Essential work places. Im sorry, senator, you broke up at the beginning of your question. If you could just say it again. Im sorry. Yes, dr. Redfield, do you think that the testing protocols currently in place in the white house present a model for other essential work places. Well, thank you for the question. I think one of the important things you bring up is the essential worker guidance the cdc put out and i think it was originally modeled on Health Care Workers where there was significant shortages. Im asking if you think the white house protocol testing are a model for other essential work places. I would say i think each work place has to define their own approach how to operationalize. Had some considerable comment on the fact osha has not stood up an enforceable mandatory temporary standard for workers in all sorts of work settings. That aside, would you say that the ppe rules and protocols in effect right now in the white house are a model for other essential work places . We would, in my own view, go back to the guidelines the cdc has put out for people if they are an essential workforce, that they go in public, maintain six feet distancing. Okay. Admiral giroir, you have testified about how far youve come with testing assessments. I want to ask if you believe we already have a National Testing strategy today that spans from the nationwide testing Needs Assessment to the nationwide testing supply assessment and a strategy to fill that gap to procure domestically what we need in terms of bridging that gap with testing platforms, swabs, specimen collection media and reagents and the ppe needed to conduct those tests. So thank you for that. We do have a strategy that spans us at least to the fall and beyond. As i mentioned were working individually with every state, and i think senator paul is correct that kentucky, wyoming, or new jersey, rhode island are different and there are vastly different testing needs. The east coast will have multiples of testing versus other states and were working those individually. So i know you testified earlier that not only are you working with the states but youre working with every lab in every state. Correct. To increase capacity. What about working with those who would be those who would need testing to, say, reopen their school, their university, their business, each of them have identified what they think are their testing needs based on guidance not mandatory enforceable rules. Are you in contact at that level . Is your dashboard have visibility at that lowest level or mostly in contact with the states and with the labs . So over the last few months weve done a lot of the individual work at Nursing Homes, at meat packing plants, down to the very granular level. We are really working with the state leadership, with the Public Health lab, the state epidemiologists, the state health officials. They need to understand what their sum will be. And in the funding were asking specifically in the cdc funding for specific plans for schools, Nursing Homes, underserved, et cetera. I have two more points to make. One is about transparency of that Needs Assessment, can the public see it . Can the state see it . Can the Health Committee members see it . Is it publicly available . And, secondly, the delivery of the supply is a critical issue. It seems to me the logistics for getting this out whether its ppe, testing or medical equipment is still extremely fragmented. We need to stand up the full power of the defense production act. Would you like me to comment on that, maam . Im happy to have you comment with the indulgence of the chairman. Weve gone over time. Give a succinct answer, admiral giroir. Yes, maam and yes, sir. Particularly for things like swabs and media there is still a very, i would say, nonmature industry and thats why weve made the decision to distribute that to the states. There are too many variables to control. Thats an example where we really moved into that and used dpa for swabs to help support american industry. In more mature aspects of the industry, helping to direct them to make sure the states get what they need that were not procuring them directly by us but, again, were going to be evidence and data driven as we move on. Thank you, sir. Thank you very much, senator baldwin. Senator collins . Let me begin by first thanking each of our Witnesses Today for their expertise, their dedication and their hard work. Dr. Redfield, i want to start with you. I am hearing from dentists all over the state of maine that the fact they cannot practice in our state, despite following very strict Infection Control protocols is causing growing health problems. Dentists tell me that teeth with cavities that could have been filled with now going to need root canals. Teeth canals. Teeth that could have been treated with root canals are now going to require extractions. People with oral cancers cannot get the treatment, the cleanings that they need before beginning their treatment. Dental health is clearly so important and maine state officials, as well as our dentists, are seeking assistance in reaching the right decisions. 47 other states either have reopened dental practices or have a date set for them to reopen. So my question to you is this. If dentists are following the American Dental Association guidelines, if theyre instituting strict protective measures for their patients, their staffs, their hygienists, themselves, and if theyre closely examining and seeing a decline in the number of covid19 infections in their county, are these reasonable factors for states to consider in reopening the practice of dentistry . Yes, senator, thank you for the question. Weve been interacting and talking with dentists and working with the state and local Public Health officials to update your guidelines on reopening a variety of medical services, as you know. And i think you raise a very important point and i would not disagree with what you said about looking at the American Dental Associations, as well as the reality of the outbreak in the area. But we are in the process of updating those guidelines and they will include direct guidelines for dental practices. Thank you very much, doctor. Dr. Giroir, and dr. Hahn, recently theres been a significant demand for remdesivir, i may be mispronouncing it, which transferred to receiving an emergency use authorization. Last week two of maines largest Hospital Systems contacted me with questions about how this therapeutic will be allocated going forward. Hhs finally released a statement on saturday about allocations going to states, interestingly not directly to hospitals. But once again, the decisionmaking behind these allocations is very unclear. Hhs and the assistant secretary for preparedness and response say that each state is expected to receive an allocation, but no timetable has been provided. Beyond those who are being treated with this drug at Maine Medical Center through a Clinical Trial, im concerned that hospitalized patients in maine will have little or no ability to be treated with this promising therapeutic for the foreseeable future. As this and more therapeutics and ultimately a vaccine come onto the marketplace, how can these allocation and distribution issues be resolved so that patient care is not delayed and so that it doesnt depend on which state you live in whether or not youre going to get access to these treatments and ultimately a vaccine . Senator collins, this is admiral giroir. Go ahead, commissioner. Senator collins, i think we completely agree with you that this has to be an evidencebased approach, getting the medical therapeutics, vaccines, remdesivir, whichever it happens to be, to the people in need. I think we can all agree upon the fact that weve learned a lot of lessons from the remdesivir situation. And as you mentioned, thats being led by hhs. What youve seen in the most recent announcement is that what the test did was provide guidance to hhs regarding where the most significant outbreak of hospitalizations where the outbreak occurred and where those hospitalized patients were. This represented about a quarter of the supply of drug that we have and more will be allocated according to methodology to where those hospitalized patients are. I think valuable lessons can be learned and will be learned with respect to other therapies and to vaccines in particular, and we must incorporate those into our operational plans moving forward. Thank you, doctor. Admiral, do you have anything to add . Im over time. Sorry, thank you. If you have anything to add, if you would do so for the record. No maam, i agree with the commission. Its absolutely critical that its evidencebased, based on the people that can benefit from it and just and fair throughout our country. Thank you, senator collins. Senator murphy. Thank you very much, mr. Chairman. Thank you to you and senator murray and thank you to all of the witnesses for your services. This is obviously an exceptional hearing today in that three of our witnesses are in quarantine. So i just want to start by asking a Pretty Simple yes or no question that i think i know the question to. Im correct that all of you are drawing a salary, as you should, during your period of quarantine, is that correct . Senator, let me start. I think we better be careful about the issue of quarantine. We are essential workers as part of the essential infrastructure, and we are, when needed, which is often, to do our duties in respective places at the white house. I was at the white house yesterday and i will likely even perhaps be there today. And in my office at the nih. So it is not really, strictly speaking, a quarantine as we know it. But it is performing our duties as critical workers and i would be happy to have my colleagues also respond to that. Senator murphy, this is steve hahn. I agree with dr. Fauci. And yes, i am drawing a salary and i have continued to work during my quarantine. And as an essential worker, will participate in meetings face to face when that attendance is considered critical. My point here, you all should draw a salary while you are taking precautionary steps because of the contacts you have made. My point is that quarantine is relatively easy for people like you and me. We can still work and get paid. We can telework. But there are million of other americans who work jobs that cant be performed from home or are paid by the hour. And its just remarkable to me that this administration has not yet developed a mechanism for states to implement and pay for a quarantine system that will work for all americans. Your plan to reopen america requires states develop that plan, and yet my state has no clue how to implement and pay for that system without help from the federal government. Which leads me to my second question. Dr. Fauci and dr. Redfield, youve made news today by warning us appropriately of the dangers of states opening too early. But as senator murray mentioned, this is in fur rating to many of us, because it comes hours after the president declared that we have prevailed over coronavirus. Which im just going to tell you is going to make it much harder on state leaders to keep social distancing restrictions in place. It comes days after the president called on citizens to liberate their states from social distancing orders. And i think youre all noble public servants, but i worry that youre trying to have it both ways. You say the states shouldnt open too early, but then you dont give us the resources to succeed. You work for a president who is, frankly, undermining our efforts to comply with the guidance that youve given us, and then the guaidoan guidance that you have provided is criminally vague. And i want to ask my last question on this topic. Obviously the plan to reopen america was meant to be followed by more detailed nuanced guidance. What is a downward trajectory . What happens if the trajectory is down in some states and up in others . What happens if you open and theres a spike in one location or another setting . And of course you knew this because you developed this guidance, this Additional Guidance that sitespecific, that frankly is helpful. Some of this is on the cdc website, but some of it is not. And we need it. My state needs it. We dont have all of the experts that you have and so we rely on you. So reporting suggests, dr. Redfield, that this guidance that was developed by you and other experts was shelved by the administration, that it was withheld from states in the public because of a decision made by the white house. So my specific question is, why didnt this plan get released, and if it is just being reviewed, when is it going to be released . Because states are reopening right now and we need this Additional Guidance to make those decisions. Senator, i appreciate your question. Clearly we have generated a series of guidances, as you know, and as this outbreak response was evolved from the cdc to an allofgovernment response, as we work through the guidances, a number of them go for interagency review and input to make sure that these guidances are more broadly applicable for different parts of our society. The guidances that youve talked about have gone through that interagency review. There are comments that have come back to cdc. And i anticipate theyll go back up to the task force for final review. But were reopening in connecticut in five days, in ten days. This guidance isnt going to be useful to us in two weeks. So is it this week . Is it next week . When are we going to get this expertise from the federal government . The other thing i will just say is that the cdc stands by the Technical Assistance to your state and any state upon any request. I do anticipate the guidance, though, to be posted on the cdc website soon. Soon . Soon. I can tell you your state can reach out to cdc and well give guidance directly to anyone in your state on any circumstance that your state desires guidance from. Soon isnt terribly helpful. Thank you, mr. Chairman. Thank you, senator murphy. Senator hasset. Thank you for your service and i will have a set of questions. I appreciate your answers to be brief. Dr. Hahn, in your testimony you mentioned that the testing for the populations and the vaccine trials now includes older americans. I guess my question, though, is what about children . Does it include children . Does it also include the obese, the diabetic, the immunocompromised, those who are at risk to having a mitigated response to vaccination . Can you comment on that, please . Yes, sir. Thank you, senator cassidy. When the phase two, phase three trials are in place, they will include our most vulnerable populations, including the individuals that you described. Were working very closely with if i can interrupt. Phase two would normally check for safety. You would not have to do a separate phase two in the patient who was younger. Do you follow what im saying . Can you assume the safety data from the adults applies to that of the children . We would also want to assess safety as well in children. So the current phase two trials, do they include children . Theyre in phase one stage right now, sir. I thought dr. Fauci said we have a phase two going on. I think its about to start for the moderna vaccine. Perhaps dr. Fauci can answer that. No, i did not say phase two. I said we are in the second dose of the phase one and we will proceed when we finish the phase one to go into phase two. So i think im hearing that children will be included in phase two trials . No, so thats under discussion between fda and nih at this time, sir. Because we do realize that its important for us to understand what this is in children. Dr. Redfield, to build back on what senator murphy said, the school opening, obviously youre about to modify. I notice as i read through them theres nothing about testing. We speak about testing, targeted testing, but the guidelines has nothing about how to integrate testing. Will these be in those guidelines that are being released . Senator, thanks for the question. Clearly theres going to need to be, as already has been stated, an integration of a testing strategy that is going to be different for Different School settings, as well as different jurisdictions. And that is going to have to be integrated into each of those. Theres general overarching guidelines, and then the testing strategy which i think is important is including the surveillance strategy and needs to be an individualized let me comment on that, dr. Redfield. In all due respect, i think children, whether youre rural, frontier, suburban or urban, is the one setting in which there is a remarkable commonality, and i will echo what senator murphy said. The resources that the federal government has greatly exceeds all but the most sophisticated populus wealthy state. And even then it exceeds it by some extent. So i do think it would be good to have okay, in a Primary School setting, this is best practices or these are three options and choose between one of these three. To say that each School District or each private or parochial or Independent School work with your state board of health, figure it out, seems a wasted effort. I say that because Children Play such a role in both protection of disease, the spread of the disease, et cetera. So your thoughts on that . Because it really seems thats the one setting where you can have, you know, not cookie cutter, but certainly a pattern which can be followed. Senator, i must have been misunderstood. When i was talking about differences, i was thinking of the difference between an elementary school, a high school, a college in terms of how a trade school. There may be differences in how you integrate a testing strategy. But i do think having a testing strategy with different options for people to evaluate based on different principles will be important in terms of guidance. Dr. Fauci, you persuasively argue that the risk of reopening prematurely is great. But i think the frustration, if i think of children in particular, the risk benefit ratio of a child being at home, potentially away from enhanced nutrition without the parent able to work because School Provides daycare, without the monitoring as sometimes occurs for incidences such as child abuse, but perhaps most importantly for all children, the opportunity cost of a brain wh