0. 7 , i saw in an article that was just published. T are your thoughts about the medical association seems to imply that it is attributable to chinas smoking rate. Why is there mortality 3 and outside china it is 0. 7 . In south korea, it was 0. 12 . Your thoughts on that. It is too soon to say because things are changing rapidly and they dont have as much data as there is in china. One of the factors in wuhan doesnt seem to be the surge in hospitals and it does seem like some of the people who could have used ventilators could not get them because they ran out. That is one possibility. If someone with Underlying Health conditions or pollution or smoking or Something Else that will fall out in analysis. I dont think we have a strong understanding of that yet. The other thing is there is a time lag from when countries discover cases and begin to see them at the time people begin to die from this illness, sometimes two weeks. If it is a country just beginning to report illnesses, is two weeks leader when we have a better sense. It is well over 3004 outside the country, you would think that would give you some degree of confidence and there is such a huge delta between 3 and 0. 7 . This, based on the way it is setting, those who have ibidities and elderly am also aware that it attacks lung tissue directly so that makes it concerning. In the interim timeframe, there are antibodies. I want to know if anyone can comment on ram to severe add other antivirals that were developed for ebola and their usefulness on other tests. Then on antibodies because of the ability to blunt the lung they can beage, and spun up more quickly than a vaccine. I will start with the antiviral question. I am hopeful, i really want these antivirals to work. At the same time, you have to think about what we learned about respiratory infections and antivirals so far. We have several for influenza and they might mitigate a little bit but they are not curative. We need to do not overpromise on what we might ultimately see. Hope for the best, what i want to be surprised if we are disappointed. Terms of antibiotics, almost every outbreak i dealt with, people use a serum from recovered people and try to see if it is helpful. That is the intellectual background. They may be useful, but on this kind of situation where the severe pulmonary disease is caused by another storm, which means broad inflammation thats tissue damaging, you have to test the safety very carefully because what you wouldnt want to have happen is put an antibody in there and make that storm worse. Got to be tested. I hope again, but i agree with you, these approaches to treatment can happen much faster than a vaccine. They are definitely a high priority. Mr. Green thank you for that. One of the things that concerns me, there is lots of legislation in congress about price fixing for pharmaceuticals and i know merck is one of those companies that would be hurt by that. My concern is, particularly those smaller companies, the bio med companies that when they have an idea, they have to go get capital in order to advance that idea. They are not going to get capital if we price fix. I wondered if someone, particularly, maam, you, because you are from the industry, could comment about how damaging price fixing might be on some of the innovation thats out there. Dr. Gerberding first of all, as i said earlier, 40 Biotech Companies have stepped up on coronavirus, understandably, the entrepreneurs have very apprehensive about what this will mean to investors. Price fixing is the thing that investors hate the most. They made that very clear when the subject came up in another topic. I live in the world of Antimicrobial Resistance because we dont have a market for antibiotics. There is no reimbursement appropriate to the danger of multidrug resistant infections. Last year we saw three companies that had new antibiotics and failed and went out of business because their investors pulled back. Its a real issue and we need to keep our biotech industry alive. Mr. Green thank you. I yield. Chair thompson the chair recognizes the gentlelady from texas, ms. Jackson lee, for five minutes. Ms. Jackson lee mr. Chairman, thank you so very much. Thank you very much for your hearing yesterday. I was detained in my district for civic matters that occurred on that date. In tribute to my constituents and the necessity for america to ensure that people can vote, i was at a College Voting at 1 00 in the morning where people remained online to vote at 1 29 because they could not vote because of shortages of machines and broke down machines. I say that because this is the greatest country in the world. Im disappointed, you are not a government witness, i am disappointed in the slow response to the coronavirus. We dealt with ebola, one of the first cases in the dallas hospital in texas. We dealt with h1n1. Im going to pose a question and hope im as straightforward as possible. There were two briefings, unclassified, one briefing was complete denial. Everything was fine. Top level leaders about government in health and emergency issues. And shortly and first to do a press conference questioning everything was fine with airport personnel and others. At that time, t. S. A. Officers had no gloves. Mismatched gloves. Mismatched masks. I know there has been discussion about masks. But id like to ask dr. Ezike, am i close to the pronunciation, the need for preparedness and awareness when the obvious is occurring. I would like to be prepared months or year out or regularly having a preparation for this to occur. When i say this, an infectious episode to occur, but the fact that china was quite public, they couldnt hold it any longer, can you comment on the preparedness of this nation . Dr. Ezike i think dr. Gerberding also has eloquently described the situation. And highlighted the importance of having increased surveillance capacity for the c. D. C. We have been as a state Health Officers, every year we try to come to washington and encourage increased funding for the c. D. C. To keep up with these surveillance efforts, to keep up with our preparedness and response. All of our preparedness and response ms. Jackson lee do you have an assessment whether or not we were prepared on the federal level for the coronavirus . Dr. Ezike i think we can always be more prepared. There are levels of preparation, and the more prepared we are the better. Ms. Jackson lee im going to go to mr. Inglesby. Forgive me, i watch my time. I appreciate it. I meet regularly with my local Health Agencies and i appreciate the director of the Illinois Department of health. I understand that you are always lobbying to make sure that there is direct funding to both state and local, this is a particular instance where that would be important. I understand our appropriations is something we have all requested is going to enhance dollars going to state and local entities. How do you translate that into helping you in your local communities be prepared for something that appears now to come from c. D. C. That an epidemic or pandemic, now they are willing to say that, and how are you doing with the test kits, and how would that help you with the test kits . My community does not have them yet. Thats a real problem. Most communities do not. Doctor . Dr. Inglesby i think, first of all, that every year there are Public Health Emergency Preparedness grants given to states from c. D. C. And they are very important grants for states and locals. And need to be supported by congress and the administration. They are crucial for longterm preparedness. They are separate and distinct from the Emergency Response funding thats coming out, we hope will come out through this appropriations. You cant build a firehouse the day before the fire. You have to build it a long time ahead of time. Thats what those preparedness grants do. In terms of expanding diagnostic capacity testing, that is now happening over the course of this week. In state health labs around the country are going to be able to Start Testing hopefully within texas as well. Ultimately, to really expand to clinics and hospitals, we need Diagnostics Companies to be fully invested. Ms. Jackson lee thats very important. If we go into a moment in time of quarantine, closing schools, restaurants, etc. Do you think we should also be concerned about, in this instance, hourlywage workers who would be caught up in that quarantine who dont get paid and may have a devastating impact on the family . So that would be a part of what we need to do in this moment to be able to provide for peoples livelihood and survival if they are quarantined for a period of time. Dr. Inglesby i do agree. Especially if a quarantine is prolonged, if there are many people in the country who receive a check every week and need that check that week. If we are telling people they cannot go to work or cannot go to school and have to stay home to take care of their kids, we need to make sure the incentives for doing that are aligned with what we want done and people arent having to basically not be able to provide for their families. Ms. Jackson lee i thank the witnesses very much. Chair thompson thank you very much. The chair recognizes the gentlelady from arizona for five minutes, mrs. Lesko. Mrs. Lesko thank you, mr. Chairman. Thank you, mr. Chairman, for having this meeting, an important issue. Thank you for being here. Debbie lesko from arizona. Our state, dr. Kris, heads up our Arizona Department of health services, and shes very competent. We just started testing within house ourselves. Its very important, obviously, that we are prepared, but also we have to balance that with panicking people. I think it may be a little bit too late because you turn on the news and this is all you hear about, right . And my husband went to sams Club Last Night and said all of the purel or whatever brand of the Hand Sanitizers sold out. All of it was sold out. So my question is, kind of a basic one, so many people die from the flu. More than i even realized until just recently. So, is this worse than the flu . We need to be concerned, but im concerned about people panicking. I guess ill ask dr. Gerberding, if thats how you pronounce your name, is this worse than the flu . Should we be more panicked than the flu . Tell me about that. Dr. Gerberding i think we are learning that this is probably as transmissible as the flu. The rate of transmission seems to vary depending on how much testing goes on in the background to really figure that out. We still have to learn what the true transmissibility dynamics are. But its obviously spreading from person to person, especially in families and on cruiseships and other closed environments. With a great degree of efficiency. The question is, how fatal is it and who is vulnerable . I think dr. Inglesby pointed out earlier that we dont know the true case fatality rate yet. Part of that is because of the differences in medical care that influence that. Part is because we dont know the denominator of the people. And part of it is because the testing is not available to sort out who is actually a case. We will learn more about that, but i think what we can say today is that it looks very much like the case fatality rate is significantly greater than the fatality rate for seasonal flu. We will learn more about that, i think thats the distinguishing issue here that makes me so concerned. That its the death rate thats high. And the death rate is highest the older you are and more underlying disease, particularly respiratory disease, that you have. So this nursing home outbreak, for example, thats a significant concern and we need to prioritize getting Infection Control precautions and other things to slow down or prevent spread in those settings as one of our highest Public Health priorities right now. Mrs. Lesko thank you very much. My next question has to do with facemasks. Anybody can answer this. What is the answer . Should people that dont dont have a cold or not coughing, should they wear facemasks . I have googled it and said, no, you shouldnt. Unless you are coughing. It will not help. Why is it that Health Care Workers wear it . Thats my question to anyone. Dr. Inglesby in hospitals, people are exposed to the sickest people. We do see a correlation between level of illness and ability to spread the disease. So Walking Around in the community, most people are well in the community. Even if they are asymptomatic, we dont think they are the fundamental largest drivers of infection. Also, when you wear a mask in the public, you fuss with it a lot. Touching your face often. Tying strings. It may be you are touching your face more often than normally. The bottom line is we dont have evidence that facemasks in public are going to do any good. We are worried that if everyone goes out and buys a mask, that that will diminish the number of masks available in the hospital where the people are the sickest and transmitting at the highest levels. We need our Health Care Workers to stay healthy, because they are going to be its going to be a long period of time, a marathon probably, of high Covid Patients in hospitals. Dr. Ezike there are different kinds of masks as well. The masks worn by Health Care Workers, they are trained and fitted to their face so that they dont leak air. When people on the streets buy those or the regular surgical masks, they are breathing all kinds of air in, around the mask and it doesnt offer the level of protection that Health Workers need. Thats why they have to be trained to use them properly. Mrs. Lesko what i think i hear is that facemasks do help if they are put on properly. They do help from getting it, its just that you advise against it in community because people dont know how to use it properly. They touch their face a lot because of the mask. Is that what youre saying . Dr. Gerberding to add one additional thing. I have had to wear a 95 respirator through many patient encounters. You cant wear them for long. They increase your work of breathing. They are uncomfortable. You go in the room, do something, you take the mask off when you come out. To walk around with one of those on all day is impossible. Mrs. Lesko if you dont mind one more question on this mask issue. Why do you think it is a lot of the asian countries, everyone is wearing masks, is it cultural . Do think they it will help . Do they know how to wear it properly . Dr. Gerberding in china right now, they are being required. Thats the main reason why you tend to see a lot of people on the streets of china wearing basically usually surgical masks. I dont think that they are there because they are having a Significant Impact on disease spread. Mrs. Lesko thank you. I yield back. Chair thompson thank you very much. A question for the committee. Dr. Gerberding, have you any assessment of how long it will take before we actually will have a vaccine . Dr. Gerberding id probably defer to dr. Faucis statements on this topic. Head of the niaid. Dr. Fauci has said well get vaccines to testing in a matter of several weeks to a few months, but that we wont have an approved vaccine for at least a year and probably longer. If im not paraphrasing him correctly, i will get back to you for the record, but realistically, its not a rapid track. Even with all of the permissions and the energy we are putting into it. Part of the reason for that is safety. We need to make sure chair thompson absolutely. Dr. Inglesby, a couple of comments have come up relative to capacity for the virus. Whether we were as robust as we needed to be as a federal government. Have you looked at the capacity issue or are we just basically caught with something that we just wasnt prepared to handle . Dr. Ezike i think it depends on what kind of capacity we are talking about. I think our Public Health agencies have been training for these things for a long time, but even as well trained as they are, there are enormous resource challenges and personnel challenges when they are working 24 7 and they are having to create new quarantine sites. I think in principle, there has been a lot of preparedness, a lot of drilling and grants for states and locals around the country, but i still think this is a challenge that they havent faced before. We do have major capacity challenges ahead in Public Health and hospitals. Chair thompson thank you very much. The gentleman from texas, mr. Crenshaw. Mr. Crenshaw thank you, mr. Chairman. Thank you all for being here on this important topic. Dr. Gerberding, ill start with you. Given your lengthy experience in this field, director at c. D. C. , dealt with threats from anthrax, sars, west nile, other outbreaks, i assume you compile constantly and persistently a best practices list and Lessons Learned. To your knowledge, are those lessons carried over administration to administration . Even when folks like you leave the administration and are those being implemented now . Dr. Gerberding thank you. When i was directing the c. D. C. , we implemented very formal after action reviews starting with anthrax, dr. Jim hughes had the National Center for Infectious Disease at the time and thats one of the things we did first was bring in anybody who we interacted with and the response and learn, what did we do, what did we do wrong, what did we need to do better . That mechanism is consistently practiced as far as i know to this very day at c. D. C. Yes, those lessons are passed forward. Each one of these situations brings a unique challenge. Its hard to extrapolate from one after action review to the next one the constant seems to go through them all are communication. Need for collaboration, and consistency approach to whole of government. Those lessons come up. I think we still have opportunities to improve in how we coordinate that as a country. Mr. Crenshaw this administrations taken a lot of heat in the media from politicians. Do you see any big differences in the response that this administration has given compared to say what a Previous Administration would have done . Dr. Gerberding since i left the government, i watch from the outside in, so dont know whats going on in the sausage factory. I do see that, broadly speaking, i think it the way the 2009 influenza pandemic was handled quite well. I think zika was hard, but people did a good job of that. There are lots of missteps in the early days of ebola. Here we are with this one. Many of the people who are acting as leaders of the response here are the same people that i worked with when i was in the government, secretary azar was part of the department when we were planning for flu pandemic. Bob cadillac was involved with the government in his role and now hes heading the as assistant secretary of preparedness. Barda has stepped up and funded, they funded the merck, ebola vaccine. Components of the government are doing exactly what they have been prepared and designed to do. Mr. Crenshaw do you think the level of outrage over the response is proportional to any actual shortcomings in the response . Dr. Gerberding earlier, i had a chance to talk about trust and whats necessary for people to trust whats going on. I think the person delivering information is critical at the federal, state, and local level. Thats something we need to really be mindful of. The consistency of the communication and, in my view, that the leading edge of the communication is about science, not politics. So i think thats a really important thing that would help a lot to calm peoples criticism and get us on track where people have confidence that their whole government is doing the right thing. Mr. Crenshaw i would just note that i think a lot of the criticism is not based on science or facts or any of the things that you just noted but in fact based on politics, which is the problem. I hope that the goal of that is not to create fear simply for the sake of getting political points. Although thats what i have seen from the media and others. I want to talk you hit on this before. About innovation and creating vaccines and creating treatments and how important the subject of innovation is. Im running out of time. Can you hit on with respect to innovation, if can you hit on again on the issue of price controls and what that might do to some of these biotech firms that generally rely on investments from venture capitalists or the larger pharmaceutical companies and some of the work they have been doing in the past decade, in fact Johnson Johnson has been looking at a corona vaccine for a decade. Would that Research Still happen if there were no incentives because of price controls . Dr. Gerberding i am not involved in the small biotech company, but one of the things i have learned in my role in bioexecutive committee and interact with some of these amazingly creative people is that a lot of times the company is based on just one idea or one really good leading approach to a critical innovation. And if there isnt the promise of reward to the investors who put their money in what is a really high risk situation, they are gone. If you take away the incentive for the investments to come forward, you have really diminished interest in pushing the envelope on innovation. Thats true in coronavirus, the same as it is in antibiotics, same as it is in any other things we wish we had and we dont. Mr. Crenshaw thank you. Chair thompson thank you very much. Id like to have entered into the record articles from the Washington Post and National Geographic on the coronavirus subject. Let me recognize mr. Correa for bringing this hearing forward. He was the first member of the committee to say that we need to bring some experts before the committee so that we can get firsthand knowledge. Mr. Correa, you want to a couple of quick followup questions. Incubation period . One to 14 days. On average, five days. Symptoms similar to flu . Yes. You dont know if you got the flu, dont know if you got corona . The expectation is fever is the sentiment system, a lot of people that end up in the hospital didnt start with fever. Half of them came to the hospital and hadnt developed fever yet. China, the rate going down in china . In actions right . The numbers reported in china are going down substantially. In cases and deaths. How certain are we that theyre accurate . The World Health Organization has said that belive theyre accurate. Its difficult to know from where we are. Death rate, World Health Organization had an article that said higher than the flu, youre saying that it is higher than flu, yet we dont know the denominator. We dont know what the death rate is at this point, we just suspect, is that correct . That is correct. The article that said w. H. O. Has concluded its a higher case fatality rate is a misquote. They have not said just that. They have basically divided the number of recognized cases by the deaths and come up and said 3 , approximately 3 have died. We do believe that there are many cases that are unrecognized. We dont know how many there are. Finally, best practices, Lessons Learned, we have to be consistent, we have to have a system and continue to invest on an annual basis, research and development, coming up with vaccines or protocols or this time this happens again, we dont have to scramble where we get the test kits, the masks, and so on and so forth. I would say two things. One is barda is a good value for americans. The work they have done is something i hope the committee is aware of and knows about because that is clearly a national asset. The second piece is included in the report, that is that our government needs to contribute to the coalition for preparedness innovation. That is a global effort. They are saying, we know some of the bad things like sars and mers that may come back. Lets get those vaccines across the finish line or at least into the freezer so that if the problem comes back, we got something we can pull out and test very quickly. The finish line or at least into in this committee, youre saying we have had those challenges, we havent come up with the vaccines and yet we know they will be back . We have to expect they will be back. We hope they wont come back. They may. Shame on us where we got started on something and didnt bring it across the finish line. Thank you, mr. Chair. Thank you, let me thank the witnesses again, there is no question about what you brought to the committee today, that information will be vital to ultimate solutions, some of it obviously is investment over the long haul with respect to detection and others. I do want to, just for the record, highlight the fact that we should be providing the public the best information we have. Its not a political issue. Its a health issue and we want to look at it in that respect. So words do matter when politicians get in it and so i caution everyone to govern themselves accordingly as we work through this. In the interim, i want to again thank you for an absolute excellent sharing of information for the committee. I would like to also say that the members of the committee may have additional questions for the witnesses. We ask you to respond are you ready to elect bernie . Ok. How many of you know someone who supports bernie but is not at this rally . Raise your hand. Keep your hand up. Of you know two people . Five people . All of these friends can make the difference for bernie here in michigan on election day. That is why the campaign made an thatalled the bern app allows us to text our friends and remind them of their polling ca
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