[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]


                CORONAVIRUS DISEASE 2019: THE U.S. AND 
                          INTERNATIONAL RESPONSE

=======================================================================

                                HEARING

                               BEFORE THE

         SUBCOMMITTEE ON ASIA, THE PACIFIC AND NONPROLIFERATION

                                 OF THE

                      COMMITTEE ON FOREIGN AFFAIRS
                        HOUSE OF REPRESENTATIVES

                     ONE HUNDRED SIXTEENTH CONGRESS

                             SECOND SESSION

                               __________

                           February 27, 2020

                               __________

                           Serial No. 116-105

                               __________

        Printed for the use of the Committee on Foreign Affairs
        
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]        


       Available:  http://www.foreignaffairs.house.gov/, http://
                            docs.house.gov, 
                       or http://www.govinfo.gov
                       
                                __________

                    U.S. GOVERNMENT PUBLISHING OFFICE                    
40-218PDF                 WASHINGTON : 2022                     
          
-----------------------------------------------------------------------------------   
                      
			COMMITTEE ON FOREIGN AFFAIRS

		 ELIOT L. ENGEL, New York, Chairman

BRAD SHERMAN, California             MICHAEL T. McCAUL, Texas, Ranking 
GREGORY W. MEEKS, New York               Member
ALBIO SIRES, New Jersey		     CHRISTOPHER H. SMITH, New Jersey     
GERALD E. CONNOLLY, Virginia         STEVE CHABOT, Ohio
THEODORE E. DEUTCH, Florida	     JOE WILSON, South Carolina
KAREN BASS, California		     SCOTT PERRY, Pennsylvania
WILLIAM KEATING, Massachusetts	     TED S. YOHO, Florida
DAVID CICILLINE, Rhode Island	     ADAM KINZINGER, Illinois
AMI BERA, California		     LEE ZELDIN, New York
JOAQUIN CASTRO, Texas		     JIM SENSENBRENNER, Wisconsin
DINA TITUS, Nevada		     ANN WAGNER, Missouri
ADRIANO ESPAILLAT, New York          BRIAN MAST, Florida
TED LIEU, California		     FRANCIS ROONEY, Florida
SUSAN WILD, Pennsylvania	     BRIAN FITZPATRICK, Pennsylvania
DEAN PHILLPS, Minnesota	             JOHN CURTIS, Utah
ILHAN OMAR, Minnesota		     KEN BUCK, Colorado
COLIN ALLRED, Texas		     RON WRIGHT, Texas
ANDY LEVIN, Michigan		     GUY RESCHENTHALER, Pennsylvania
ABIGAIL SPANBERGER, Virginia	     TIM BURCHETT, Tennessee
CHRISSY HOULAHAN, Pennsylvania       GREG PENCE, Indiana
TOM MALINOWSKI, New Jersey	     STEVE WATKINS, Kansas
DAVID TRONE, Maryland		     MIKE GUEST, Mississippi
JIM COSTA, California
JUAN VARGAS, California
VICENTE GONZALEZ, Texas                              

                    Jason Steinbaum, Staff Director
               Brendan Shields, Republican Staff Director
                                 ------                                

         Subcommittee on Asia, the Pacific and Nonproliferation

                  BRAD SHERMAN, California, Chairman,

                    BRAD SHERMAN, Chairman

DINA TITUS, Nevada                   TED YOHO, Florida, Ranking Member
CHRISSY HOULAHAN, Pennsylvania	     SCOTT PERRY, Pennsylvania
GERALD CONNOLLY, Virgina	     ANN WAGNER, Missouri
AMI BERA, California		     BRIAN MAST, Florida
ANDY LEVIN, Michigan		     JOHN CURTIS, Utah
ABIGAIL SPANBERGER, Virginia                         

                     Don MacDonald, Staff Director
                            
                            
                            C O N T E N T S

                              ----------                              
                                                                   Page

                               WITNESSES

Fritz, Jonathan, Deputy Assistant Secretary, Bureau of East Asian 
  and Pacific Affairs, U.S. Department of State..................     7
Brownlee, Ian, Principal Deputy Assistant Secretary, Bureau of 
  Consular Affairs, U.S. Department of State.....................    13
Walters, Dr. William A., Executive Director and Managing Director 
  for Operational Medicine, Bureau of Medical Services, U.S. 
  Department of States...........................................    18
Redfield, Dr. Robert, Director, U.S. Centers for Disease Control 
  and Prevention.................................................    23

                                APPENDIX

Hearing Notice...................................................    81
Hearing Minutes..................................................    82
Hearing Attendance...............................................    83

 
     CORONAVIRUS DISEASE 2019: THE U.S. AND INTERNATIONAL RESPONSE

                      Thursday, February 27, 2020

                           House of Representatives
              Subcommittee on Asia, the Pacific and
                                   Nonproliferation
                       Committee on Foreign Affairs
                                                    Washington, DC,

    The subcommittee met, pursuant to notice, at 2:56 p.m., in 
room 2172 Rayburn House Office Building, Hon. Ami Bera 
(chairman of the subcommittee) presiding.
    Mr. Bera. The subcommittee will come to order.
    First-off, I appreciate the audience's patience given 
votes. We do not control voting schedules, so thank you, and 
thank you to the witnesses.
    Without objection, all members have 5 days to submit 
statements, questions, extraneous materials for the record, 
subject to the length limitations in the rules.
    I will now make an opening statement and then turn it over 
to the ranking member for his opening statement.
    I want to thank Mr. Yoho, my ranking member, for his 
longtime friendship and partnership in this issue. Also, I want 
to thank the members of the CDC and senior State Department 
officials for taking the time to come up here. Obviously, this 
is a very timely subject. This is our second hearing on the 
topic. A couple weeks ago, we had the first hearing in Congress 
on coronavirus and this will be my second hearing.
    As I think about this issue I apply my background as a 
physician, but more importantly, my background as the former 
chief medical officer for Sacramento County who was in charge 
of the public health delivery system there. I also use my 
expertise as a former faculty member in my last home 
institution, the University of California Davis School of 
Medicine.
    The reason why I give that background because is last night 
it became personal for me and it is now hitting close to home. 
The first novel coronavirus case potentially person-to-person, 
non-transmission is in Sacramento County as we speak. That 
patient is housed at U.C. Davis. And I have been in 
communication with my former colleagues that were over there.
    There are a couple concerning issues that are happening 
over there. There are a couple of concerning issues that as we 
go through the hearing, I am going to want to ask questions 
about. But if I think about this particular case, it initially 
arose in Solano County, which is close to where Travis Air 
Force Base is, and is one of the points of entry where we are 
quarantining patients as we evacuate them from overseas. Thus 
far, we do not know how the patient was infected; this patient 
did not have any travel history, and we are not aware of any 
contact tracing.
    That work continues.
    The patient arrived at U.C. Davis last Wednesday or 
Thursday and was intubated at the time on a ventilator. At that 
juncture, the doctors at U.C. Davis medical staff did not have 
a concrete diagnosis and had requested testing for coronavirus. 
It was determined that this patient did not fit the criteria 
for testing for the coronavirus.
    This past Sunday, the doctors and the medical staff 
insisted on the test. The test was performed. Last night we got 
the results back and the news that all of you have heard. This 
is the first patient testing positive where we do not have 
confident contact tracing.
    One thing that I will want to talk about, and perhaps with 
Dr. Redfield during our questioning can discuss, is the testing 
criteria. Also, I would like to discuss the rapidity of getting 
testing capabilities quickly to every State, and the 
distribution of test kits.
    I was chatting with the Ambassador from Korea earlier today 
and found out that Korea is testing 15,000 people a day right 
now. So, we should be doing whatever we can do to assist our 
scientists in get testing capabilities up and running as 
quickly as possible.
    There are a couple of other areas that I would like to 
focus on in this hearing as well. I do applaud President Trump, 
although I think the was delayed in announcing and identifying 
someone as the head, he did not use the term ``czar'' but I 
will use that term, who is the focus point to work across the 
interagency and who has direct access to the President and Vice 
President.
    That said, I really do want to applaud Dr. Birx's 
appointment announcement. She is very well qualified and has 
our support.
    I also appreciate the Administration's funding flexibility. 
I did think the initial amount of $2.5 billion was not going to 
be sufficient. I know the Senate suggested $8.5 billion. That 
may not be enough. And I thinkwe are allocating this funding in 
a bipartisan way, we should just be ready to make sure that our 
scientists and the folks that are on the front line, 
particularly the folks that are in public health systems and 
hospitals on the front line, have the resources and support 
that they need. Our No. 1 job is protecting domestic national 
security. And at this juncture, while we do not know a lot 
about this rapidly evolving public health threat, we have to be 
ready to make sure that our communities, our public health 
infrastructure, and our global health leadership has the funds 
and ability to do their jobs.
    In addition, as we are thinking about the dollar amount to 
appropriate, we have to do a quick assessment of public health 
infrastructure and assess the needs as well as the gaps. Having 
been in charge of the public health system in a large county, I 
know we run on shoestrings. Given the state of our 
infrastructure, a bad flu season would overwhelm our hospitals 
and emergency room capabilities. Slap on potentially what we do 
not know about coronavirus. We just have to be prepared for the 
worst and hope for the best here.
    I also want to make sure, and I talked about this with some 
of my colleagues on both sides of the aisle earlier this 
morning, that we keep politics out of this. This has to be a 
non-partisan effort. This has to be about looking at the 
science, following the facts, and doing what we have to do to 
keep the American public safe, but then also to focus in on the 
international community. That is going to be extremely 
important.
    In addition, we have to make sure, in this era where it is 
easy to put out false information, and with a very concerned 
public, that we communicate clearly. We are all leaders as 
Members of Congress and have the ability to communicate 
effectively. So, we must coordinate with the CDC and others to 
get accurate information out there to make sure the public is 
accurately informed. This will help us quickly dispel any 
misinformation and will allow us to do our jobs, allow you to 
do your jobs, and our scientists to do their jobs better.
    Lastly, this is the Foreign Affairs Committee and global 
health security is something that we look very closely at. In 
this sense, American leadership has to be central to how we 
approach this in a global aspect. So, Dr. Redfield, I will be 
curious to get an update on how our scientists are doing, how 
our CDC workers are doing in China in the hot zone, and if they 
have accommodated our workers. We have got to have an 
international response, with everyone working together in a 
transparent way and sharing information so we can get ahead of 
this.
    So, again, I appreciate the witnesses for taking their time 
to come down here to inform us as Members of Congress but also 
to inform the general public on what is rapidly evolving here. 
And, again, I appreciate the members that are here.
    And with that, let me turn it over to the Ranking Member 
Mr. Yoho for your opening statement.
    Mr. Yoho. Mr. Chairman, I appreciate those words. And this 
is like yesterday, it is deja vu all over again; right? We had 
the opportunity to meet with the chief of missions yesterday, 
and Chairman Bera opened up pretty much with the same thing 
about we are all on one team. This is Team America and we have 
to work forward. And we have to be like a virus or a bacteria: 
we know no borders; we do not care what your political 
affiliation is; this is something we need to come together and 
make sure we have the right response for America.
    We had this meeting, this hearing 3 weeks ago. And you look 
around about the concern because I think that speaks loudly 
with the attendance here for people to wait as long as they 
did. This is something that we need to be prepared for. And we 
want to make sure that we are in that.
    I am a veterinarian by trade. We dealt with herd 
situations. That is not to mean we should treat people like 
animals, but we should make sure we put in the proper 
safeguards so that we protect our population.
    We have a bill that we have sponsored, it is called the One 
Health bill, which coordinates animal diseases with human 
diseases. And this is why: seven out of ten human diseases 
originate with the animals. We have dealt with coronavirus for 
the last 30, 40 years in horses, cattle, dogs, cats, and other 
species. And so we know what viruses do.
    And I think the important thing that comes out of this, we 
lived through the Zika virus up here, and we saw the 
misinformation that was going out, the panic, the media, 
politics got put into that and it was a disaster. What I have 
seen in this response is there's a level, kind of a calm--I do 
not want to say a calm, but there is more of a rational 
approach. And I hope we can do that in this hearing. I think it 
will help this and help inform the American people.
    Other things that we are doing is this is appropriations 
season, and we are putting in appropriations for NIH, for NSF, 
for the research and development, but also for organizations 
like Gavi that does vaccinations around the work, and 
organizations like CEPI, the Coalition for Epidemic 
Preparedness. They are looking at the new and upcoming diseases 
to have vaccine models already ready for when something like 
this happens, because we can all rest assured this is not going 
to be the last time we are faced with something like this.
    And then I think the collaboration that we have with other 
countries. And we brought up the epidemiology last meeting that 
we had here, we had two epidemiologists, and we looked at the 
origin of where this was supposed to have come from in that 
province in Wuhan. And it was the fish market or fresh market. 
And we asked the epidemiologists if enough research was done. 
And they felt, no, it had not. But yet, the Chinese Government 
came and removed that market.
    And so those start raising questions. I mean, you look at 
the amount of response, the severity of the response of the 
quarantines and people isolated, it sometimes does not match 
what we are looking at as the disease or what we are being 
told: it is not that severe; we can control it. But yet when 
you have, you know, that province that was under quarantine, it 
is about 20 percent of the United States of America under 
quarantine. And then we have heard it is over 100 million 
people under quarantine.
    And what we want to make sure is that we have a measured, 
accurate response, and that we have readiness that we are ready 
to respond to this in the appropriate ways. And I think so far 
what we have seen I am kind of proud of what our country has 
done. And I said our country not an administration, but it was 
the country. And a lot of that comes from you guys here in this 
audience. And so we appreciate that.
    And then as I was talking about collaboration with other 
countries, we want to make sure no countries are excluded, 
countries like Taiwan that was so instrumental in the SARS 
epidemic. For a country like China to put pressure on other 
countries to exclude them from this process and the WHA, World 
Health Assembly, or the WHO, I think that is, I just think that 
is a wrong move. You know, this is, again, viruses do not care 
what your political affiliation is, we need all hands on deck 
to deal with this.
    And so, with that, Mr. Chairman, I am going to yield back. 
And thank you.
    Mr. Bera. Thank you to the ranking member.
    I am very pleased to welcome our witnesses to today's 
hearing. We are joined by four excellent public servants.
    Jonathan Fritz serves as Deputy Assistant Secretary for the 
Bureau of East Asian and Pacific Affairs. He will be followed 
by Principal Deputy Assistant Secretary for the Bureau of 
Consular Affairs, Ian Brownlee.
    The final State witness will be Dr. William Walters, the 
Executive Director and Managing Director for Operational 
Medicine at the Bureau of Medical Services.
    Finally, we are honored to be joined by Dr. Robert 
Redfield, the Director of the Centers for Disease Control and 
Prevention.
    Please summarize your written statements in 5 minutes. And 
without objection, your prepared written statements will be 
made part of the record.
    Mr. Fritz, if you would like to begin.

STATEMENT OF JONATHAN FRITZ, DEPUTY ASSISTANT SECRETARY, BUREAU 
  OF EAST ASIAN AND PACIFIC AFFAIRS, U.S. DEPARTMENT OF STATE

    Mr. Fritz. Thank you, Chairman Bera and Ranking Member 
Yoho. Thank you for the opportunity to testify today regarding 
the outbreak of the COVID-19 novel coronavirus and the 
Department of State's response.
    Throughout this global public health emergency the 
Department has worked around the clock on what has always been 
mission No. 1 for us: ensuring the safety and security of U.S. 
citizens abroad. The Secretary and the senior leadership team 
have been personally engaged in directing and supporting the 
U.S. response to this outbreak, in close consultation with our 
colleagues at the Department of Health and Human Services, 
including our CDC colleagues; at the Department of Homeland 
Security; the Department of Defense and others.
    Utilizing their expertise, our diplomats and staff serving 
in the region executed evacuation plans, provided consular 
services, engaged foreign governments, and reported on economic 
issues arising from this outbreak. We simply could not have 
done so much to care for U.S. citizens and our own personnel in 
China without a department-wide effort. U.S. diplomats in 
China, Seoul, Tokyo, Phnom Penh, and elsewhere contributed to 
our evacuation efforts, ably aided by our locally employed 
staff, including those at our Consulate General in Wuhan.
    Throughout it all, we regularly engaged with the People's 
Republic of China at the most senior levels, including 
President Trump's February 7th conversation with President Xi. 
Secretary Pompeo also spoke with his counterpart about the 
evaluations from Wuhan, and stressed that protecting U.S. 
citizens in times of crisis is our No. 1 priority.
    Our Ambassador to China Terry Branstad worked directly with 
the Ministry of Foreign Affairs of China to facilitate 
evaluation flights and U.S. deliveries of donated assistance. 
Our team in China was on the ground helping obtain permissions 
for our flights and processing passengers, operating in often 
difficult conditions. This work was instrumental in evacuating 
U.S. citizens and even some of our allies to safety.
    We faced challenges in evacuating U.S. citizens from the 
quarantine zone in China, and additional complexities 
supporting U.S. citizens on cruise ships. The Department worked 
closely with our allies in Japan to ensure the health and 
safety of U.S. citizens onboard the Diamond Princess cruise 
ship docked in Yokohama. The U.S. Embassy Tokyo coordinated 
closely with the Japanese Government, with Carnival 
Corporation, and CDC and other components of the Department of 
Health and Human services to assist U.S. citizens on the ship.
    After a high number of COVID-19 cases were identified 
onboard, and out of consideration for Japan's already 
overburdened health system, the Department of Health and Human 
Services made an assessment that the U.S. citizens and crew 
onboard were at high risk of exposure and should be repatriated 
to minimize risks to their health going forward.
    In Cambodia we organized response teams in Sihanoukville 
and Phnom Penh to assist U.S. citizens on the cruise ship 
Westerdam. Working in close coordination with Holland America, 
Cambodian authorities, and the embassies of other countries 
with citizens onboard the ship.
    Embassy teams included consular, medical, and logistics 
experts to facilitate health screenings, lodging, and travel 
needs of more than 600 U.S. citizen passengers. Our embassy 
also utilized its consular messaging platform and social media 
accounts to provide timely updates to passengers.
    In coordination with these efforts, USAID has provided an 
initial tranche of funding for affected and at-risk countries 
to address critical gaps in COVID-19 country readiness, 
including risk communication and community engagements, 
laboratory detection, enhanced surveillance, and infection 
prevention and control.
    In addition, USAID is arranging shipments of essential 
personal protective equipment to selected countries in 
coordination with the World Health Organization.
    Our efforts continue apace. We are continually engaging 
with host governments in the Asia Pacific region to ensure they 
are informed of our policies and that we can share information 
and best practices to address this outbreak. We successfully 
encouraged Beijing to accept U.S. experts in the WHO mission to 
China.
    On February 7th, 2020, the U.S. Government announced that 
it is prepared to provide up to $100 million in existing funds 
to assist countries, including China, impacted by and at risk 
from the virus. Assistance to contain and combat COVID-19 will 
be provided bilaterally and through multilateral organizations. 
This commitment, along with the hundreds of millions generously 
donated by the American private sector demonstrates strong U.S. 
leadership in response to the outbreak.
    Thank you, Mr. Chairman. I look forward to answering your 
questions and those of other members of the subcommittee.
    [The prepared statement of Mr. Fritz follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    
    Mr. Bera. Thank you, Mr. Fritz.
    Mr. Brownlee.

     STATEMENT OF IAN BROWNLEE, PRINCIPAL DEPUTY ASSISTANT 
SECRETARY, BUREAU OF CONSULAR AFFAIRS, U.S. DEPARTMENT OF STATE

    Mr. Brownlee. Chairman Bera, Ranking Member Yoho, thank you 
for the opportunity to testify today.
    The consular mission has always been the safety and 
security of U.S. citizens at home and abroad. We have worked in 
recent weeks hand-in-hand with our colleagues from the CDC, HHS 
ASPR, NIH, DHS, and others to provide critical information and 
travel alerts for U.S. citizens overseas, to help arrange 
repatriations of U.S. citizens from two countries, and to 
provide in-person consular services to U.S. citizens impacted 
by the outbreak in many other countries.
    In China, U.S. Embassy and consular staff made thousands of 
phone calls and corresponded tirelessly via email and various 
online platforms to reach U.S. citizens in Hubei Province. We 
worked with the Chinese Government to help Chinese grandmothers 
accompany their U.S. citizen grandchildren on evacuation 
flights.
    As the Chinese Government locked down Wuhan, our team in 
China coordinated with local authorities to allow U.S. citizens 
to travel to the airport to be evacuated. Using State 
Department chartered evacuation flights, and working with our 
interagency partners such as HHS, CDC, and DoD we brought 
approximately 800 U.S. citizens from Wuhan back to the United 
States.
    In Japan, U.S. Embassy staff created a dedicated webpage 
for U.S. citizens quarantined on the cruise ship Diamond 
Princess, and reached out to them individually by email and 
phone. As some U.S. citizens developed health problems, not all 
related to COVID-19, consular officers worked with Japanese 
hospitals to ensure U.S. patients received appropriate medical 
care.
    In collaboration with our interagency partners, the 
Department transported over 300 U.S. citizens back to the 
United States on February 16th. We remain in close 
communication with Japanese authorities and the cruise line to 
assist those U.S. citizens who remained in Japan after the 
evacuation.
    In Cambodia, U.S. Embassy staff met the cruise ship 
Westerdam in the port city of Sihanoukville. Our staff 
coordinated--excuse me--our staff provided key liaison roles, 
ensuring U.S. citizens were connected to the appropriate cruise 
ship authorities and Cambodian health care professionals. We 
also sent a team to the airport in Phnom Penh to provide 
consular services.
    Consular personnel in Kuala Lumpur, Karachi, and Amsterdam 
worked late into the night to help 91 of those stranded U.S. 
citizens get home last week.
    We are supporting U.S. public health authorities' efforts 
to contain the virus outside the United States. These officers 
have implemented Presidential Proclamation 9984, which suspends 
the entry into the United States of any aliens who were present 
in China, except Hong Kong and Macau, during the 14 days before 
any attempted entry into the United States.
    The Bureau of Consular Affairs is entirely fee funded. And 
most of those fees come from these applicants. Under our 
current authorities, we use these fees to cover most of the 
costs of providing services for U.S. citizens abroad such as 
those I just described. However, based on what we now know, we 
anticipate a loss of approximately 100--excuse me, of 98 
million, a loss of 98 million dollars in visa revenues this 
year as a result of COVID-19.
    To ensure we can help U.S. citizens in distress, despite 
falling visa revenues, I would ask that you grant the 
Department greater flexibility in spending existing fees.
    We remain committed to protecting the health and welfare of 
U.S. citizens overseas, and working actively with the 
governments and international partners to achieve this goal in 
this crisis.
    Thank you, Mr. Chairman. I look forward to answering your 
questions or those of the other members of the subcommittee.
    [The prepared statement of Mr. Brownlee follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    
    Mr. Bera. Thank you, Mr. Brownlee.
    Dr. Walters.

  STATEMENT OF DR. WILLIAM A. WALTERS, EXECUTIVE DIRECTOR AND 
 MANAGING DIRECTOR FOR OPERATIONAL MEDICINE, BUREAU OF MEDICAL 
              SERVICES, U.S. DEPARTMENT OF STATES

    Dr. Walters. Chairman Bera, Ranking Member Yoho, and 
distinguished members of the subcommittee, thank you for the 
opportunity to testify today.
    As my colleagues have stated, the Department of State is 
committed to taking all necessary steps to protect the health 
of our overseas work force and promote the well-being of U.S. 
citizens around the world. Between January 28th, 2020, and 
February 16th, 2020, the Department executed the most complex 
non-military evacuation of U.S. citizens in its history. The 
safe and efficient rescue of 1,174 people from Wuhan, China, 
and the Diamond Princess cruise ship in Japan is a testament to 
the agility, proficiency, and dedication of our work force, our 
interagency partnerships, and others to accomplish our core 
mission: advancing the interests of the American people.
    Following the SARS outbreak of 2004, the U.S. Government 
Accountability Office recommended that the Department work with 
interagency partners and the private sector to develop 
capabilities to support the medical evacuation and 
transportation of U.S. citizens from areas impacted by the 
sudden outbreak of infectious disease.
    And the 2014 Ebola virus disease outbreak again served as a 
reminder that the Department must have a standing crisis 
response aviation capability to protect U.S. employees and 
citizens when emergency situations arise.
    Such a prompt repatriation of U.S. citizens from quarantine 
conditions could not have been possible had it not been for the 
Bureau of Medical Services' existing aviation contract and 
solid corporate partners. The MMS contract is the Department's 
only standing response aviation support and critical care 
medical evacuation capability, and the U.S. Government's only 
standing biocontainment transport capability.
    Upon receipt of the mission directives, we managed to 
configure and simultaneously choreograph the movement of five 
aircraft, including the coordination of all flight clearances, 
overflights, and other required logistics. Department of State 
personnel onboard these aircraft were trained and equipped to 
manage these operations.
    The Department successfully directed and executed a total 
of seven flights over four missions, with evacuees transported 
to five different locations within the United States equipped 
to safely receive, evaluate, and house persons exposed to the 
virus. This operation involved close coordination with our 
interagency partners, including the Federal Aviation 
Administration and the Departments of Defense, Health and Human 
Services, Homeland Security, and others.
    We also coordinated with international partners, including 
the Governments of the People's Republic of China, Japan, the 
Republic of Korea, and Canada. I was the lead medical service 
officer overseeing these missions from the second and third 
mission on the ground in Wuhan.
    Some 41 countries and territories have reported cases of 
COVID-19 infection, placing the health of our employees and 
U.S. citizens in these countries and territories at risk. In 
these unprecedented times, the Department's medical 
professionals are committed to doing everything we can for the 
health and safety of our work force and the U.S. citizens 
overseas.
    In summary, I would like to thank each of you for your 
continued support as we keep pace with this international 
emergency. We know that your support to the Department, the 
Bureau of Medical Services in particular, has made this all 
possible, and that your continued support will be critical in 
the months and years to come.
    Thank you.
    [The prepared statement of Dr. Walters follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    
    Mr. Bera. Thank you, Dr. Walters.
    Director Redfield.

 STATEMENT OF DR. ROBERT REDFIELD, DIRECTOR, U.S. CENTERS FOR 
                 DISEASE CONTROL AND PREVENTION

    Dr. Redfield. Well, thank you, Chairman Bera and Ranking 
Member Yoho, and the members of the committee for the 
opportunity to speak to you today.
    CDC, the Department of Health and Human Services, the State 
Department, and other U.S. Government partners are fully 
committed to confront the serious level health threat presented 
by coronavirus disease 19. CDC's public health approach to 
COVID-19 is built on decades of infectious disease expertise 
and prior public health emergencies such as SARS, MERS, Ebola, 
and pandemic influenza. Our goal is to keep America safe and to 
slow the introduction of this new virus into the United States.
    Our response involves multi-layered, aggressive 
containment, and potential mitigation measures, as needed. 
These proven health--proven effective public health 
interventions include early diagnosis, isolation, and contact 
tracing. These public health interventions also include 
targeted travel restrictions as well as the use of quarantine 
for individuals returning from transmission hot zones such as 
Hubei Province, China, and the Diamond Princess cruise ship 
docked in Japan.
    Internationally, CDC is working with the World Health 
Organizations and ministries of health across the globe to 
continue to combat this outbreak. CDC has deployed over 600 
staff to the response, including staff supporting Japan, South 
Korea, and our country office in China.
    This outbreak underscores our national leadership role on 
the global scale and the necessity of strengthening our global 
capacity to stop disease threats at their source before they 
spread. When this outbreak was first reported in December 2019, 
China reported 27 cases of pneumonia linked to a seafood 
market. Today there are more than 78,000 cases and over 2,700 
deaths.
    Over the past few months we have seen confirmed cases 
reported in 46 international locations, including the United 
States. And several of these countries now are supporting--are 
reporting sustained community spread.
    In the United States, 15 cases have been confirmed by our 
Nation's public health and medical community based on clinical 
guidance provided them by CDC. On February 26th, CDC confirmed 
the infection with the virus caused by COVID-19 in a person who 
reportedly did not have any relevant travel history or exposure 
to other COVID patients. It is possible this could be an 
instant--an instance of community spread of COVID, which would 
be the first time this has happened in the United States.
    Three cases have been detected among the Americans 
repatriated from Wuhan, and another 43 cases were confirmed 
among the cruise ship passengers that were repatriated from 
Japan.
    We commend the efforts of the Government of Japan to 
institute quarantine measures onboard the ship, and we 
appreciate Japan's cooperation with the U.S. Government to 
evaluate and care and evacuate American citizens. CDC works in 
partnership with the State Department to assist in this 
repatriation effort of American citizens, both from China and 
Japan.
    All of the individuals repatriated from Wuhan by the State 
Department charters have now been released from their mandatory 
quarantine. These individuals are not at risk of spreading the 
virus to others and should return to their normal lives. 
Passengers from the Diamond Princess are in the process of 
completing their quarantine at several locations across the 
United States.
    We are grateful to all the Americans who have and still are 
undergoing quarantine for their patience and their cooperation, 
as well as their willingness to ensure that they, their 
families, their communities and our Nation remain safe.
    We also want to thank the Department of Defense, the 
military personnel, their families on the installations where 
the evacuees have been quarantined for their hospitality and 
service to our Nation.
    Efforts to direct flights from mainland China to 11 U.S. 
airports continue. CDC is working closely with Customs and 
Border Protection to screen arriving passengers from mainland 
China for illness, and to identify people at high risk of 
exposure to this new virus and ensure that they are referred 
for the appropriate public health followup.
    To inform future travelers of the virus and where it is 
spreading, CDC continues to post travel advisories and alerts. 
Specifically, China and South Korea are now Level 3 warnings 
that advise travelers against non-essential travel.
    Finally, CDC's current assessment, including the United 
States, is the risk of this infection remains low. However, we 
do anticipate new community cases. We have implemented a 
successful containment strategy, but we must be prepared to 
move to a blended containment mitigation approach. We also need 
to make sure we continue to strengthen our public health 
infrastructure, as alluded to by the chairman, and be ready for 
broader community spread.
    CDC and HHS will continue to keep Members of Congress 
informed of new developments. We recognize that you are trusted 
leaders in your community, and communication with the public is 
essential during this emergency.
    Thank you. And I look forward to your questions.
    [The prepared statement of Dr. Redfield follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    
    Mr. Bera. Thank you, Director.
    I will now turn to my opening questions. And then I will 
recognize the ranking member and our other members for 5 
minutes for the purpose of questioning the witnesses.
    Director, in my opening statement, as well as as you 
alluded to it in your opening statement, I mentioned this 
potential first patient community spread. And it is in my home 
county, Sacramento County, and the patient is housed at the 
hospital that I used to attend, and have taught lots of medical 
students in.
    In talking to my colleagues earlier today and getting a 
sense of the time lines of this patient, one thing is a bit 
consuming. I have taken care of patients like this who get 
transferred up, who are intubated, whose respiratory diagnosis 
is unknown cultures are coming back negative, et cetera. And in 
this case, it does seem like last Wednesday the medical staff 
asked for a test of coronavirus and were told this patient did 
not meet the criteria and this was not a coronavirus patient.
    As the patient worsened, it does sound like this past 
Sunday there was an insistence and a strong push, and 
ultimately the patient did get tested. And we know the results 
that came back 72 hours later as a positive test.
    A question that I have, and maybe it is twofold, is No. 1, 
what current criteria are we using to determine who is going to 
get a test and who is not going to get a test? When a doctor 
caring for this patient and they are looking at a patient and 
they request it, it is a no-brainer, we ought to do that test 
based on the medical expertise of the folks that are trying to 
confirm a diagnosis.
    At a minimum, with this new case, we ought to rethink what 
those criteria are. I would be curious to hear what criteria 
are we using today and if the CDC is updating that criteria?
    And the second component is that our testing capabilities 
seem a bit too slow at this juncture. And I would be curious to 
hear what we are doing to increase the rapidity and 
availability of tests, if we are getting testing kits out to 
all 50 States as well as more broadly to cities and others.
    And then another issue is that it did take 72 hours from 
testing to get the results. If we could get those testing 
facilities a little bit closer, the results might come back 
quicker. I'd be curious to see how the CDC is thinking about 
that.
    I am also told that one of my sister institutions, GCSF, 
have produced a more rapid test. We need the ability to get 
some samples to confirm the specificity and sensitivity of that 
test. And there are some private sector companies that are also 
working on rapid diagnostic tools as well.
    So, Dr. Redfield.
    Dr. Redfield. Mr. Chairman, thank you for the questions.
    First, I think you know when this outbreak started, for 
better or worse, even in China, it was linked to whether you 
were exposed to the sea market, so, or food market. So, obvious 
every confirmed case was from the market.
    And then in discussions I had with the Chinese CDC director 
I suggested they go out and look at other people with flu-like 
illness. And, of course, then they reported that there were 
many cases that were not around the market.
    When the United States began this PUI, we had the 
epidemiological advantage of the link to Hubei initially, where 
most of the cases came from. Clearly what has been demonstrated 
by the recent case is that is no longer operational.
    I will tell you that as soon as that case was recognized we 
met and we revised our case definition for persons under 
investigation. And I am, you know, today that has been posted, 
along with a new health advisory, that the recommendation 
should be when a clinician or a public health individual 
suspects coronavirus then we should be able to get a test for 
coronavirus.
    So, that is the current guidance that went out today.
    And this is a fluid situation.
    And your second question is also critical: how do we expand 
the availability of testing?
    We think it was an accomplish to, within a week to develop 
a test so we could get eyes on this. And I think the CDC 
scientists were able to do that. But that was not to take away 
the broader responsibility to the private sector to come in to 
be able to provide broader testing for the non-public health 
community.
    We have had aggressive discussions about how to expand 
that. And we are continuing. We have shipped our kits, as you 
know, initially out to many, many jurisdictions. We had trouble 
with one of the controls. That has now been corrected, and 
there are now 40 jurisdictions that have the ability to do the 
test modified with the FDA approval. And in the next today, 
tomorrow, we anticipate more kits from the private sector that 
have been contracted by CDC to get out. And, hopefully, our 
real goal is that LabCorp and Mayo Clinic and others.
    But you get at the root of it: why is there a difference? 
And I used to run a diagnostic lab and developed tests. The 
other countries have the ability for someone like me to develop 
a laboratory test and to deploy it. In our country, we develop 
a laboratory test and we need to go through a regulatory 
process in order to get it deployed. And, again, I'm not 
criticizing the regulatory process, I am just saying that is 
the difference.
    And many labs in this country, many hospitals could stand 
up--as you mentioned, San Francisco and others, your own 
Davis--could stand up a test within several days. Because we 
have published the sequences and the methods and exactly how to 
do this, and that is how that one company IDT is now ready to 
sell a test, which is really basically a copy of the CDC test.
    So, I do think we have to look at that because this is an 
example where we were slowed in a sense because of the way we 
want to assure accuracy of these diagnostic tests. And I know 
you all are wrestling with that. But we are having work kits 
out later today that are going to be sent to the States.
    The State of California, I talked to your secretary of 
health just today because they were down to 200 tests, we are 
sending more out there. There are three laboratories now, I am 
told, in California that have the ability to do the testing.
    But both of your points are very, very important. We take 
them very seriously. One at least we are not going to let 
happen again because we corrected it after the first case, and 
the other we are working hard to get these tests out and hoping 
that the private sector comes in for the clinical use. CDC 
develops them for the public health use, and we need the 
private sector to come in for the clinical.
    Mr. Bera. Director, I appreciate the change in the 
criterion and applaud that.
    I do think this is a unique situation where we need all 
hands on deck. And we do need to take a look at speeding up the 
regulatory process. We do need to allow the academics and those 
that have the ability to develop their own testing capabilities 
to quickly move through the process to make sure these are 
sensitive, specific, and accurate diagnostic tests.
    And then if the private sector can augment our ability, 
especially now that there may be community spread, we have to 
stop the bottleneck and get these tests out to all parts of the 
country.
    So, we can take that up here, but looking at the 
Administration, we all need to do whatever we can do to speed 
up that regulatory process to make testing readily available to 
the practitioners that are out there.
    And with that, let me recognize the ranking member.
    Mr. Yoho. And I appreciate it. And I appreciate you all's 
testimony. And I think what you are just bringing up is a lot 
of the questions I had. You know, I assume it is PCR test, 
analyze test. Okay.
    The variation in those, you guys created that. And I think 
along that line there should be provisional approvals quickly. 
And that is the thing, if you guys are in a bottleneck where 
you cannot get that, let us know so we can help relieve that 
and then do the testing and verification down the road. But you 
have to have a place to start.
    And then when we get to the point where we have private 
manufacturing of these, we just need to make sure that we are 
all on the same page, it is the same test so we do not have a 
variation in sensitivity or specificity. And that we need to 
make sure that other countries are doing the same.
    My concern is, you know, with so much of the APIs being 
created in China--about 80, 85 percent plus is what I have 
heard--you know, I look at it from a national security 
standpoint or a national health standpoint, not just our 
country but other countries. You know, if somebody needs Advil 
and you have a population of 1.3 billion people, you know, are 
they going to service their customers first before over here?
    And I think this is a wake-up call for American 
manufacturers and our pharmaceutical companies not to be 
dependent on a country.
    What are your thoughts about that? Whoever wants to tackle 
that? Mr. Fritz, you are the one.
    Mr. Fritz. Thank you, Ranking Member Yoho.
    There is clearly going to be all sorts of economic impacts 
as the outbreak continues to develop. We are paying very, very 
close attention to not just the general macroeconomic impacts 
that are going to occur with regard to the United States 
economy and other economies around the world, but also to the 
impacts on supply chains and, particularly, as you mentioned, 
supply chains that are important to our ability to react to 
future instances, future outbreaks.
    I do not have anything that I can share with you right now, 
ranking member, in terms of what those responses will look 
like, but it is something that we are looking at very 
carefully. We have people across the interagency process who 
are actively considering ways we can make sure that we are able 
to make sure that we do have access to the necessary supply 
chains.
    Mr. Yoho. Right. Let me ask about the cooperation. Do you 
guys feel that the cooperation is adequate with the Chinese 
Government as far as transparency, just working side by side? 
Or do you feel like it is here is the information we will give 
you, and kind of guarded?
    Mr. Fritz. Sir, why do not I take a first----
    Mr. Yoho. Go ahead.
    Mr. Fritz [continuing]. Shot at that on certainly with 
regards to the evacuation of our personnel and American 
citizens, very diplomatically and logistically challenging. I 
would have to say that we were able to achieve a very high 
level of coordination with the relevant Chinese authorities to 
make the five flights that we got into and out of Wuhan happen. 
They weren't easy, but we did in fact, we were able to rely on 
our Chinese counterparts working with us to make sure that 
those succeeded.
    Mr. Yoho. Do you feel like they are treating all the 
countries that way? Because they heard reports that they were 
not letting the Taiwanese out.
    Mr. Fritz. I would not be able to characterize whether they 
have been able--whether they have been treating everyone as 
well as they have been treating us. I do know that they have 
worked well with a number of other partners, but I, I have 
heard similar reports about our friends from Taiwan being 
treated differently with regard to their evacuation plans.
    I would say in general, however, I think the PRC 
authorities have generally made good faith efforts to help 
evacuate folks from Wuhan of other nationalities.
    Mr. Yoho. Does anybody have reports about this being in 
North Korea, which I would assume it is? I mean, do we have any 
definitive proof?
    Dr. Redfield. We do not have any confirmed reports, no.
    Mr. Yoho. Okay. Let's see. I think with that, Mr. Chairman, 
I am going to yield back. And I appreciate everybody here. I 
look forward to the questions, and I am going to gather some 
more information.
    So, thank you all. And I know working together as you are, 
we will be prepared for this in the United States. And, 
hopefully, we can be the ones that help the other countries the 
most.
    Thank you.
    Mr. Bera. Great. The gentleman from Michigan, Mr. Levin, is 
recognized to question the witnesses for 5 minutes.
    Mr. Levin. Thank you, Mr. Chairman.
    On Tuesday, Nancy Messonnier, the Director of the National 
Center for Immunization and Respiratory Diseases at the CDC 
said this of coronavirus:
    ``Ultimately, we expect we will see community spread in'' 
the United States. ``It's not . . . a question of if this will 
happen . . . but . . . when this will happen, and how many 
people in this country will have severe illness.''
    But National Economic Council Director Larry Kudlow then 
said:
    ``We have contained this, I won't say (it's) airtight but 
(it's) pretty close to airtight.``
    And also, this is all on Tuesday, President Trump said the 
coronavirus in the United States ``that it's under control.'' 
And a ``problem that's going to go away.''
    So, that was all on the same day.
    Americans are scared of this situation. And they want to 
know what is being done to keep them safe. And hearing mixed 
messages like this within the span of hours is not reassuring.
    Dr. Redfield, how can the virus be both a problem that is 
going away and also not a question of if but when?
    What should we be telling our constituents about what to 
expect?
    Dr. Redfield. Thank you very much. I think it is a very, 
very important question.
    Right now at this stage, and I have said this and I 
continue to say it, the risk to the American public is low. We 
have an aggressive containment strategy that really has worked 
up to this time--15 cases in the United States. Until the case 
that we just had in Sacramento, we had not had a new case in 2 
weeks.
    We do believe we are going to continue to see new cases, 
and we do believe now there may be the initial cluster 
occurrence of a community acquisition.
    Some countries this has moved very quickly, like we saw in 
Korea now where we had more cases in Korea last, in the last 24 
hours than we had in all China.
    Mr. Levin. Right.
    Dr. Redfield. We see it in Italy, it is moving fast. Iran 
it is moving fast.
    But other countries have really used a containment and a 
blended mitigation strategy, like Singapore and Hong Kong, and 
they have really limited the spread after the initial 
introduction from China.
    We are of the point of view that we are still in aggressive 
containment mode, and which is dependent on early case 
recognition, isolation, and contact tracing that now is going 
to be looking to identify these community introductions, and 
practice public health to minimize them.
    But at the same time, we have done this to give us time. 
And I think what Dr. Messonnier was trying to say, I think it 
maybe could have been done much more articulately from what the 
American public heard, what she was trying to say it is also a 
good time for us to prepare if we have to go to more 
mitigation. We are still committed aggressively to get 
aggressive containment.
    And I think I want the American public to know at this 
point that the risk is low. I want them to know that we are 
going to start identifying more cases, like we did the other 
day. I am going to ask them to, obviously, accelerate their own 
view of the standard things that we do for flu: handwashing 
often, do not go to work or school if you are sick.
    And we are, we have launched a larger, for our next level 
of our multi-layered public health response, is to now 
institute broad surveillance. And we have initiated it. We are 
planning over the, hopefully, the new, in the next 4, 8 weeks, 
obviously linked to the supplemental, to actually make our 
surveillance for corona the same as flu nationwide. So, we can 
be, you know, very quickly picking up when there is an 
introduction in the community, go in and try to stop it.
    So, I think that is our position at this point.
    Mr. Levin. Good. But let me quickly ask you one other 
question in my limited time.
    I want to ask you to speak about the danger of xenophobia 
in the situation like this. CNN reported last month on a 
disturbing example from the SARS outbreak when, and quoting 
now, ``people of Asian descent were treated like pariahs in the 
west. There were reports of white people covering their faces 
in the presence of Asian co-workers, and real eState agents who 
were told not to serve Asian clients.''
    We saw similar incidents during the H1N1 swine flu outbreak 
in 2009, and during the 2014 Ebola outbreak. And, sadly, I have 
heard reports of incidents like this around coronavirus.
    So, I would like you to talk about why it is so important 
to avoid stereotyping people as carriers of the coronavirus and 
how incidents like these can be avoided, and how they are 
dangerous really for public health.
    Dr. Redfield. I could not agree with you more. For those 
who have heard me talk before, I have always said that stigma 
is the enemy of public health in all its forms. Whether it is 
in dealing with HIV, whether it is dealing with drug use 
disorder, whether it is dealing with obesity, whether it is 
dealing with a response to coronavirus at this time, stigma has 
no role, no place in public health. It is counterproductive.
    Mr. Levin. So, I think we are going to have to proactively 
get that message out to the American people so that we do not 
harm our own public health with stereotypes folks may have. 
Don't you agree?
    Dr. Redfield. Yes, I, I will continue to echo it. And I 
think you make an important point because we have, you know, we 
have seen those reports. And I think, again, we have to re-echo 
that stigma has no role in public health.
    Mr. Levin. Thank you. And thank you, Mr. Chairman. I yield 
back.
    Mr. Bera. Thank you.
    The gentleman from Florida, Mr. Mast, is recognized for 5 
minutes.
    Mr. Mast. Thank you, Mr. Chairman.
    Mr. Redfield, I want to start with you. And you spoke 
specifically about early diagnosis being part of the positive 
that is going on here. Can you discuss with me what are early 
symptoms which lead to early diagnosis?
    Dr. Redfield. You know, I think the first thing I want to 
say is there is a lot we do not know. And we are learning more 
each day. That is what concerns those of us that are 
confronting this. If it was flu, we understand flu. But there 
is a lot we do not know.
    But what we have learned in the last 8 weeks is that this 
virus can actually cause asymptomatic infection, no symptoms. 
Now, that is complicated when you are dealing with a public 
health threat if you can have it. And on the Princess ship over 
50 percent of the individuals that were diagnosed in the 
process in Japan lacked symptoms.
    Now, there may be an ascertainment issue because if they 
thought if they had symptoms they would be treated different. 
But, clearly, there is a significant percentage of people that 
lack symptoms. And there is clear evidence now that we have 
learned, those individuals can actually transmit the virus.
    So, as the chairman knows, from a public health point of 
view that, that makes this more complicated.
    The other side of it, its symptoms can be as negligible as 
a scratchy throat, a dry cough. And you can see that is why 
initially we had PUI definitions that were pretty narrow 
because if all of a sudden everybody with a scratchy throat or 
a dry cough were during flu season came, then we have some 
complexities.
    At the severe end it can cause really a very significant 
pneumonia, respiratory compromise requiring critical care. And 
overall it does look like 5 to--5 percent of individuals in the 
China situation are critical, 15 need critical care. Other 
countries are starting to show similar. But on the other 
spectrum there can be this asymptomatic illness.
    So, we are still earning. It is complicated. Obviously, in 
the individual case that we talked about here where severe 
pneumonia in an otherwise healthy individual, in light of what 
we now know that can prompt the medical community to consider 
coronavirus in a differential diagnosis. But a lot of 
individuals may just present with a sore throat and a dry 
cough.
    Mr. Mast. Let me go to the other side of the table. Eighty-
plus thousand cases diagnosed. And the number that I have read 
is 33,000 recovered in mainland China, recovered from having 
the diagnosis. Can you say what has been a chief factor that 
has led to those that have recovered through it? Is that 
something that we know?
    Dr. Redfield. I think there is probably two major factors. 
One--or maybe three--one is age, and one is comobidities. So, 
individuals that happen to have diabetes, or hypertension, or 
chronic obstructive lung disease, and happen to be elderly, 
these individuals have a much higher mortality.
    But the other issue that needs to be stressed is the 
effectiveness of the health care system. So, in Wuhan the 
mortality right now is somewhere over 4 percent. Their health 
system is beyond strained. Before this outbreak they had 132 I 
think isolation beds for infectious disease. Today they have 
over 20,000.
    Now, you can go from 132 beds to 20,000. You can build the 
structure. But, as the chairman knows, where are the doctors? 
Where are the nurses? Where are the ventilators? Where is the 
trained health care professional?
    So, we see a mortality and we believe it is the integrity 
of the health system that is a major factor. Because if you 
just go to the rest of China, the mortality is probably about a 
half a percent.
    Okay. So, I think, I think the major factors I would say 
were co-morbidities, age, and the resilience of the health 
system that you happen to be in when you get sick. If you do 
not have access to oxygen, the mortality is going to be a lot 
higher. This is why we are worried about Pakistan, Afghanistan, 
Bahrain, you know, North Africa, all the countries that have 
come on board recently, many of them do not have health systems 
that are going to be able to sustain life in the presence of 
pulmonary compromise.
    Mr. Mast. And this is something you have a lot more faith 
in our health system, obviously, than Wuhan, or pick any of the 
other countries that you just listed off?
    Dr. Redfield. Yes. I think we have, we are in a strong 
position, we have an effective health care system. You know, I 
think, you know, at this stage if we can continue to do what we 
are trying--early identification, find these community cases, 
get our arms around them--I think we can continue to respond. 
Obviously, if the numbers get to the point that we cannot 
control, then that is a different, a totally different part, 
totally different issue. But right now----
    Mr. Mast. I will pause you there because my time is about 
to end just to say I think you, you mentioned something that is 
important to realize about this, that our health system has a 
different starting point than that health system of Wuhan and 
many other places. Certainly does not make us impervious to 
this but it is a better starting place to be.
    I thank you for your comments.
    Mr. Bera. Thank you, Mr. Mast.
    The gentlelady from Pennsylvania, Ms. Houlahan, is 
recognized for 5 minutes to question the witnesses.
    Ms. Houlahan. Thank you. I am actually going to start, I 
know that it is my obligation in some ways to ask complicated 
questions about policy, but, Dr. Redfield, I would actually 
like to start and lead off with Mr. Levin's conversation for 
the human beings who are at home, you know, my kids, my family 
members, my community, and ask the doctor, you are the 18th 
director of the Center for Disease Control and Prevention, and 
Administrator of the Agency for Toxic Substances and Disease 
Registry. And in your capacity could you help me to answer a 
few questions that I frequently get asked.
    The first--and they can be any answer, I do not know the 
answers, I am just asking on behalf of my community--should 
people be afraid?
    Dr. Redfield. No.
    Ms. Houlahan. Thank you. Could you turn on your microphone.
    Dr. Redfield. No.
    Ms. Houlahan. Should people engage in regular hand washing 
and coughing into their sleeves?
    Dr. Redfield. Absolutely.
    Ms. Houlahan. Should people be stocking up on cleaning 
supplies?
    Dr. Redfield. No.
    Ms. Houlahan. Should people be stocking up on prescription 
medications that they have?
    Dr. Redfield. Not at this time.
    Ms. Houlahan. Should people be stocking up on food 
supplies?
    Dr. Redfield. Not at this time.
    Ms. Houlahan. Should you wear a mask if you are healthy?
    Dr. Redfield. No.
    Ms. Houlahan. And is there a website--and you can answer 
this later if you do not know it by heart--where people can go 
to access good information about these questions?
    Dr. Redfield. Absolutely, in the CDC. CDC.gov we have all 
of the information on that website, and a sub thing can take 
you to coronavirus and where we are in any preparedness, and 
all our recommendations.
    Ms. Houlahan. And, sir, is there anything else that I 
should have asked you that is a regular, everyday person kind 
of question?
    Dr. Redfield. The one comment I would make, because I do 
see people feeling a need to go buy masks, and I would ask 
them--and some people scoff at me when I say this--we need to 
make sure those N95 masks are available to the doctors and 
nurses that are going to be taking care of individuals that 
have this illness.
    And it really does displease me to find people going out. 
There's no role for these masks in the community. These masks 
needs to be prioritized for health care professionals who as 
part of that job are taking care of individuals and/or 
individuals who have this virus and are in home isolation or 
home quarantine for those family members.
    I would like to have them prioritize the uses that we 
recommend and get people to realize that that is what these 
masks need to be reserved for.
    Ms. Houlahan. Thank you. I appreciate that.
    And with the last couple minutes of my questioning, I think 
this is either for Mr. Fritz or for Dr. Redfield based on how 
people have answered questions, I am going to followup on the 
line of questioning that has to do with prescription and 
pharmaceutical supply chains and the integrity of the supply 
chain.
    Is there a place, a way that we have historically been 
tracking various supply chains? In my old business we would 
make sure that you had at least or three suppliers of the same 
material just in case. Is there something that we have, a data 
base or other system that tracks those kinds of suppliers and 
where they are geographically?
    Mr. Fritz. Thank you, Congresswoman, for the question.
    As I mentioned, there is a very intense interagency process 
under way. I think HHS in particular, the Food and Drug 
Administration, and other relevant agencies are all looking 
very carefully at this exact question and making sure that the 
answer to that question going forward is that we do have access 
to whatever we need to sustain ourselves in the current 
outbreak and to make sure that we are ready for future ones.
    Ms. Houlahan. So, I understand that the FDA largely is, you 
know, sort of lead on this, but is there a role that the State 
Department can play on this? Is there something that we in this 
body can do to be helpful in that?
    Mr. Fritz. What the State Department is doing is we are 
looking very closely at the impact of the outbreak on our 
global supply chains. And, of course, we are working with some 
of our other foreign affairs and trade-related agencies to map 
that out.
    And then we are, again, together with HHS and others 
looking at how that impacts our ability to access what we need 
in time of crisis here in the country.
    Ms. Houlahan. Yes. And I am just looking for this to be 
sort of a sad lessons learned, you know, how can we take this 
experience and make sure it does not happen to us again? And 
how can we make sure we know where our supplies--suppliers are 
and how to make sure that we are safe from this kind of 
exposure again.
    Mr. Fritz. Yes, ma'am. I think this crisis is teaching us 
that we need to pay very, very close attention to this in the 
era of globalized supply chains. And we are bound and 
determined to make sure that whatever lessons are learned from 
this are applied going forward.
    Ms. Houlahan. Thank you. And with my last half a minute of 
conversation I just wanted to kind of take off on something 
that we were happy that our health care system was better than 
Wuhan. That is awesome. But can you comment a little bit more 
about how we need to work with other nations to make sure all 
of our health care systems are working together in tandem on 
this?
    Mr. Fritz. Thank you for that question, ma'am.
    I would like to point out that U.S. foreign assistance over 
a number of years now has focused in large part on helping 
countries around the world build public health systems that are 
able to be resilient in the face of these crises. Of course, 
that is being put to the test in many instances.
    I think what we can say is things probably would be much 
worse if it had not been for our efforts over a number of years 
to share best practices and actually make resources available 
to build capacity around the world in this aspect. And, of 
course, we have announced up to $100 million of assistance for 
partners around the world to respond to the COVID-19 crisis. 
And----
    Mr. Fritz. Thank you. I have run out of town. I yield back.
    Mr. Bera. Thank you, Ms. Houlahan.
    The gentleman from Ohio. Mr. Chabot, is recognized to 
question the witnesses for 5 minutes.
    Mr. Chabot. Thank you very much, Mr. Chairman.
    Mr. Fritz, I will direct my question at you if I can. I was 
one of the original founding co-chairs of the congressional 
Taiwan Caucus. And I am now one of the co-chairs of that 
caucus. And as you know, and as we all know, the PRC, China, 
considers Taiwan a breakaway province. Taiwan, for all intents 
and purposes, conducts itself as an independent nation, not 
necessarily recognized by the world as such, but it is. And the 
people there are free. They ought to be a model to other 
countries around the globe. They have been bullied by the PRC 
for many years now.
    But my question is this: they have sought to be recognized 
as an observer status basically at the WHO for many years. In 
my view they ought to be essentially a fully recognized 
participant in the WHO. It is kind of a gap in our world health 
system in not recognizing them, not letting them fully 
participate. But at this point China has still blocked them 
from so participating.
    With something as serious as the coronavirus and, 
obviously, its origins in the PRC, in China, and Taiwan being 
right next door, and Taiwan having some of the top medical 
institutions and doctors, medical personnel in the world there, 
you know, it seems to make no sense that China continues in 
this effort. Taiwan could be helpful, even more helpful to 
China.
    So what gap does this create in the world's response to 
this very serious medical and the situation we have with the 
coronavirus, what is the problem with what China is doing 
relative to Taiwan?
    Mr. Fritz. Thank you very much for the question, 
Congressman.
    As you said, Taiwan is a robust democracy. It is a model in 
that respect. It is a reliable partner on public health and a 
number of other concerns that we share. And it is a force for 
good in the world. I could not agree more.
    And I think this COVID-19 outbreak only further underlines 
the unacceptability of Taiwan being excluded from the World 
Health Organization and the World Health Assembly because the 
People's Republic of China blocks every attempt for it to do 
so.
    As you mentioned, not only has the COVID-19 outbreak 
affected Taiwan, they have 30 some cases there, and to the 
extent that they are unable to get timely information from the 
WHO, that impacts public health on Taiwan.
    On the other hand, as you pointed out, Taiwan has a lot of 
expertise, and they have some experience. And, in fact, they 
have their own epidemiological track record now dealing with 
COVID-19. And to the extent that that is not being shared in a 
complete and timely fashion with other WHO members, clearly 
that does not do anything for the public health of the rest of 
the international community. Which is, of course, why the 
United States has and continues to push very hard for Taiwan to 
have meaningful participation in the WHO and to be granted 
observer status at the World Health Assembly.
    China, it is worth pointing out that the People's Republic 
of China was okay with Taiwan being an observer back when a 
different party was in power in Taiwan. So, through 2016 Taiwan 
did have observer status at the WHA. It is only when, when the 
democratic, the DPP party came into power in 2016 that China 
began blocking across the board Taiwan's participation.
    And we continue to push back very, very hard against that 
with as many of our like-minded partners as possible. And I 
think our argument is only bolstered now by the COVID-19 
outbreak
    And I would point out that, you know, this push by the U.S. 
is fully with our U.S. One China policy and, of course, with 
the Taiwan Relations Act which governs unofficial relations 
between the United States and Taiwan.
    Mr. Chabot. Thank you very much. My time is almost expired, 
so let me just reiterate what you said. I agree with all the 
points that you made. Thank you for that. And I want to thank 
the Administration for continuing to be a friend of Taiwan. And 
we would encourage that they continue to do so, even step that 
up.
    And it is a shame that the PRC, China, allows its 
intransigence with respect to Taiwan to put not only the people 
of Taiwan and its own people but the rest of the world more at 
risk than we ought to be. So, they ought to, they ought to do 
the right thing here and allow Taiwan not just to be observer 
status but to be a full member of the World Health 
Organization, the WHO.
    Thank you very much.
    Mr. Bera. Thank you, Mr. Chabot.
    The gentleman from Rhode Island, Mr. Cicilline, is 
recognized to question the witnesses for 5 minutes.
    Mr. Cicilline. Thank you. And, Mr. Chairman, I want to 
thank you for the courtesy in allowing me to participate in 
this hearing.
    Thank you to our witnesses for their testimony.
    Dr. Redfield, I want to ask you kind of to followup a 
little bit on Ms. Houlahan's question about the supply chain 
because, as you described this potential pandemic becoming 
really a global challenge--I guess it already is by most 
estimates--what are we doing to assure that there is a 
sufficient supply of medical supplies? You mentioned oxygen. Do 
we have a coordinating body that is figuring out if this 
pandemic proceeds in a serious way in this country that we will 
have access to the resources we need both for the kind of 
containment we've spoken about and treatment? Is there someone 
doing that sort of planning?
    Dr. Redfield. Yes, that is not really within what I do at 
CDC, but I will tell you that the Assistant Secretary for 
Preparedness and Response, ASPR, has done extensive work. And 
as was mentioned by Mr. Fritz, there is an interagency group 
that is really going through this in quite detail with the FDA 
and ASPR in terms of many of the medical issues. But there is a 
broader intergovernment group going in the broader issues.
    And so I can tell you that is ongoing. And we could 
obviously get to you who is the leadership on it, but I know 
ASPR and FDA have done it on the medical side. And there is a 
broader intergovernmental working group to really get down to 
all of these issues.
    Mr. Cicilline. Right. And you also made reference to the 
China CDC or counterpart. Can you speak a little bit about the 
relationship between the CDC in the U.S. and the Chinese, 
particularly as it relates, particularly just in this health 
care worker transmission.
    Two weeks ago China reported 1,700 health care workers had 
been infected by coronavirus. And just wondering what we are 
learning about that transmission and whether or not that is 
informing protocols here in this country to protect our health 
care workers?
    Dr. Redfield. Yes. Thank you.
    CDC has had now over a 30-year working relationship with 
China's CDC. There is a reason they call it China CDC. And I 
actually have a U.S. CDC component that is affiliated with the 
embassy but is attached to the China CDC.
    The chairman, the head of CDC China and I have been in 
regular discussions since the very beginning when this happened 
on New Year's Eve, and had very open scientific discussions 
about what he knew at the time, what he was learning so we 
could use that information. And that continues bi-
directionally, as I said.
    From the be--you know, at the beginning there was not a 
thought that there was human-to-human transmission and 
nosocomial transmission. They saw that, you know, in the first 
week, they did not see any in the second week. But, remember, 
they were using, you know, a definition of whether people were 
very severely ill. They were not recognizing that this could be 
mildly symptomatic.
    Since then there has obviously been extensive hospital-
based transmission. One series that was published in one of our 
journals, in JAMA, recently showed that up to 40 percent of the 
cases got infected either because they were health care workers 
or because they went into a hospital where they were infected 
after they got there.
    So, health care transmission is really a high, high risk, 
particularly in areas that really are not vigilant in the 
importance of infection control. We are happy to say to date we 
have not had a health care worker.
    Obviously, the new case as was mentioned by the chairman, 
raises concern because people were intubated and not 
necessarily in precaution, so we are aggressively evaluating 
that health care setting.
    Mr. Cicilline. Thank you.
    And, Dr. Redfield, could you just give us a quick update on 
the vaccine development status and whether or not additional 
resources are necessary, what the timetable looks like for 
that? I think lots of people are interested in that.
    Dr. Redfield. Sure. Well, the NIH, Dr. Fauci has the lead 
on this. But I can tell you what he has told us and others is 
that they do have a candidate product that they are planning to 
move into a phase one trial, hopefully in the next 6 weeks, 
which will evaluate immunogenicity and safety. Assuming that 
that candidate--and they have partnered already with a private 
sector company--and assuming that goes well, then they would 
move into an expanded phase two trial.
    And in reality, if everything goes really well and they get 
the strategic partners that they need, he is saying he looks at 
a year to 18 months before we could have it.
    We do believe scientifically that this is a virus that 
should be able to have a successful vaccine based on the 
coronavirus as opposed if we were trying to do this, say, for 
HIV, you know, we would say, well, we do not know because we 
are not sure how that is going to work or not. But for this 
virus there is a lot of scientific reason to think that it will 
be successful. And the NIH is really moving forward very 
aggressively to try to make that happen.
    Mr. Cicilline. Thank you. Thank you, Mr. Chairman. I yield 
back.
    Mr. Bera. The gentlelady from Virginia, Ms. Spanberger, is 
recognized for 5 minutes.
    Ms. Spanberger. Thank you very much. Thank you to the 
witnesses for being here.
    And, as you might imagine, I am very concerned about this, 
the issue of this virus, and constituents across central 
Virginia, the district I represent, are deeply concerned. So I 
want to start by saying thank you, Dr. Redfield, for what you 
said to my colleague Representative Houlahan which is that they 
should not be afraid. I think that is incredibly important. I 
appreciate you being here today to talk about this important 
issue but also to mention that because so much of how we are 
handling this, this disease, this outbreak, will also be 
determined by how we are communicating and what the temperament 
and feeling on the ground is.
    I wanted to speak very briefly about some local 
preparedness. And, Dr. Redfield, I will start with you.
    The coronavirus is expected to put additional strain on our 
health care system. And you have noted that our health care 
providers are already at near max capacity due to a bad flu 
season. How is the Federal Government ensuring that medical 
providers across the country have what they need and the 
resources that they need? And what else could we be doing?
    Dr. Redfield. A very important question. And I want to say 
that my partnership agency in the Health and Human Services, 
ASPR, has been working and continues to work to see that 
hospitals begin to get prepared. That is one of their central 
missions to the Assistant Secretary for Response and 
Preparedness, ASPR. And so they are going through that in great 
detail. They have had dialogs with different hospital 
corporations, with hospital leaders to begin to see that.
    Because you do say that this, you know, for us there is not 
a lot of flex in our health system right now. And most 
hospitals right now because of influenza if you are looking at 
them they may be at 95, 96, 97 percent capacity. This is why I 
stress that our current public health response, that multi-
layered response is containment, containment, containment, 
containment, to try to buy us time for the fruits of labors by 
NIH, and Dr. Fauci, and the private sector. So, hopefully, in 
the not-too-distant future, in a year, year-and-a-half, 2 years 
we will have a vaccine.
    But I can tell you ASPR is very aggressively working and 
evaluating this and trying to, the term they use is 
``resilience,'' to try to make sure they can build resilience 
into the system.
    Ms. Spanberger. And following up on that notion of 
containment, in order to contain we need to identify it, in 
your written testimony you noted the importance of using 
illness surveillance systems. Can you tell us a bit more about 
how we are applying existing systems to this virus and our U.S. 
public health agencies developing new surveillance, illness 
surveillance systems specific to coronavirus?
    Dr. Redfield. Yes. This is really important. This is really 
one of the most important components from CDC's perspective in 
the recently requested supplemental.
    We have an excellent surveillance system in this Nation for 
flu. We have multiple surveillance system, as you have just 
mentioned. We have the--we have multiple. And rather than 
recreate the wheel, what we have proposed, and we have actually 
begun this in to at least initiate it, is we are really 
adapting our entire respiratory disease surveillance systems 
and now interfacing coronavirus-19.
    And, you know, I am very hopeful in the next 8, 12 weeks we 
will be in a position that we will have your flu surveillance 
system, if you follow that, and you are going to have your 
national coronavirus system.
    I am more interested in this as I am hoping is the canary 
in the mine field--in the mine that I can see when and if we 
are getting community, I do not have to wait until an 
individual gets hospitalized and is on a ventilator. You know, 
I have to be honest with you, we do not know what we are going 
to find when we start this, but we are very anxious to get this 
broad coronavirus surveillance system using all the systems 
that we have right now for respiratory disease and get that 
operational as soon as possible.
    Ms. Spanberger. And to be able to see the trends that we 
may be seeing that in fact demonstrate that we are looking at 
potentially an outbreak in a locality or in a State?
    Dr. Redfield. Absolutely. And then, and then be able to put 
the full power of the public health approach of case 
recognition, isolation contact tracing to try to make sure that 
that cluster is contained.
    Ms. Spanberger. And do you have the financial resources and 
the employee capacity for this surveillance system and what you 
need into the future?
    Dr. Redfield. Well, I will say that is one of our major 
components of the supplemental that was put forward----
    Ms. Spanberger. Okay.
    Dr. Redfield [continuing]. Was to be able for us to roll 
this out nationally.
    Ms. Spanberger. Great. Thank you so much to the other 
witnesses. I know I concentrated my question on Dr. Redfield, 
but I do appreciate your time and your presence here today.
    Thank you. I yield back.
    Mr. Bera. Thank you, Ms. Spanberger.
    The gentleman from California, Mr. Lieu, is recognized to 
question the witnesses for 5 minutes.
    Mr. Lieu. Thank you, Chairman Bera, for calling this 
important hearing.
    Thank you, Dr. Redfield, for your public service, including 
your service to the U.S. military.
    The Washington Post published an article, headline is ``A 
Faulty CDC Coronavirus Test Delays Monitoring of Disease's 
Spread.'' So, my first question to you is does the CDC's test 
for coronavirus work?
    Dr. Redfield. Yes.
    Mr. Lieu. Okay. What is the error rate on that test?
    Dr. Redfield. So, we created a test really very rapidly 
based on the sequence of the virus, within really a week of the 
sequence being published. And it is a PCR-based test. And the 
way it was designed at CDC was it actually measures three 
different, if you will, components.
    Mr. Lieu. I just need to know the error rate about, if you 
know it.
    Dr. Redfield. Yes. The problem was in when the test sent to 
the States one of the components had a contaminant in it. That 
is what had to be corrected.
    The test at CDC works fine. When it was given to a 
manufacturer to scale up for the States----
    Mr. Lieu. Has the CDC fixed it?
    Dr. Redfield. It has been corrected and there are tests 
that are being shipped out as we speak.
    Mr. Lieu. Okay. So, in fact that first test did not work?
    Dr. Redfield. First test works because it was developed at 
CDC, and it works fine. We test every one in the country. When 
the manufacturer scaled to send to the States, when the States 
got it they could tell positives, they could tell negatives, 
but because of one of the contaminants in the control there was 
another group that was we do not know if it is positive or 
negative; it was inconclusive.
    And at that time the FDA requested that we not use that 
test and have people send it to CDC where the initial lots that 
we made were quite functional and there was no contaminant. And 
that is the test we continue to use today.
    There are now over----
    Mr. Lieu. All right, I just needed so the current test 
works?
    Dr. Redfield. Current test works.
    Mr. Lieu. Okay, great.
    So, it is they are reporting now that 48 countries have 
coronavirus cases. In Italy it has skyrocketed now to 650 
cases. South Korea has now 1,700 cases, as you yourself stated. 
There are more new cases in South Korea than in China. Why is 
it that we are only testing people who have traveled to China? 
That seems to make not a lot of sense to me.
    Dr. Redfield. Well, when this outbreak originally 
occurred----
    Mr. Lieu. I am talking about right now, not when it 
occurred. Right now. Why aren't we testing people----
    Dr. Redfield. Well, we are going----
    Mr. Lieu [continuing]. That traveled to South Korea, 
traveled to Italy, traveled to----
    Dr. Redfield. Right.
    Mr. Lieu [continuing]. The 11 European countries where 
there are now coronavirus cases?
    Dr. Redfield. We are continuing the travel restrictions 
that were initiated----
    Mr. Lieu. No, no, I am just talking about testing people. 
Why do not you expand the test? Because there is a person in 
Northern California that doctors recommended get the test and 
CDC said no because the person had not traveled to China. That 
is just really stupid because, you know, this has extended way 
beyond China to 48 countries, every continent except Antarctica 
has these cases. We really should be testing not just those 
that have traveled to China.
    Can you commit to expanding the test to beyond those that 
have just traveled to China if they have the symptoms that look 
like they have coronavirus?
    Dr. Redfield. Congressman, I mentioned earlier, I think 
before you were here, just so you know we initially had a 
geographic restriction. We have changed that. We have posted 
there is no geographic restriction. That if a clinician or a 
health department official considers the coronavirus in the 
differential diagnosis, that now meets our criteria for----
    Mr. Lieu. When did you make that change?
    Dr. Redfield. We made that, well, yesterday we did it and 
posted it today.
    Mr. Lieu. Thank you for making that change. Okay.
    So, in terms of transmission, because earlier you said 
people should not be afraid, my understanding based on the 
articles, Reuters reported that coronavirus contagion rate 
makes it hard to control. And there are these two scientific 
studies that show essentially each person infected with 
coronavirus is passing the disease on to between two and three 
other people on average at current transmission rates. And then 
you have this long incubation period, potentially 14 days or 
more. You could have an exponential explosion of cases rather 
quickly such as in Italy; isn't that correct?
    Dr. Redfield. I think we have seen that, obviously, in 
Italy, Korea, and Iran. And yet----
    Mr. Lieu. All right. So, this person in Northern California 
who did not travel to China, where we do not know where he got 
the coronavirus, he could have passed it on to two more people, 
who passed it on to two more people, who passed it on to two 
more people. So, there could be a whole cluster of cases. But 
until as of yesterday we do not know because we were not 
testing anyone who did not travel to China. Am I understanding 
this correctly?
    Dr. Redfield. The current public health evaluation of the 
case in the chairman's district is being led by the State 
public health system of California. We are supporting it. We 
have a large number of contacts that have been evaluated, that 
are being isolated, that are being tested to really look at the 
full extent of the potential transmission around that case.
    Mr. Lieu. Thank you.
    I am going to conclude by saying Donald Trump has attempted 
to minimize the coronavirus outbreak. There is an article in 
the Daily Beast titled ``Coronavirus May Explode in the U.S. 
Overnight Just Like in Italy.'' I will request that when the 
data and science contradicts what Donald Trump says that you 
follow the data and the science.
    I yield back.
    Dr. Redfield. Yes, I could just say that I commit that CDC 
is a science-based, data-drive service organization. And that 
is one of the prides that I have to be the director now, to be 
in a science-based, data-driven, but most importantly service 
organization.
    Mr. Lieu. Thank you.
    Mr. Bera. Let me recognize the gentleman from California, 
Mr. Sherman.
    Mr. Sherman. Thank you. China failed to, well, actually hid 
this disease at the beginning. China continues to try to 
exclude Taiwan from the WHO. There are number of things China 
could be doing. We need Chinese cooperation to start clinical 
trials. Dr. Redfield, are we getting it?
    Dr. Redfield. There is a drug called Remdesivir that is now 
in clinical trials in China and Japan. And it has been extended 
actually to the United States for the repatriated individuals.
    Mr. Sherman. There are similarities, vague similarities to 
the flu. As flu is often seasonal, is this disease--our 
president has said, oh, it is going to be gone by April. How 
confident are we that transmission will be substantially less 
when the winter is over?
    Dr. Redfield. It is unknown.
    Mr. Sherman. There are various treatments that are used for 
flu such as Theraflu. Is there any reason to think that there 
is some chance that that would be helpful in reducing the 
effect of the disease?
    Dr. Redfield. Not for the coronavirus-19.
    Mr. Sherman. And, likewise, the SARS vaccine, would that 
provide any protection?
    Dr. Redfield. It is unlikely that they cross-reacted. But 
the methods that they used to develop that vaccine is the 
reason that Dr. Fauci has been able to accelerate the vaccine 
he is developing.
    Mr. Sherman. And what is the earliest we could have a 
vaccine?
    Dr. Redfield. Well, Dr. Fauci has said 1 year to 18 months, 
if everything goes well.
    Mr. Sherman. Got you.
    Let's see, how well are we cooperating with China today? 
Are they providing the information we need and our people on 
the ground, Mr. Fritz?
    Mr. Fritz. Thank you, Congressman.
    I pointed out a bit earlier that we did get a very--we got 
good faith cooperation from Chinese officials as we worked to 
send in and get out our five planeloads of evacuees.
    Mr. Sherman. I am not talking about--yes, but do we have 
people on the ground at the epicenter of this epidemic getting 
information that is helping Dr. Redford do--Redfield do his 
job?
    Mr. Fritz. I will defer to my colleague on the actual----
    Mr. Sherman. Are you getting what you need from China?
    Dr. Redfield. I have regular discussions with my 
counterpart George Gao, who is the head of CDC. We do have a 
CDC U.S., a CDC that is embedded into the China CDC, so we are 
having daily interactions. I have a team of respiratory experts 
that are there working there.
    At a scientific level we are having good dialog.
    Mr. Fritz. Congressman, if I could, I would point out that, 
you know, Secretary Pompeo and others have also, of course, 
made it clear that China's allergy to freedom of speech, 
freedom of expression, et cetera, have been obviously had a 
very negative impact on the ability of----
    Mr. Sherman. The initial response of local officials was to 
try to keep it under wraps, and the failure to be a free 
society. That is why this thing got going. And we are now in a 
position that perhaps could have been avoided if China had a 
different policy toward free expression versus hide things and 
hope that you can keep them under wraps.
    Let's see, why does the Administration request for 
additional funding rely overwhelmingly on transferring funds 
from other disease-fighting accounts? Dr. Redfield, do we need 
to spend any money on Ebola? Can we just grab that money, no 
problem?
    Dr. Redfield. Obviously we have an ongoing Ebola outbreak 
right now in the Congo. I really cannot----
    Mr. Sherman. Do you think it is wise then to take all the 
money that we had appropriated for Ebola and not spend any 
money on Ebola?
    Dr. Redfield. I really cannot comment on the budgetary 
decisions that were made.
    Mr. Sherman. Are you doing useful work that will save lives 
or may save lives with regard to Ebola? If we leave the money 
in the budget will you spend it effectively in ways that help 
save lives?
    Dr. Redfield. We currently have an ongoing Ebola outbreak 
in the eastern DRC where we have a substantial number of CDC 
people deployed. And we are, if you will, and I say this in 
knock-on-wood, we are finally close to winning. Okay. We are 
down to really in the last week we did not have a single case.
    So, we now, we now project based on our models that we 
might actually end this outbreak by the end of June. But, 
obviously, when instability happens again we could be right 
back where we were 2 months ago, so.
    Mr. Sherman. And if this Ebola outbreak expands in the 
eastern Congo, it could be a threat to the United States, just 
as a Chinese-epicentered problem has been a threat to the 
United States and in California?
    Dr. Redfield. Well, we have been fortunate with Ebola in 
that there is very little movement from the Ebola eastern Congo 
where this outbreak is and the United States. But we obviously 
have had to invest significantly in what we call exit screening 
from the Congo as we have dealt this.
    As you know, we have been in this outbreak now for almost 
about to start the third year.
    Mr. Sherman. If we do not fight Ebola in Africa does that 
mean Americans are safe and everything is fine, and you are 
assuring me that we can just not worry about Ebola, and we are 
not going to have a problem this year or next year?
    Dr. Redfield. I think one of the most important things our 
Nation can do is build a robust global health security 
capacity, all right, so that we can detect, prevent, and 
respond to these outbreaks at their source. And this is exactly 
what we are doing with Ebola. And the more that we can expand 
that capacity, and I believe strongly it is a core mission of 
CDC, we are the tip of the spear to identify these infectious 
disease threats, and obviously we appreciate your continued 
support in that regard.
    Because what we are seeing with the coronavirus is just 
another example of why it is so important that we have global 
leadership and the ability to detect, prevent, and respond to 
these outbreaks.
    Mr. Sherman. I would just comment that the outbreak of this 
coronavirus demonstrates the importance of your work and the 
absolute folly of pulling the plug on some of your work because 
of an unwillingness to fund the additional work that we need to 
do for the coronavirus.
    With that, I will yield back.
    Mr. Bera. Thank you.
    I am going to use the chairman's prerogative to ask a 
couple questions because I feel bad, Mr. Brownlee, Dr. Walters. 
I appreciate your coming down. See, I do not know if I am doing 
a favor asking you questions or if the goal as witnesses is to 
slide out of here with no questions. But I appreciate your 
coming down.
    Mr. Brownlee, I hear your concerns, and we will continue an 
ongoing conversation about flexibility and consular functions. 
I have been honest in my concerns with the Administration in 
announcing travel restrictions for individuals coming from 
China. I understand the rationale and reasoning behind it, but 
also have some concerns about whether it is going to do what we 
hope it does with regards to containment.
    Mr. Brownlee, going forward are we considering similar 
measures against other nations? And if we are, under what 
specific circumstances?
    And then the last question is has the CDC and the State 
Department issued travel advisories for countries who have been 
impacted by coronavirus?
    What specific objective criteria are we using to make these 
determinations? Dr. Redfield, that is a question for you.
    Mr. Brownlee. Thank you very much for your question, 
Chairman.
    With regard to further possible proclamations, this remains 
the prerogative of the White House. They are gathering 
information from all available sources as to whether further 
restrictions might be necessary to help contain the virus.
    As Dr. Redfield has noted now several times, we are still 
in the containment phase. Whether CDC and other health care 
provide--public health authorities will recommend that is 
beyond my scope.
    With regard to travel advisories, this too is something we 
revisit constantly in the Bureau of Consular Affairs. We are 
looking at a variety of different issues with regard to any 
single country. Health is one, crime is another, risk of 
terrorism another, natural disaster, et cetera.
    We look at information that we draw from a variety of 
sources. The U.N. provides some information on health issues. 
We talk with the Bureau of Diplomatic Security with regard to 
the crime and terrorism risks. We pull information from the 
intelligence community, in other words, from a variety of 
different sources. We talk to our friends, the five like-minded 
countries, U.K., Australia, et cetera.
    We gather all this information. We use a fact-based 
metric--matrix to decide whether we are going to rank a country 
one, two, three, or four.
    Mr. Bera. Okay. Thank you.
    Mr. Brownlee. I hope that answers your question, sir.
    Mr. Bera. Dr. Redfield.
    Dr. Redfield. The purpose of the CDC levels is really a 
different purpose: it is really for public health purposes 
only. And we actually have three levels that, you know, makes 
it confusing.
    We have the first, which is just an alert to let the 
American public know that there is an ongoing infectious 
disease issue. And so right now for the alert, Singapore, 
Taiwan, Thailand, Vietnam.
    Once we see that there is significant human-to-human 
transmission, so it is not just say there is something going on 
there, we go to what we call Level 1. And right now that is 
Hong Kong.
    When there is actually multiple clusters of human-to-human 
transmission, then we go to a Level 2. And that really tells 
people, particularly if you have your older or if you have any 
comorbidities, you really ought to reconsider travel. And that 
right now for us is Iran, Italy, and Japan.
    Now, this changes every day, as we said.
    And then Level 3 we are telling people--this is when we 
have broad community-based transmission--we are telling the 
American public that we recommend they do not travel.
    So those are our levels. And we reevaluate them every day 
based on the data that we see of what is happening in the 
country at the time really around human-to-human transmission, 
how isolated it is, how broad it is. And right now, obviously, 
in Korea we have very broad transmission throughout the 
country. It has moved to a Level 3. China, very broad 
transmission throughout the country.
    But you should anticipate that these are going to continue 
to change. They can go up or down. I would not be surprised if 
we do not have changes even in the next 24, 48 hours based on 
what is happening in these countries.
    Mr. Bera. Thank you, Dr. Redfield.
    And, Mr. Fritz, I know you are on a tight time-line. So, we 
appreciate your being here. If you have to leave the panel, 
thank you.
    If I can ask Dr. Walters a question because, again, I 
appreciate your coming down here and making yourself available 
to us.
    In thinking through the evacuation of some of the Americans 
on the Diamond Princess and so forth, there were reports that 
positive-testing patients--and again it may be that those 
results were not communicated--were commingled with negative-
testing patients. I am curious how that might have happened, 
and then how we avoid that happening in the future?
    Dr. Walters. Mr. Chairman, thank you for the question.
    The time line matters. So, the Diamond--the decision to 
evacuate American citizens from the Diamond Princess was not 
based on, you know, there is an outbreak of COVID-19 on the 
ship. The decision was based on there was evidence of ongoing 
person-to-person transmission. This was a problem that was not 
getting better, it was getting worse, and despite the best 
efforts of the Government of Japan.
    Once the decision was made that it was safer to move these 
American citizens, many of whom were in an age range that puts 
them at the greatest risk, we followed a protocol. This was I 
think the sixth flight that we had done in, like, 2 weeks. Each 
of those individuals, each of the 329 individuals that we took 
off that ship were evaluated by a medical officer from either 
the State Department or Health and Human Services, ASPR, within 
that 24-hour period.
    The embassy in Tokyo had reached out to the Ministry of 
Health, Welfare, and Labor and asked that all lab results be 
reported by 4:30 that afternoon. The evaluations were done. The 
evacuees then were handed from the Government of Japan over to 
the care of the U.S. Government. They were disembarked from the 
ship. They were loaded onto buses. And this was to be one 
single movement of 15 buses from the ship to the airport.
    It was only once those evacuees were, 329 people on 15 
buses, and in the minutes after midnight on the docks at 
Yokohama that an official from the Government of Japan 
approached the embassy personnel with a list. And on that list 
were 16 names. And of the 16 names, 14 people were manifested 
and somewhere on 15 different buses. And the buses were already 
in movement.
    In the movement from the docks at Yokohama to the airport 
there was some discussion, hey, we have got this problem, we 
are working through it. And that is only a 40 or 45 minute 
movement.
    Once they arrived at the airport the 14 were identified in 
a way that was efficient but protected their privacy. And it is 
important to remember, none of these individuals had symptoms. 
They were not coughing, sneezing, you know, they did not have 
fevers. That had all been confirmed. They were removed from the 
bus. They were taken to the only place--now, imagine, morning 
is breaking at that airport, it is raining, these are 60 to 80 
year old American citizens that are helped off the buses and 
put into an isolation area aboard the aircraft.
    The way the aircraft is set up, the air flow moves from the 
nose to the tail. So, the most at risk area is near the tail of 
the aircraft. We had already partitioned off, as we had in 
previous flights, an area to protect other passengers from any 
contagion that might be with those folks. And they were placed 
there. And then there was a robust interagency discussion.
    Much has been made about the discussion, but at the end of 
the day we reached consensus. And there was consensus between 
the Department, our partners that we rely on from Health and 
Human Services, State Department, and others that yes, these 
are evacuees; yes, they have been placed in the care of the 
U.S. Government; yes, they are contained and they pose no 
further threat. And with that, we brought them back to the 
finest quarantine facility in the world to receive the best 
care available.
    Mr. Bera. Thank you for that explanation.
    And now the ranking member had additional questions.
    Mr. Yoho. Yes. And that is for State Department, because we 
heard over in China I think it was 1,600 health workers came 
down and they were sick. We had talked to our Ambassador from 
Cambodia, we had a discussion with him today and he was saying 
what a stellar response our State Department did, working 24/7 
at six different locations moving people out.
    What kind of protections do we have for our State 
Department personnel? Because I know when we go on details you 
guys work your tails off, and we appreciate it, and we want to 
make sure you have the coverage and the health care that you 
need. Do you feel adequate?
    Dr. Walters. Yes, sir. Thank you for the comments and the 
question.
    Here is what I would say. This is an international 
emergency that signals----
    Mr. Yoho. Right.
    Dr. Walters [continuing]. A domestic risk. But in 220 
locations around the world we have a work force of 75,000 
people, some of whom are in countries that have active cases. 
Others are in countries that may tomorrow find themselves with 
active cases.
    Mr. Yoho. Right.
    Mr. Fritz. We learned our lessons in 2004. We learned our 
lessons again in 2014-2015. And we are thankful to Congress for 
the support we have had in the preparedness side of this. There 
is PPE at every embassy. Our health care workers, our work 
force is almost 700 in all these locations. They are well 
educated, they are well prepared.
    We continue to look at our resource requirements. And we 
continue to look at our authorities, not just to take care of 
American citiz--to the chief of mission personnel, but really 
in that global picture to protect Americans abroad.
    Mr. Yoho. And we feel confident that if, you know, an 
embassy were to come down and the workers get exposed that we 
can get the supplies needed in there? If it is in an area that 
is more remote where we do not normally have good health care 
maybe, that we can get it in there in sufficient numbers, we 
feel like we are protected there; right?
    Mr. Fritz. So, there are two parts to that answer. The 
first part is the same aviation contract that made these 
evacuations possible is the same aviation contract that makes 
delivery of critical supplies possible.
    The second part to that is actually a greater risk. And the 
greater risk here is when you look at the way we do medical 
evacuations of chief of mission personnel around the world, 
they do not typically come back to the United States. They go 
to medivac centers with established relationships in South 
Africa or U.K.
    Mr. Yoho. Okay.
    Mr. Fritz. Those countries are now making it more and more 
difficult in a way that you can understand to bring non-U.K. 
citizens or non, you know, South African citizens in if there 
is any risk that they have COVID-19. So, we continue to work 
with our international partners to keep those diplomatic 
platforms open so that Dr. Redfield's teams have a place to 
work and the resources and relationship to do it, but still be 
able to medivac our chief of mission people home when the time 
comes.
    Mr. Yoho. Okay, thank you.
    Dr. Redfield, again there is this cloud of lack of 
transparency that we keep getting from China. What signals can 
we see from China to see what the real extent of damage is 
behind the containment?
    You know, the National People's Congress meeting has 
recently been canceled. I mean, that is a pretty strong signal 
to show that that threat is really--they are really that 
concerned about it as they should be.
    But then with the people over there not getting, you know, 
an open press where they can get reliable information, do we 
feel like they are being forthright with you. I man, you are 
working with them on a more of a scientific platform. Do you 
feel comfortable with the information you are getting?
    Dr. Redfield. From my colleagues, the scientific 
interaction we are having with our CDC colleagues and from the 
China CDC I am very comfortable with what we have. As I said, I 
have my own director of the American CDC in China. They are 
regularly interacting.
    So, at the scientific level we are having collaboration. I 
really cannot really comment beyond that.
    I will say it is worth nothing that they have probably 
introduced some of the most aggressive containment strat--
mitigation strategies that we have ever seen----
    Mr. Yoho. Ever seen on the planet, I think.
    Dr. Redfield [continuing]. In the history of the world, you 
know. But and I would like to say, just so people are feeling 
better, that there is a reduced number of cases in China. Just 
last night----
    Mr. Yoho. If that is accurately reported.
    Dr. Redfield. If accurately reported. But even then it was 
434 people and over somewhere between 25 and 30 deaths last 
night. So they still have a major problem despite everything 
they have done in mitigation.
    Mr. Yoho. I want to throw one thing out, and I do not 
really expect an answer on this. Being a veterinarian, we have 
seen the porcine viral diarrhea syndrome broke out several 
years ago. Within a year it was in America. Lost about 300,000 
sows in America.
    African swine fever broke out I think it was May 2018. I 
cannot remember the exact date. We have not seen that here. But 
we do know this: it is a very hardy virus that can be 
transmitted in different fomites. It can resist freezing, it 
can resist heat, and it can make the transshipping from China 
to the United States in containers, in different materials, 
whether it is feed, packaging. And so this is something we need 
to be alert through APHIS, or USDA, through CDC that we are 
monitoring these things better than we ever have before because 
that is a port of entry that we might not even be looking 
about.
    We are looking at people, but we also need to look at 
containers and fomites coming in that way.
    Dr. Redfield. Yes. The only comment I would make for this 
virus, just so you know, we are aggressively evaluating how 
long this virus can survive and be infectious. And where on 
copper and steel it is pretty typical, it is really pretty much 
about 2 hours, but I will say that on other surfaces, cardboard 
or plastic, it is longer. And so, we are looking at this 
because we do not know the role of fomite transmission.
    Now, I do not think it is going to impact cargo, OK, unlike 
maybe some of the other viruses that you talked about. But I do 
think that it may have contributed to the huge outbreak we saw 
on that Diamond Princess. It may not have all have been 
aerosolized. It could have been fomites.
    So, we are aggressively evaluating that to understand how 
well this virus survives in different conditions.
    Mr. Yoho. We would appreciate you keeping us informed on 
that. Thank you.
    Mr. Bera. I understand Ms. Spanberger has additional 
questions.
    Ms. Spanberger. Yes. Thank you, Mr. Chairman.
    Since we have been in this hearing there is a breaking 
story with the Washington Post, and I do not expect that you 
all have seen it yet. But it is there is a whistleblower report 
that a senior HHS official who oversees workers at the 
Administration for Children and Families has now filed a 
whistleblower report that HHS employees were sent to an 
airplane hangar to meet evacuated Americans at the March Air 
Force Base in Riverside, and that they were not given any PPEs 
or protective equipment while they were interacting directly 
with those who were potentially impacted.
    I raise this, recognizing that we are dealing with 
different agencies here present today. But I think this speaks 
to a general concern. It is a little bit of a followup to 
Congressman Bera's question related to whether or not State 
Department officers have what they need to stay safe.
    And I would, so I will pose that question.
    But then also wanted to make sure to make the point that 
this is deeply concerning because as we are dealing with a 
significant outbreak, something that is personally causing 
great fear in our communities among individuals, we need to 
ensure that our constituents have faith that the Administration 
and the U.S. Government is doing everything possible.
    And there are already some concerns about whether or not 
that is the case, and what--how people can keep themselves 
safe. And so, finding out that the U.S. Government might have 
put its own personnel in harm's way is deeply concerning to me.
    So, if you could comment both whether or not your agencies 
are ensuring that their personnel are safe, and then comment 
on, you know, what we can do in light of this when we are back 
in our districts and people are saying, How can we trust the 
government to keep us safe if this is happening to its own 
people? I would love your comments on that.
    Dr. Walters. Yes. Thank you for the question and the 
concern.
    I can speak, having been on those missions, and certainly 
the first trip out of Wuhan, the second, the third, the Diamond 
Princess, and based on a relationship that I have had with HHS 
ASPR and CDC dating back to 2014. Every precaution has been 
taken.
    Ms. Spanberger. So, was it your experience that you did not 
witness any individuals who were not wearing PPE?
    Dr. Walters. No, I can say unequivocally that everyone 
involved with those evacuations was appropriately equipped and 
trained.
    Ms. Spanberger. Okay. Well, and I do not seek, I do not 
seek to be argumentative with you, sir, I am reading breaking 
news in the Washington Post. But that is good to hear.
    And then specifically with State Department officials and 
the availability of protective gear and the attention to detail 
there?
    Dr. Walters. We take every precaution. We have the 
equipment and the training that we need to do this safely.
    Ms. Spanberger. Thank you.
    And would you care to comment as well, Mr. Brownlee?
    Mr. Brownlee. Yes, please.
    My consular colleagues in China, Japan, and elsewhere have 
been working on an ongoing basis with people. So, for example, 
in Japan there are still 100-plus U.S. citizens from the 
Diamond Princess in the country. A number of those are 
hospitalized. We are regularly engaging with those people but 
we are doing so in a safe fashion, taking professional advice.
    So, whereas initially some of the visits were taking place 
in person, that became cumbersome because they were having to 
suit up. Now these visits are taking place on a telephonic 
basis.
    I have here a photograph, I gave the chairman a copy of it, 
that shows my colleagues standing on the quayside. As they were 
processing people coming off the Diamond Princess they were 
properly taken care of.
    Ms. Spanberger. I can see the photo from here that they 
are----
    Mr. Brownlee. I will leave you a copy.
    Ms. Spanberger [continuing]. That they are equipped.
    And then the general concern about, again this is just a 
report that is breaking news, the veracity of it will be 
determined later, but it is in the news and people are reading 
it as adding to this story, are there other comments that you 
all would like to make related to ensuring that our 
constituents, people we represent have faith that we are 
handling this, that all involved agencies are handling this 
virus and concerns in the way that it should be handled? And 
just in light of what might otherwise be some concerning news.
    Dr. Walters. What I would say is that the psychology in 
dealing with highly infectious disease is often worse than the 
pathology. We have the best medical care in the world. And 
whether it is Ebola or coronavirus, the American health care 
system is ready to receive and ready to take care of our health 
care workers and our public.
    From the State Department's perspective, we have a work 
force that is at the front line. We are happy to be there to 
facilitate the relationships that are going to be critical for 
containing this overseas, whether it is a delivery of foreign 
assistance of the exchange of technical information.
    What I tell my family is that you live in the best country 
in the world and that people who know how to do this are in 
positions where they can advise State, local, and international 
health care workers.
    Ms. Spanberger. Thank you. I thank you for the indulgence 
of the second question, Mr. Chairman.
    And to the witnesses, thank you so much for all of the work 
I know that you are putting in on this. Thank you for your 
continued service to our country, and to keep us all safe and 
healthy. I truly appreciate it.
    I yield back.
    Mr. Bera. Thank you.
    Let me recognize the gentleman from California, Mr. 
Sherman.
    Mr. Sherman. Doctor, what is your best estimate as to the 
mortality rate of this disease among those who are healthy and 
under age 65?
    Dr. Redfield. Again, I think the most important thing in 
that scenario, under 65 and healthy, is whether you are health 
system functional or not. So, as we have seen with the Wuhan 
health system----
    Mr. Sherman. Healthy health system, healthy human under age 
65.
    Dr. Redfield. Yes, well----
    Mr. Sherman. My constituents.
    Dr. Redfield. Yes, I think, again, you know, we do not have 
the data. But I, we suspect if you look at the mortality rate 
of this disease outside of China, we are probably looking right 
now at somewhere around a half a percent. Right? But, again, we 
will have to see more data to really be clear on that.
    Mr. Sherman. And seasonal flu has a mortality rate of?
    Dr. Redfield. About .1 per, .1 per thousand.
    Mr. Sherman. Point one per thousand or .1 percent?
    Dr. Redfield. Point 1 percent. I am sorry. Yes, .1 percent.
    Mr. Sherman. The Chinese are telling us that there is a 
decline. Should I, should we believe them, Doctor?
    Dr. Redfield. I think that there probably is a decline. 
Again, I do think some of the mitigation strategies are 
starting to have impact, particularly out of Hubei. Most of the 
cases now are in the Hubei area.
    Mr. Sherman. Want to ask you about masks. It is funny, I 
went onto Amazon. Buy 50 masks is 50 bucks which, and you know, 
they are not very heavy, less than a pound. And then Amazon 
wants to charge an additional $400 for shipping and handling.
    Needless to say we will be in touch with Amazon on this. 
But I do not think that Amazon has ever charged $400 to ship a 
box, and not a rush basis actually, a delay for 2 weeks from 
now, on less than a pound $400 shipping and handling seemed an 
extraordinary charge. But, you know, given Mr. Bezos' need for 
food and the necessities of life, I can understand.
    We see pictures from all over the world, people wearing 
these masks. Who should wear the masks in the United States?
    Dr. Redfield. Yes, as I mentioned earlier, the masks, the 
N95 masks really need to be reserved for health care providers 
that are taking care of these patients in the hospital, as well 
as confirmed individuals that are in home isolation to minimize 
the spread while they are in home isolation.
    We would not recommend the American public go out and get 
these masks. And I----
    Mr. Sherman. Does the mask protect the person wearing it or 
protect others from the person wearing it?
    Dr. Redfield. Well, there is really the issue here is to 
protect the individual who is being exposed to someone who has 
the pathogen. And we believe that that is where the mask should 
be.
    A lot of the people you see wearing these masks they are 
really not going to have a functional impact whatsoever in 
terms of transmission. These surgical masks that you see 
everybody wearing on the--even when I, you know, was traveling 
today here in the city I saw people again even in our own city 
wearing masks.
    Some of them do it, they have a cold or an illness that 
they think it might minimize them. I would tell those people to 
stay home. That would be more effective than trying to feel 
that you have to go to work and wear a mask.
    So I think the CDC has on its website really good guidance 
on the appropriate use of masks. And I encourage people to go 
look at it.
    Mr. Sherman. It looks like the Chinese have had a decline. 
They dealt with extraordinary lockdowns of entire areas. Should 
we be locking down any neighborhood where we find that 
someone--what level of lockdowns do we need, if any?
    Dr. Redfield. Yes, the backbone of our response right now, 
and really the most important part of our multi-layered 
response, even though sometimes people do not recognize it 
because it is not like travel restrictions or screening at 
airports, the backbone is the American medical community and 
public health community. As I mentioned, of our 15 cases that 
we diagnosed in this country, 14 of them were diagnosed by our 
medical public health community.
    So, I am going to maintain confidence on early diagnosis, 
isolation, and contact as our major mechanism to confront this.
    Mr. Sherman. To test for this is it sufficient to just take 
people's temperature as they were doing? Or is it contagious 
before it is symptomatic, and do we need to give a lot of 
people blood tests?
    Dr. Redfield. Yes, so the issue on how infectious this 
virus is at different States of symptomatology is still 
unknown. But we do know that you can transmit this virus before 
symptoms.
    Does that contribute meaningfully? We do not know. And I 
think that is what we are trying to learn.
    Clearly, we and the CDC is working on another, other task 
which the chairman would understand, we are trying to develop 
serological tests so that we can understand the extent. Like, 
in China right now what they are doing is they are measuring 
the active virus, and that is what we are doing, but that does 
not really tell us what the denominator is of who has really 
been infected. You need a serological test to do that.
    We are currently working on----
    Mr. Sherman. I know the chair, the chairman understands 
what you are saying.
    Dr. Redfield. Okay.
    Mr. Sherman. You are saying we want to test to see which 
people have been exposed, have the antibodies, and may have 
been asymptomatic throughout the whole process----
    Dr. Redfield. Yes, sir.
    Mr. Sherman [continuing]. And just did not know they had 
the disease.
    Got you.
    See, now you are not the only member----
    Mr. Bera. There you go.
    Mr. Sherman [continuing]. Up here who understands it.
    I yield back.
    Mr. Bera. Well, thank you.
    Once again, I just want to recognize the witnesses and say 
I that appreciate your service to our country. And, obviously, 
this is a very fluid situation.
    I did just want to make reference to the breaking story 
that Ms. Spanberger identified. I am fully confident that we do 
everything we can to protect our personnel and our workers as 
we were evacuating folks from China, putting them on airplanes, 
bringing our citizens back home. It does sound like there was 
someone who did see some personnel that did not have protective 
gear and were released.
    I hate to use the term whistleblower because it has gotten 
politicized. But it is important that if there are folks that 
are raising issues, we must address them. And I do feel that it 
is very important for this body to say publicly we want to 
encourage folks who see things, for the sake of bettering 
ourselves, to report the issue. Those whistleblowers are those 
individuals that are raising issues.
    We are fully committed to protecting them. And we fully 
want folks that are seeing things to feel comfortable and 
protected coming forward. I am not commenting on whether this 
story is accurate or inaccurate, but I am commenting on the 
fact that it is important for folks that see things to identify 
them and not fear retribution for coming forward. That is our 
law. That is the way this process works.
    Dr. Redfield, I appreciate your coming up to the Hill and 
keeping us informed. Again, we look forward to working very 
closely with the CDC.
    And, you know, as one doctor to another, you know, as we 
work through the regulatory process to speed up our testing 
capabilities and availability of diagnostic tests throughout 
this country, we look forward to working with--well, you are 
not the one holding it up necessarily, but we do look forward 
to speeding up that regulatory process to make sure we get 
these tests out and are able to do it.
    And, again, I appreciate updating the folks that we are 
testing. I do think that is going to be helpful. And trusting 
our doctors that are on the front line if they do suspect 
coronavirus, being able to get that test done.
    Dr. Redfield. I just want to make one comment for the 
record, that we have been working very closely with the FDA. 
They have been very supportive. I just want to make sure but 
they are operating within the regulatory framework that we 
have.
    And I think the point that I wanted to make is that the 
loss of laboratory development tests to be used when we are 
developing new tests and responding to new emergencies I think 
is something that should be re-looked at.
    Mr. Bera. I appreciate that.
    And, again, thank you and thank all three of you as well as 
your colleagues at HHS, USAID, and Homeland Security for 
regularly coming up to the Hill to brief Members of Congress. 
And again, this is fluid, so let's maintain close contact and 
dialog.
    And with that, this hearing is adjourned.
    [Whereupon, at 4:56 p.m., the subcommittee was adjourned.]

                                APPENDIX
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                           OPENING STATEMENT
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]


                                 [all]