Samoa, the commonwealth of northern Mariana Islands come along, puerto rico and u. S. Virgin islands. More poorly we want to receive the perspective from our congress can help localss governments adequately address this world pandemic. Not just for the territories, its even i think have a better understanding when we say world pandemic as opposed to just try to keep it to the mainland here, discussion. The territories face unique challenges, geographic location, the unequal treatment under federal programs and the dire financial situation. And so the islands have been hit, have been hit by severe Natural Disasters including hurricanes, typhoons, earthquakes, and now theyre weakening the Healthcare Infrastructure in the economys is covid19. The local governments have been working to recover these communities and rebuilding these events, but w i believe theres more that needs to be done, and that one of the things that this virus has provided all of us, and helped provide everyone in congress is a perspective that as you i go through talk about recovery and relief, that theres a cumulative effect and theres not been enough resources to a territory. As part of history. Suddenly, you are drowned economically antigens of Health Response with this very deadly virus, and so it becomes a cumulative effect. The disparity at the beginning and then the disparity on top, you demand, a response that is already taxing local communities and local governments. I welcome this discussion. I think its important. I think my colleagues, mr. Sablan who is vice chair of the full committee. Mr. Mike san nicolas welcome and thank you much for joining us as well. Their advocacy and their assistants, equity in full attention to the territories has been very, very necessary and essential so that we respond to the spent in the of issue the federal level that theres inclusion and these gentlemen have been very, very effective in ensuring inclusion for all the areas to represent but the totality of the insular territories of the jurisdiction of our committee. I want to welcome the panelists to this format and introduce in each of the go along. But before i do since they are witness what we as the bite you if he has any opening comments before introduce our panelists and if there is any of the panelists in particular that you likeke to introduce yourself, mr. Sablan, the time is yours. Thank you mr. Controlling this and thank you everyone for taking part of this. I want to thank all the staff were in the background pulling this together. For those of us who are in d. C. , good afternoon to chairman grijalva and the caribbean, good evening as well. Good morning to those of you in the pacific. And thank you again for the participants who are being here today, welcome. Im thankful will be hearing directly from those of you and the secretary, individuals on the f ground with knowledge of e situation and the respective challenges and needs. From the northern Mariana Islands will hear from ms. Esther muna, no stranger to the committee who is ceo of the commonwealth healthcare corporation. I couldnt think of anyone better to share the emergence response in the northern Mariana Islands. And, of course, nearly all the territories as chairman grijalva said has been recovering from Natural Disasters before this pandemic hit our shores with hurricanes, super typhoons and cycles and pacific that had a devastating impact on individual slides come , public infrastruc, on our economies. And congress is already provided the liens of dollars. We were slowly starting to rebuild and then covid19 pandemic started to spread throughout the globe. This Public Health disaster is unprecedented. Theli whole world, world communy and individual, for individually individually. Ll surely be felt for years to come. An even before this, it was to 2018. Tributable but since the outbreak, the businesses have shattered. Residents have lost their jobs, teachers have been furloughed, pension payments have been reduced, and the arm felt throughout the islands continue to mount. So, i would say the commonwealth was slow to recognize the severity. But since, have done a commendable job at keeping the virus at bay. 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. And the measures that were set in place are working with the stayathome orders, public education, and the need for handwashing. It all seems to be working. I hope that continues. Congress and fema, hhs, dod and a host of federal agencies have provided critical assistance. We want to make sure that continues if more is needed. To mr. San nicolas, to the virgin islands, were really having a difficult problem which the department of education is trying to get them to release the education stimulus fund. We got a notice yesterday [inaudible] they would accrue that notice to today, just were trying everything. Its way overdue but thank you. Thank you again everyone for joining us. Comments and introducing one of the guests from the district you represent, while . Thank you for your leadership and for your constant vigilance in looking out for our territories apple in the jurisdiction of the Natural Resource can. I want to thank my colleague mrd his mentorship in making sure that the pacific territories in particular but all the territoriesrr in general are constantly being out for in the responsibilities that we carry as members of a Natural Resources committee. Mr. Chairman, i was really moved by her Opening Statement because it was very profound and if represented a sound insight into circumstances and the territories and particularly have circumstances become exacerbated when we face challenges like these. 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. This particular panel is supplemental security income. And the recent case in puerto rico, the circumstances in guam, we do not have supplemental security income in most of our territories. The commonwealth of the northern marianas 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 werent already receiving the most basic level of american decency in terms of support. And as a result of not receiving that support, theyve 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 those who need their help, they are out of work. Their job prospects are unknown and we now have a community of individuals who not only lacks a little security income buty evn lack the support of those who are taking care of them previously. So they have gone from not being supported the downright destitute. As we move forward with these care packages and as a look for ways to try and preserve the american way of life and the decencye that wield true in ths country, believe this is not for a startling to address the challenge that being face as a result of this pandemic but to have a very keen understanding now of how leaving out our people in the territories of things basic s ssi is just unacceptable. We have an opportunity to not only address these challenges today i to circle back into correct these injustices that are today just absolutely horrificct for those that are being impacted. I wanted to thank you,fo mr. Chairman for affording us the opportunity to be able to vocalize what we are going through. I wanted to recognize dr. Tom shea was been a very, very vocal advocate for the necessary procedures and equipment and just a real good general view of the severity of what were going through on guam and the necessary advocacy at our people have had to take on themselves in order to be able to fill the gaps are people facing on a daily basis. Thank you so much, mr. Chairman, and a thank you, mr. Chairman thank you. We begin with our first panelists and collectively thank each and everyone of you for taking the time for bringing the perspective to continuing to prioritize what the territories not onlyti need but are justifid in demanding that they get. With that let me introduce ms. Esther muna, chief executive officer, commonwealth of the north Mariana Islands, healthcare corporation. Ms. Mina, the time is yours. Thank you, chairman grijalva, vicechairman salon and committee members. Last may i give testimony to this committee under very different circumstances. I presented to the powerful positive impact of equitable medic is fun on our healthcare system. Last december the federal government took us to task by granting two more yearsng of equitable medicaid funding for the territories, but only a couple months later it was introduced to the greatest challenge yet, the coronavirus. In january we begin messaging coronavirus prevention in our community and screening patients for symptoms. In early february we sent our first coronavirus testing of a thousand miles away. It took ten days to receive a negative result. Over the next month we took steps to reduce traffic on our campus, incorporated quarter virus screening into a regular disease surveillance at the airport. On march 15th we activated our Area Operations command diverting nearly onethird of our staff tort the response. On march 28, we announced its first two positive cases with 12 more cases confirmed since then. In the past 40 past 40 days oft from our governor his task force, we have screened my 500watt inpatient for coronavirus symptoms. We have screened more than 1500 passengers at the airport, identified and reviewed more than 215 contact the positive cases, responded to more than 700 phone calls about the coronavirus, overseen the care of a a least 250 individuals fm quarantine and a isolation, had more than 300 specimens tested including moreth than 200 at our own lab, and conducted more than 90 tala consults with her patience. Three days ago cnmi begin conducting communitybased testing at a collected samples of more than 400 people. Of the 14 cases confirmed, two have died and the other 12 have recovered. It has been nearly two weeks since the most recent case was identified. We have been vigilant. Weve beenhe effective but we ae still vulnerable. The cnmii is uniquely susceptibe tole a people should reexperiene a larger outbreak upheaval. The virus cuts through the power of her social capital. Built on family gatherings, multigenerational household and close relationships. It lays bare our noncommunicable disease crisis and threatens to tear way the gains weve made to our healthcare. It has evaporated our likelihood. The cnmi Government Shutdown and is projecting a 65 million deficit. The island is close, many public and private employees have been furloughed, skyrocketing unemployment, the retiree pensions cut 25 rendering health careny unaffordable for o many families. The success thus far is result of a herculean effort required nearly 18,000 staff hours and over 7 million. Thanks to the governor come support from the government and the covid19 task force and the federal partnership with hhs and beauty from fema and for the supported by the care staff we have been able to secure additional ventilators, ppe, equipment, testing reagents, establish a temporary 40 bed care site and a longerterm alternate care site. We received help to assess our Surge Staffing needs and develop a territory action plan. We can now test for the coronavirus on island, and ability that fell far from our reach just 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 mustsu fulfill our obligatios while balance the coronavirus response. And forging an ambiguous future to prepare for the worst. Our strength and our weaknesses are brought into focus while the disruption has spark innovation. We are an apples supply and determination but we need your help to establish a reliable, equitable supply chain ppe and testing reagent. We need funding to keep our staff, including our robust contact racing team at work. We need support for the long overdue expansion and modernization of our 35yearold hospital. Along with our governor, his cabin and task force and mr. Sablan, we are working hard to safely bring the rest of cmmi back to work. Help us get there. Thank you. Thank you very much. Thank you, appreciate it. Let me introduce doctor shieh. The floor is yours. Thank you. Thank you, mr. Chairman, vice chair and our congressman Michael San Nicolas and all the panelists in this meeting. I have to say i dont work for the government andnd an independent and i will speak frankly as a person that is on the ground. Guam is a small but we were considered for the military and the United States as the tip of the spear. What america begins and right now its about 8 00 in the morning, and we are trying to adjust our Living Standards for the people here because people outt of jobs and many are suffering. But covid19 asset guam prettyed hard. Its unexpected. The sadd part about our first case is that on the very first case the island was already acquired virus. The spread was already there. So far weve been lucky. We dont have five deaths. Sadly, they are part of the family of, you know, guam is very compassion so even if it is just five deaths, it affects a lot of people, including one death and the United StatesTheodore Roosevelt which is the aircraft carrier. Those that hit guam pretty hard. The island tour rightha now is about 145 positive and we tested about 1200 deaths far. The u. S. Navy positive is approximately 1000 and i commend the United States need for being able to test 5000 sailors within just two weeks. I did also write to the admiral to congratulate him on that task. Its not an easy task. We asked as a sales return to the ship, perhaps time is, for the u. S. Navy to us with existing capacity, supplies and personnel. Im hoping ill get a positive response. Guam is really always been good with the military, and that cannot be forgotten as you take our voice to congress and to the president of the United States. To be transparent, projections coming from the Governors Office here has been way off course. The projected 30006000 deaths and over 400 hospitalize Covid Patients or more by now, its just not happening. Luckily i think the hospitalization rate has reached flat so thats great. I keep saying theres really no models to compare guam to new york city, wuhan, korea or japan. Our population compared toh othr places thats over 8 Million People such as new york city. That being said we cant take the virus lightly. Guam is trying to add another i think of rejection from the Governors Office strained at another 2 million beds to the t island. Seriously, its like building a restaurantnt with 2000 incapaciy but you only have 100 waiters and ten cooks. Theres just enough medical staff for doctors and nurses. This is just to show you that the lack of medical staff is part of the Big Health Care disparity on the island experiencing. With that said im glad one has already received 128 million in federal aid and i really like our government to be transparent in showing the people were dollars are being spent. The money should be directed to people first and ask our government to be transparent on that. Over the last few months are people really have suffered, sacrifice, lost their jobs. Money for families, losing healthcare insurance is so critical at this time. But the people reallyis want to get back to work. Just give itt a perfect exampl, i had a patient that was pregnant and she had four children. Her and her husband both work right now they been furloughed and no incomes coming in. They have no savings but over the last month and have they really dug into the citys and their hard time paying the bill, not to mention they have a hard time tryingey to buy cereal and milk. I gave them 100 ago by food just the other day. These are hardworking people that are suffering, and this is just one case amateur theres hundreds of them, thousands of the other. The stimulus checks i think is going to help but not enough. I think our people cannot continue to be living under this emergency declarations. I think want to get back to work. They stay at home, they social distance, it could put on the mask and we have stark bars now so the committee is to engage the community and how to reopen a new normal. Guam is small and we cannot and should not be forgotten by the United States of america. Eight we do not get our working force back we are really going to hang onto economic recession and it will affect health cover people as well. So handwashing, facemask is new normal to ask the federal government to help us with funding but at the same time i think we really ask our government to be transparent on for every dollar spent, and that dollars should be spent on the people of guam. Thank you. Welcome, sir. Let me introduce the next panelists, someone i know and have worked with, federico de jesus, senior policy advisor, powerha for puerto rico, working on issues affecting the island and again i think will speak to the human defect as we go forward as he of the panelists have spoken as well. Mr. De jesus, the time is yours. Muchas gracias. Good afternoon. Im a senior policy its owner to be with you today. Thank you, chairman, vice chair for inviting me to share our thoughts and concerns about the covid19 pandemic as it affects the commonwealth of puerto rico and thank you to the Committee Staff and to my fellow panelists. Unfortunately netted but has the lecture spending time at home working with comforts although this has been a taxing time for everyone around the world. It isme important to understand the just territories and puerto rico in particular come to this global struggle with two hands tied behind our backs. The corona