Treatment under federal programs, and the financial situation. And so the islands having been hit by actual disasters in turn including hurricanes, typhoons, earthquakes. Now those are we getting the aslth care infrastructure covid19. Local governments has been working to recover and rebuild under these events. But i believe there is more than needs to be done. Things that this virus has provided all of us is a perspective that as we go through and talk about recovery and relief, that there is a cumulative effect. And theres not been enough resources. Suddenly you are drowned economically and in terms of Health Response this very deadly virus. So it becomes a cumulative effect. Disparity at the beginning, and then you put disparity on top, you demand a response that is already taxing local communities and local governments. So i welcome this discussion. I think it is important. I think my colleagues, vice chair sablan of the full and internal affairs in. Particular. Thank you very, much for joining us as well. Insistence,cy and equity, and full attention to the territories has been very necessary and essential so that we can respond to this pandemic or any other issue at a federal level that there is inclusion and these gentlemen have been very effective at sharing that inclusion for not only the areas that they represent, but the totality of the territories, of the jurisdiction of our community. So i want to welcome the panelists to this format and introduce them each as we go along. Before i do, let me ask the vice chair if he has any opening comments before i introduce our panelists. And if there are any panelists in particular that you would like to introduce yourself. The time is yours. Tan thank you vice chair sablan thank you for holding this and thank everyone for taking part in this. Good evening. For those of us who are in d. C. , good afternoon to chairman gri jalva and in the caribbean, good evening as well. And good morning to those of you in the pacific. Thank you again to the participants for being here today. Hearing from individuals on the ground with your knowledge of the local situation and their respective challenges and needs. From esther muna, ceo of the health care operation. I could think of no one better to share about the Emergency Response in the northern islands. Nearly all the territories have been recovering from Natural Disasters before this pandemic hit our shores. Hurricanes, earthquakes in the caribbean, super typhoons and cyclones in the pacific have had on lives,ing Impact Infrastructure and our economies. In congress has already provided billions of dollars to recovery. And we are slowly starting to rebuild. Then the poll then the covid19 been amick pandemic started spreading. This Public Health disaster is unprecedented. Community and individually. The economies of every state and territory has been devastated. It will be felt for years to come. The economy was intrabiddable [indiscernible] shuttered,have residents have lost their jobs, pension payments have been reduced, and the arm felt throughout the islands continue to mount. Commonwealth was slow to recognize the severity. But since has done a commendable. Ob the number of cases has remained at 14. We have unfortunately had two deaths. Both were citizens and residents of the philippines who were missionaries on missionary work. Working with the stayathome orders, Public Education and the need for handwashing. It all seems to be working. I hope that continues. Hhs, dod andfema, a host of federal agencies have provided critical assistance. Thatnt to make sure continues if more is needed. Nicolas, the virgin islands, we are really having a difficult problem which the department of education is trying to get them to release the education stimulus fund. Yesterday bute then withdrew the notice yesterday. We are trying everything. So, its way overdue for our schools. But thank you again everyone for joining us. Comments anda introducing one of the guests from the district you represent . Thank you solas much again for your leadership and constant vigilance and constant vigilance in looking out for our territories that fall in the jurisdiction of the committee. I want to thank my colleague for his leadership and mentorship in making sure that the pacific territories in particular, but all the territories in general are constantly being looked out for and the responsibilities that we carry as members of the Natural Resources committee. Mr. Chairman, i was really moved by your opening statement, because it was very profound and it represented a profound insight of the circumstances in the territories, in part and how they become exacerbated when we face challenges like these. And i wanted to take this opportunity to kind of share how those preexisting challenges are circumstances that have become exacerbated in the most unamerican way. And this issue i wanted to kind of bring to the attention of this particular panel, is supplemental security income. The recent case in puerto rico, the circumstances in guam, we do not have supplemental security income in most of our territories. They were wise enough to negotiate receiving it when they negotiated their commonwealth relationship with the United States, but unfortunately the rest of the territories do not have it. And the absence of supplemental security income means that those at risk groups were not already receiving the most basic level of american decency in terms of support. And as a result of not receiving that support, they have been relying on caregivers and family members being able to supplement their needs and in these circumstances, those brave caregivers and family members who have been working extra hard to care for those who need their help, they are out of work. Their job prospects are unknown. Of we now have a Community Individuals who not only lacked supplemental security income, but even lengthy support of those who were taking care of them previously. So they have gone from not being supported, to downright destitute. And so as we move forward with these cares packages, and as we look for ways to try to preserve the american way of life, and the decency that we hold true to in this country, i believe that this is an opportunity for us to not only address the challenges that are being faced as a result of this pandemic, but to have a very keen understanding now of how leaving out our people and just territories is unacceptable. So we have an opportunity to not only address these challenges today, but to circle back and to correct these injustices that are, today, just are absolutely horrific for those that are being impacted. And so i wanted to thank you, mr. Chairman, for affording us the opportunity to be able to vocalize what we are going through. I wanted to recognize dr. Tom shieh, who has been a very vocal advocate for the necessary procedures and equipment. View ofeal good general the severity of what we are going through on guam and the necessary advocacy that our people have had to take on themselves in order to be able to fill the gaps that our people are facing on a daily basis. Thank you so much, and i yelled back. I yield back. Chair grijalva let me collectively thank each and everyone of you for taking the time, for bringing the perspective, for continuing to e territoriesat th are justified but in demanding that they get. And with that let me introduce ms. Esther muna. Shes executive officer of the islands health care corporation. Ms. Muna, the time is yours. Ms. Muna thank you chairman, vicechairman, and distinguished committee members. Last may i gave testimony to this committee under very different circumstances. I presented to you the powerful positive impact of equitable medicaid funding on our Health Care System. Last december the federal government took us to task by granting two more years of equitable medicaid funding for the territories. But only a couple months later, we were introduced to our greatest challenge yet, the coronavirus. In january they begin messaging coronavirus prevention and our community and screening patients for symptoms. Weearly february we spent sent our first it took 10 days to get a negative result. We took steps to reduce traffic on campus, inc. Coronavirus screening at the airport. On march 16 we activated our Area Operations command, diverting nearly one third of staff to the response. 28, we announced our first two positive cases with 12 more sense. In the past 40 days with support from our governor, his task force and staff, we have screened more than 500 walking ,atients walkin patients screened more than 1500 passengers at the airport, identified and interviewed more than 215 contacts of positive cases, responded to more than 700 phone calls about the coronavirus, overseen the care and release of more than 250 individuals from quarantine and isolation, had more than 300 specimens tested, including more than 200 and our own labs, and conducted more than 90 teleconsults with our patients. We began communitybased testing and collected samples of more than 400 people. Of the 14 confirmed cases, two have died. The other 12 have recovered. It has been nearly two weeks since our most recent case was identified. We had been vigilant, we had been effective, but we are still vulnerable. The cnmi is uniquely susceptible to upheaval should we experience a larger outbreak. The virus undercuts the power of our social capital. ,uilt on family gatherings multigenerational households, and close relationships. Noncommunicable disease crisis and threatens to tear away the gains we have made to our Health Care System. It has evaporated our livelihood. Throwing our tourismbased economy into a swift decline. Shut downovernment is and projecting a 65 million deficit. The island is closed, many employees have been furloughed, skyrocketing unemployment, retiree pensions cut 25 , rendering health care unaffordable for so many families. Resultcess thus far is a of a herculean effort requiring nearly 18,000 staff hours and over 17 million. And theo the governor, covid19 task force, and the federal partnership of hhs and dod from fema, further supported by the care staff, we have been able to secure additional ventilators, ppe, laboratory equipment, testing reagents, establish a temporary care site, and a longerterm alternate care site. We have received help to assess our search staffing needs our Surge Staffing needs. We can now test for the coronavirus on the islands. An ability that fell far from our reach this one month ago. This assistance has been core to our success, but we do need continued federal assistance to put an end to this war. We must fulfill our regular obligations while battling the coronavirus. Ambiguous feature to prepare for the worst. Our strengths and weaknesses are brought into focus while it has sparked innovation and illuminated improvement we need your help to establish a reliable, equitable supply chain for ppe and testing reagents. We need funding to keep our staff, including our robust Contact Tracing team at work. We need support for the longoverdue expansion and modernization of our 35yearold hospital. Along with our governor, his cabinet and task force, and congressman sablan, we are working hard to bring the rest of us back to work. Help us get there. Thank you. Chair grijalva thank you very much. Appreciate it. Shieh. Introduce dr. Sir, the floor is yours. Dr. Shieh thank you. Thank you mr. Chairman, vice andr, and our congressman, all the panelists. I do not work for the government , i am independent, and i will speak frankly as a person on the ground. Guam is small. As the tip ofred the spear. About just past 8 00 in the morning. And we are trying to adjust our Living Standards for the people here, because people are out of jobs and many are suffering. But covid19 has hit guam pretty hard. Its unexpected. The sad part about our first case is that from the very first island had the virus in our community. So far we have only had five deaths. Sadly, they are part of the veryy guam is compassionate. Even if it is just five deaths, it affects a lot of people, from the one death Aircraft Carrier theodore roosevelt. The island total right now is about 154 positives. We have tested about 1200 thus far. The u. S. Navy positive is approximately 1000, and they commitment i commend the navy to being able to test 5000 sailors within two weeks. I wrote to them, congratulating them on that task. It is not an easy task. We ask that as the sailors return to their ships, perhaps time has come for the u. S. Navy to actually help them get capacity, supplies, and personnel. I hope i get a positive response. Guam has always been good with the military, and that cannot be forgotten as you take our boys our voice to congress and to the president. Projectionsarent to coming from the Governors Office here have been way off course. The projected 3000 to 6000 deaths, and over 400 hospitalized patients or more by now, its just not happening. Luckily the hospitalization rate has remained flat, so that is good. I keep saying there are really no models to compare guam the new york city, wuhan, korea, japan. Our population of 160,000 compared to other places with over 8 million people. That being said, we cannot take the virus lightly. Guam is trying to add, i think the projection from the Governors Office, add another 2000 beds to the island. Seriously, it is like building a restaurant with 2000 sitting capacity, but you only have 100 waiters and 10 cooks. Theres just enough staff for 2000 additional beds. This is just to show you the lack of medical staff is part of it Big Health Care disparity our island is its periods in. That said island is experiencing. That said, im glad guam has received so much aid. I want our government to be transparent and where the dollars are being spent. The money should be directed to people first, and we ask our government to be transparent on that. Over these last three months, are people really have suffered a sacrifice, lost their jobs. Money for families, losing Health Care Insurance is so critical at this time. But the people really want to get back to work. Just to give you an example, i had a patient who was pregnant. She had four children. Her and her husband both work, but right now they are furloughed with no income coming in. They have some savings, but over the last 1. 5 months they really dug into their savings. They had a really hard time paying the bill, not to mention having a hard time buying cereal and milk for the kids. I gave them 100 to buy food the other day. These are hardworking people that are suffering. This is just one case, and i am sure there are thousands of them out there. The stimulus checks will help, but it is not enough. Be people cannot continue to living under these emergency declarations. I think they want to get back to work. There is stayathome, they social distance, they put on their masks. The key right now is to engage the community in how to reopen to a new normal. Not,is small, and we could and should not be forgotten by the United States of america. If we do not get our working force back, we are really going to hang onto an economic recession. Social distancing, handwashing, face masks is the new normal. So we ask the federal government to help us with funding, but at the same time we ask our government to be transparent on where every dollar is spent. And that dollar should be spent for the people of guam. Thank you. Chair grijalva you are welcome, sir. Let me introduce the next panelist, someone i know and have worked with. Jesus, Senior Advisor for puerto rico. Working on the issues affecting the island. I think you will speak to that cumulative effect as we go forward, as the other panelists have spoken as well. The time is yours. Mr. De jesus good afternoon. I am senior policy advisor for power for puerto rico. It is an honor to be here with you today. Me toyou for inviting share thoughts and concerns about the covid19 pandemic that affects the commonwealth of puerto rico. Thank you to the Committee Staff and my fellow panelists. Unfortunately not everybody has the luxury of spending time at home, working with comforts. Though this has been an effecting time for everyone around the world, it is important that the coronavirus outbreak is the Third StraightNatural Disaster to hit our island since 2017. Together with the manmade disasters of the botched federal hurricane response, as well as a fiscal crisis and economic depression from puerto rico in the last 15 years, this has puerto rico cannot effectively rebuild in a Sustainable Way while being hemmed by federal restrictions resulting from more than 120 years of u. S. Colonial rule. We hope the Natural Resources committee where people were akin to a natural park or gas line is denigrating for puerto rico and the u. S. Promised toeral quote, the greatest amount of liberty compatible with its military operation. 120 years later those words ring as hollow as and contradictory as ever before. How can this committee address many of the grievances in the shortterm while effectively fighting the pandemic, and also addressing medium and longterm challenges . It will become apparent as i go along. First of all, what is the situation on the ground . People have tested positive for covid19. 86 have unfortunately died. A proximally 30 five tests what explains the lack of testing . First off, the Trump Administration has refused to implement a National Testing strategy and is not properly invoked the defense production act. Games type ofger situation competing against each other and the federal government. Also, the government of puerto rico entered into a questionable contract for one million koba tests that never arrived. Had threeo since has Health Secretaries resign, and the current secretary has admitted mistakes. The Commonwealth Legislature is investigating the scandal. The reality is no other contracts have been signed to get a significant amount of tests. We have also barely begun addressing the earthquakes in january t