[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
CORONAVIRUS PREPAREDNESS
AND RESPONSE
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON
OVERSIGHT AND REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
SECOND SESSION
__________
MARCH 11-12, 2020
(A Two Day Hearing)
Serial No. 116-96
__________
Printed for the use of the Committee on Oversight and Reform
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available on: http://www.govinfo.gov,
oversight.house.gov or
docs.house.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
40-428 PDF WASHINGTON : 2020
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COMMITTEE ON OVERSIGHT AND REFORM
CAROLYN B. MALONEY, New York, Chairwoman
Eleanor Holmes Norton, District of Jim Jordan, Ohio, Ranking Minority
Columbia Member
Wm. Lacy Clay, Missouri Paul A. Gosar, Arizona
Stephen F. Lynch, Massachusetts Virginia Foxx, North Carolina
Jim Cooper, Tennessee Thomas Massie, Kentucky
Gerald E. Connolly, Virginia Mark Meadows, North Carolina
Raja Krishnamoorthi, Illinois Jody B. Hice, Georgia
Jamie Raskin, Maryland Glenn Grothman, Wisconsin
Harley Rouda, California James Comer, Kentucky
Ro Khanna, California Michael Cloud, Texas
Debbie Wasserman Schultz, Florida Bob Gibbs, Ohio
John P. Sarbanes, Maryland Clay Higgins, Louisiana
Peter Welch, Vermont Ralph Norman, South Carolina
Jackie Speier, California Chip Roy, Texas
Robin L. Kelly, Illinois Carol D. Miller, West Virginia
Mark DeSaulnier, California Mark E. Green, Tennessee
Brenda L. Lawrence, Michigan Kelly Armstrong, North Dakota
Stacey E. Plaskett, Virgin Islands W. Gregory Steube, Florida
Jimmy Gomez, California Fred Keller, Pennsylvania
Alexandria Ocasio-Cortez, New York
Ayanna Pressley, Massachusetts
Rashida Tlaib, Michigan
Katie Porter, California
Deb Haaland, New Mexico
David Rapallo, Staff Director
Daniel Rebnord, Subcommittee Staff Director
Alexandra Golden, Chief Health Counsel
Richard Trumka, Subcommittee Staff Director
Amy Stratton, Clerk
Christopher Hixon, Minority Staff Director
Contact Number: 202-225-5051
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C O N T E N T S
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March 11 and 12, 2020
(Day 1 and Day 2)
Page
Witnesses
Dr. Anthony Fauci, Director, National Institute of Allergy and
Infectious Diseases, National Institutes of Health
Oral Statement............................................... 5
Dr. Robert Redfield, Director, Centers for Disease Control and
Prevention
Oral Statement............................................... 6
Dr. Robert Kadlec, Assistant Secretary, Preparedness and Response
Department of Health and Human Services
Oral Statement............................................... 7
Dr. Terry M. Rauch, Acting Deputy Assistant Secretary of Defense
for Health Readiness Policy and Oversight Department of Defense
Oral Statement............................................... 8
Mr. Chris Currie, Director, Emergency Management and National
Preparedness Government Accountability Office
Oral Statement............................................... 9
* The prepared statements for the above witnesses are available
at: docs.house.gov.
Index of Documents
----------
The Documents listed below are available at: docs.house.gov.
* Letters sent from Chairwoman Maloney to HHS and CDC on March
3, 2020; submitted by Chairwoman Maloney.
* Statement from the National Nurses Union; submitted by Rep.
Wasserman Schultz.
* Article, Congressional Doctor Predicts 70-150 Million COVID
19 Cases; submitted by Rep. Tlaib.
* Statement from AFTE; Rep. Sarbanes.
* Questions for the Record: to Dr. Anthony Fauci, Director,
National Institute of Allergy and Infectious Diseases, National
Institutes of Health; submitted by Chairwoman Maloney.
* Questions for the Record: to Dr. Robert Kadlec, Assistant
Secretary for Preparedness and Response, Department of Health
and Human Services; submitted by Chairwoman Maloney.
* Questions for the Record: to Dr. Robert Redfield, Director,
Center for Disease Control and Prevention; submitted by
Chairwoman Maloney.
CORONAVIRUS PREPAREDNESS
AND RESPONSE
(Day 1)
----------
Wednesday, March 11, 2020
House of Representatives
Committee on Oversight and Reform
Washington, DC.
The committee met, pursuant to notice, at 9:33 a.m., in
room 2154, Rayburn Office Building, Hon. Carolyn Maloney,
[chairwoman of the committee] presiding.
Present: Representatives Maloney, Lynch, Cooper, Connolly,
Krishnamoorthi, Raskin, Rouda, Khanna, Plasket, Welch,
Wasserman Schultz, Haaland, Pressley, Kelly, Sarbanes, Gomez,
Jordan, Foxx, Massie, Hice, Grothman, Comer, Green, Norman,
Cloud, Roy, Keller, Steube, Armstrong, and Higgins.
Chairwoman Maloney. The Committee will come to order.
Without objection, the Chair is authorized to declare a recess
of the Committee at any time. I want to inform members that we
have a change in schedule. As we explained in the hearing memo,
we were planning to do opening statements from 9:30 a.m. to 10
a.m. and testimony and questions from 10 a.m. to 1 p.m.
This morning, we were informed that President Trump and
Vice President Pence have called our witnesses to an emergency
meeting at the White House. We don't know the details, just
that it is extremely urgent. Now the witnesses have to leave at
11:45 a.m. In light of this sudden change, we are going to
significantly reduce opening statements. Instead of doing 30
minutes, we will do 10 so we can get right to questions.
For the witnesses, we have your written statements so
please keep your oral statements as brief as possible. At 11:45
p.m., we will recess the hearing and we will work with the
agencies to determine when the witnesses can return. With that,
I recognize myself for a few remarks. I want to thank everyone
for being here for this extremely important hearing. Let me say
at the outset that our thoughts go out to everyone who is sick
or in isolation, including two members of our very own
Committee, our colleagues Representative Meadows and
Representative Gosar, who cannot be here to participate in
today's hearing. We are now in the middle of a global health
crisis. Our response as a Nation must be swift, it must be
coordinated, and it must be based on science and the facts.
That is what we all want on a bipartisan basis.
Unfortunately, when we look at the last three months
objectively, it is clear that strategic errors and a failure of
leadership impaired our Nation's ability to respond to this
outbreak. This in turn endangers us all. Let's start with
testing. The Trump Administration's testing for the Coronavirus
has been severely inadequate, plagued by missteps and resulted
in substantial deficiency in our ability to determine who may
be infected. Yesterday, Director Redfield testified that CDC
has tested about 4,900 people.
By comparison, South Korea tested more than 66,000 people
with just one--within just one week of its first case of
community transmission. South Korea has now tested more than
196,000 people but we are not anywhere close to that. They
started conducting drive-thru testing, but people here in the
United States can't even get tested by their own doctors. This
is the United States of America. We are supposed to be leading
the world. Instead, we are trailing far behind. How did South
Korea test so many people so quickly, but we didn't even test a
fraction of that number? Why did it take so long?
We must do better. Unfortunately, these delays have been
systemic. Just last week, the Trump Administration promised to
deliver a million tests by the end of the week, but it did not
even come close. On Sunday, they admitted that they delivered
only 75,000 tests. That is more than 900,000 tests short. And
this was their own stated goal to the American people. Now, the
Trump Administration is saying that they have distributed 1
million tests and will be distributing 4 million by the end of
this week, but that is difficult to believe given their record.
We need facts, we need information, and we need it quickly. If
we don't have testing, we don't know the full scope of the
problem.
And if we don't test people, then you have no idea how many
people are infected. We don't even know where community
transmission is happening. We don't know where to direct
resources. We are operating in the dark. My question is whether
the Administration and President Trump is exacerbating the
crisis by downplaying it? Over and over again, we have heard
blatant misstatements that consistently diminish this crisis
and negatively affect our preparations and response.
Last week, President Trump said and I quote, ``anybody that
needs a test gets a test.'' He said the tests are beautiful. He
was absolutely wrong. My constituents are telling me they can't
get tested. The same is true of President Trump's top adviser
Larry Kudlow who made this incredible statement two weeks ago
and I quote, ``we have contained this. I won't say are tight,
but pretty close to airtight. The business side, the economic
side. I don't think it is going to be an economic tragedy at
all.
The numbers are saying the U.S. is holding up nicely.'' He
could not have been more wrong. The stock market just had one
of the worst weeks in history with the single biggest point
drop of all time in history. The President and his aides may
think they are helping with political spin and happy talk, but
the American people want the truth. We need the facts. We need
accurate information. The CDC has now reported more than 647
cases across 36 states, but according to experts at John
Hopkins and others, the real number is far higher.
My home state of New York has 173 confirmed cases, and
every Member of Congress is worried about their constituents.
As we proceed this morning, I would like to recognize several
of our Subcommittee chairman for their tremendous leadership.
This is truly a team effort. Chairman Lynch of the Security
Subcommittee held a hearing last week on our Nation's
biodefense capacity and he paved the way for today's hearing.
Chairman Krishnamoorthy of the Economic and Consumer Policy
Subcommittee has been focused on the effects of this crisis on
consumers. And Chairman Connolly of the Government Operations
Subcommittee has been working with states and localities on the
front lines of our response efforts.
I now recognize our distinguished Ranking Member. I would
like express my regret that he is moving to chair yet another
Committee. Ranking Member Jordan.
Mr. Jordan. Thank you, Madam Chair. Thank you to our
witnesses for being here today and for all your hard work to
ensure the safety of the American public and combat the spread
of this Coronavirus. We recognize that your task is ongoing. I
hope today's discussion will be as efficient as possible so you
can get back to work doing the important work that you are
doing to help combat this.
I also want to express my condolences to the Americans who
have lost loved ones, as the Chair indicated earlier, from the
Coronavirus and we pray for those families. We must continue to
support the Trump Administration and its work to protect the
health and safety of the American people. As Vice President
Pence has reiterated and I hope our experts will explain today,
the risk to the American people of contracting the Coronavirus
remains low.
Even still, as the outbreak continues, it is important for
all Americans to follow the best practices to maintain good
hygiene. No. 1, you can protect yourself and your family by
practicing proper hand washing techniques and washing your
hands often. Second, avoid crowds as much as possible and stay
home if you are in fact sick. And third, we can protect
ourselves from the virus like we do other viruses, for
instance, cover your coughs and sneezes, avoid close contact
with those who are sick, and clean and disinfect your home
frequently. All good common-sense protocols and procedures that
we should be implementing.
These steps are common sense. They make sense and they help
prevent the spread of the virus. The risk to Americans remains
low in large part due to the leadership and early action of the
Administration and his team, many of whom are here with us
today. When the threats started to emerge from China, which is
ground zero for this virus, President Trump recognized the
importance of limiting the exposure from those who had traveled
there to the American people. That decisive action brought our
public health professionals important time to get a head start
in preparing for the virus here at home. Since that time, we
have seen clusters of community spread. In other words,
instances where people have become sick without traveling to
affected areas in the world.
There are important steps we can all take to prevent
community spread. Those who are experiencing the Coronavirus in
their communities can also take steps to limit the spread of
this virus. Today, I look forward to our experts offering some
specific recommendations on how people can minimize the spread
of the Coronavirus. Also want to commend President Trump and
Vice President Pence for safely repatriating the passengers
from The Diamond Princess cruise ship in California. Their
leadership drew praise from California Governor Newsom.
I also want to commend the American pharmaceutical industry
for working to deliver results to fight this virus. The
innovation that drives our economy also helps to advance
innovations in public health. As HHS Secretary Azar has
explained, our pharmaceutical industry has been developing test
kits to distribute around the country. The Vice President
explained yesterday that over 1 million test kits have been
sent out to date. I hope we can learn more about the efforts to
increase the number of these test kits that are going to be
deployed. We should also understand that an increase in test
kits will inevitably show an increase in positive cases around
the country.
Last, I want to say that often times in this Committee, we
disagree vigorously on many hot-button issues. We don't always
see eye-to-eye on matters of oversight. But on this issue, I
think we should all work together for the health and well-being
of every American. We should not play politics with the
Coronavirus. We should not use it as a reason to advance
partisan objectives.
Now is the time for us to come together under President
Trump's leadership and work to help all Americans. With that, I
would like to thank our witnesses again for their work. We are
grateful to you and your teams. Please relay our gratitude back
to the people who work for you, and work for our country, and
work for the American citizens. Madam Chair, I yield back.
Chairwoman Maloney. Thank you very much, and I would like
to begin by introducing our witnesses today. Dr. Anthony Fauci
is the Director of the National Institute of Allergy and
Infectious Diseases at the National Institute of Health. He has
served well over four Presidents. He is truly America's doctor.
We are honored to have you testifying today. Thank you for
coming.
Dr. Robert Kadlec is the Assistant Secretary for
Preparedness and Response a the Department of Health and Human
Services. Thank you for coming. And Dr. Robert Redfield is the
Director of the Center for Disease Control and Prevention.
Thank you for being here today. And Dr. Terry M. Rauch is the
Acting Deputy Assistant Secretary of Defense for Health
Readiness, Policy and Oversight at the Department of Defense.
Thank you for being here.
Mr. Chris Currie is the Director of Emergency Management
and National Preparedness for the Government Accountability
Office. Thank you for being here.
I will begin by swearing-in the witnesses. And if you will,
all please rise and raise your right hand. Do you swear or
affirm that the testimony you are about to give is the truth,
the whole truth, and nothing but the truth so help you God?
[Witnesses sworn.]
Chairwoman Maloney. Let the record show that they answered
in the affirmative. Thank you and please be seated. The
microphones are very sensitive so speak directly in them and
bring them closer to you. Without objection, your written
testimony will be part of the record. Thank you all for being
here. We appreciate your service. And with that, Dr. Fauci, you
are now recognized to provide your testimony.
STATEMENT OF DR. ANTHONY FAUCI, DIRECTOR, NATIONAL INSTITUTE OF
ALLERGY AND INFECTIOUS DISEASES, NATIONAL INSTITUTE OF HEALTH
Dr. Fauci. Thank you very much, Chairwoman Maloney, Ranking
Member Jordan, and members of the Committee. Thank you for
calling this hearing and thank you for giving me the
opportunity to speak to you for a few minutes on the role of
the NIH and the research involved in addressing the 2009 novel
Coronavirus.
The NIH is involved, as you know, in understanding the
pathogenesis of how these viruses work, but also in developing
countermeasures. Given the limited time, I would like to have
my remarks confined to two aspects. One is the development of
vaccines, what is the realistic expectations. And the other is
the development of countermeasures in the form of therapeutics.
With regard to vaccines, as I have mentioned publicly many
times, we were able to very quickly go from an understanding of
what this virus was, to what the genetic sequence was, to
actually developing a vaccine. But there is a lot of confusion
about developing a vaccine. In the next, I would say, four
weeks or so, we will go into what is called a Phase 1 clinical
trial to determine if one of the candidates, and there are more
than one candidate, there are probably at least 10 or so that
are various stages of development.
The one that we have been talking about is one that
involves a platform called messenger RNA but it really serves
as a prototype for other types of vaccines that are
simultaneously being developed. Getting it into Phase 1 in a
matter of months is the quickest that anyone has ever done
literally in the history of vaccinology. However, the process
of developing a vaccine is one that is not that quick. So, we
go into Phase 1. It will take about three months to determine
if it is safe.
That will bring us three or four months down the pike and
then you go into an important phase called Phase 2 to determine
if it works. Since this is a vaccine, you don't want to give it
to normal, healthy people with the possibility that A, it will
hurt them, and B, that it will not work.
So, the phase of determining if it works is critical. That
will take at least another eight months or so. So, when you
have heard me say we would not have vaccine that would even be
ready to start to deploy for a year to a year and a half, that
is the timeframe. Now anyone who thinks they are going to go
more quickly than that, I believe, will be cutting corners.
That would be detrimental.
What does that tell us? It tells us now the next month, the
next several months, we are going to have to rely on public
health measures to contain this outbreak. So, let me--and I
will be happy to answer questions later. Let me just go on
quickly to therapy. The timeline for therapy is a little bit
different. The reason it is different is that you are giving
this candidate therapy to someone who is already ill.
So, the idea of risks and how quickly you determine if and
when it works, is much more quickly than giving a lot of
vaccine to normal people and determine if you protect them.
There are a couple of candidates that are now already in
clinical trial. Some of them in China and some of them right
here in the United States, particularly in some of the trials
that are being done in some of our clinical centers including
the University of Nebraska. It is likely that we will know if
they work in the next several months.
I am hoping that we do get a positive signal. If we do,
then we may, and I underline may so that it doesn't get in
misinterpreted, have therapy that we could use. But that needs
to be proven first.
So, in summary, the work that is being done at the NIH is
involved both in the development of a vaccine in the long term
and in the development, hopefully, of therapies in the shorter
term. I will be happy to answer questions after all the
presentations. Thank you.
Chairwoman Maloney. Dr. Redfield, you are now recognized
for your testimony.
STATEMENT OF DR. ROBERT REDFIELD, DIRECTOR, CENTERS FOR DISEASE
CONTROL AND PREVENTION
Dr. Redfield. Thank you very much. Good morning, Chairwoman
Maloney, and Ranking Member Jordan, and members of the
Committee. Thank you for the opportunity to share CDC's role in
the U.S. response to this novel Coronavirus. CDC is a science-
based, data-driven organization. Science and data drives our
decisionmaking and will continue to do so as we form changing
guidelines and recommendations. This is a new virus and many
uncertainties remain. Our public health response must be
flexible.
From the outset, CDC and the U.S. Government partners
implemented an aggressive multi-layer strategy to slow the
introduction of this virus to the United States to buy time for
our scientists to learn how this virus behaves, to prepare our
Nation's public health infrastructure and healthcare system for
the possibility of a global pandemic that would impact your
communities, and to educate Americans on how best to prepare
for eventual disruptions to their daily life and the potential
risk to their families.
The Administration's interagency containment strategy
relied on evidence-based public health interventions.
Initially, early case recognition, isolation, and contact
tracing, travel advisories, and targeted travel restrictions,
the use of quarantine for individuals returning from
transmission hot zones such as China, Japan, and now the Grand
Princess. Absence of immunity and treatment, our Nation's
public health response has relied on traditional public health
activities.
As I said, early diagnosis, case isolation, contact
tracing, and targeted mitigation to slow the emergence of this
virus in the United States. On February 25, this global
outbreak reached an inflection point. This was the first day we
saw more cases outside of China than inside of China. We
observed rapid wide spread person-to-person transmission in
South Korea, Iran, and Italy, and long before the first case of
communities spread in California.
Science and data collected from here in the United States
and abroad are revealing certain characteristics about this
virus. At first, the Chinese scientists reported fewer than 30
cases of pneumonia combined to one province, the Hubei
province. Today, there is more than 110,000 confirmed cases
worldwide, and yesterday 99 percent of the new cases that
occurred in the world were outside of China. This virus spreads
through respiratory droplets, sneezing, coughing, and hand
contamination.
Asymptomatic transmission is possible. Reports out of China
looked at more than 70,0000 individuals with this infection and
found that 85 or 80 percent of the patients actually developed
mild illness and recovered, while 10 to 20 percent developed
serious illness. Children and young people seem not to get
sick. This disease disproportionately affects older adults and
particularly those with serious underlying health conditions.
Two months ago, Chinese scientists shared the genome
sequence of the virus to the world, and within a week, CDC
scientists developed a diagnostic test that is now being used
in more than 75 U.S. public health labs across 50 states with
the capacity in the public health system to test up to 75,000
people. As of today, CDC has received confirmation of more than
990 cases of COVID-19 in 38 states plus the District of
Columbus. It is with great sadness that I report now 31 deaths
in the United States.
As we experience the growing community spread in the United
States, the burden of confronting this outbreak is shifting to
states and local health professionals on the front lines. We
appreciate your support to increase the public health capacity
of your communities and our Nation. This difficult, critical
decisions are being made by state and local leaders to mitigate
the spread and CDC continues to provide guidance and support as
requested.
There is not a one-size-fits-all approach to the mitigation
decisions that need to be made. They need to be made based on
the local situation by local health authorities and civic
leaders. CDC has put more than 630 staffers in the field to
support the state and local Health Departments in the
repatriation efforts.
Finally, CDC is committed to this mission. We will continue
to work 24/7 to protect the American people from this
significant global health threat. Thank you, and I look forward
to your questions.
Chairwoman Maloney. Thank you. Dr. Kadlec, you are now
recognized for your testimony.
STATEMENT OF DR. ROBERT KADLEC, ASSISTANT SECRETARY,
PREPAREDNESS AND RESPONSE, DEPARTMENT OF HEALTH AND HUMAN
SERVICES
Dr. Kadlec. Thank you, Chairman Maloney, Ranking Member
Jordan, and the distinguished members of the Committee. My
remarks will be very brief because I think in some ways we want
to retain all the time for your questions, but I do want to
acknowledge the vital role Congress has played in this outbreak
that began in 2002 with the passage of the Bioterrorism Act
that created critical programs like the Public Health Emergency
Preparedness Program at CDC, the Hospital Preparedness Program
that I manage, and as well as a number of other critical pieces
of legislation such as Project Bioshield, the Pandemic All
Hazards Preparedness Act, and its reauthorization most recently
as the Pandemic All Hazards Preparedness and Advancing
Innovation Act, and finally the Public Readiness and Emergency
Preparedness Act.
All these tools that you have given us have been vital in
confronting this virus in this current outbreak. I also want to
acknowledge the role that additional moneys that you provided
in supplementals over the years for the H1N1 pandemic in 2009,
for the Ebola outbreak in 2014 that helped us create a national
Ebola treatment network that has been vital to manage and care
for patients who have been afflicted with this disease.
As far as my role in this activity at this point, I have
four principal functions. My first and foremost responsibility
as we transition from containment of this disease to a hybrid
approach and strategy of containment and mitigation is to be
the incident management for the Secretary of Health and Human
Services to ensure that we have a unified, coordinated, and
synchronized effort across HHS and across the U.S. Government,
consistent with the national response framework and emergency
support function number eight for medical and public health
preparedness and response. I also basically support the
healthcare system through the Hospital Preparedness Program and
our regional disaster response network that we have created
with your support.
Then third, it is basically work with NIH, with FDA, with
our DOD colleagues to rapidly develop, accelerate the
development of therapeutics, diagnostics, and vaccines that
could be used in this outbreak.
And finally, providing direct support to state and local
entities. During this most recent event with the Grand Princess
that is now docked in Oakland, we are working directly with the
state of California, the city of Oakland, and with our
interagency partners to safely disembark all those passengers,
American and non-American, and manage the crew to ensure that
they are safe and return to their homes, but more importantly
protecting the communities that will be receiving these
individuals.
So, with that, I will yield the remaining of my time back
to you, Madam Chairman, and thank you.
Chairwoman Maloney. Thank you very much. Dr. Rauch, you are
now recognized for your testimony.
STATEMENT OF DR. TERRY M. RAUCH, ACTING DEPUTY ASSISTANT
SECRETARY OF DEFENSE FOR HEALTH READINESS POLICY AND OVERSIGHT,
DEPARTMENT OF DEFENSE
Dr. Rauch. Chairman Maloney, Ranking Member Jordan, and
members of the Committee, thank you for this opportunity. The
Department's top priority is the health and safety of our
personnel around the world. To address the COVID-19 outbreak,
we immediately disseminate for self-protection guidance
beginning early in the outbreak and continue to issue a series
of guidance as the situation evolves.
The Department remains aligned with guidance from the CDC,
while allowing limited location and command flexibility as
required by mission or local circumstances. In the area of for
self-protection, the Department issued an initial guidance on
January 30, 2020 that addressed the current situation at the
time, the risk to DOD personnel, individual prevention and
protection measures, healthcare information, patient screening
and isolation information, and information on diagnosis,
treatment, and reportable medical events.
The guidance also listed the CDC travel advisory level for
China and referred to the CDC criteria for identifying a person
at risk or under investigation. The guidance also directed
personnel on actions to take if they suspect they have had an
increased risk of exposure due to travel or close contacts.
Following the initial for self-protection guidance, on
February 7, 2020 we issued guidance for monitoring personnel
returning from China. This guidance remained in step with the
CDC and provided further measures to prevent the spread of the
disease. Furthermore, the guidance directed the identification
of service members and a 14-day restriction of movement and
monitoring of service members returning from mainland China
after February 7, 2020. It has specified actions by the service
member during their restriction of movement to reduce the
potential spread of disease.
The guidance is recommended to DOD civilian employees, and
contractor personnel, and family members returning from China
follow existing CDC guidance. On February 25, 2020, the
Department issued additional guidance providing a risk-based
framework to guide commanders in implementing health protection
measures based on local circumstances and their command
mission.
The entire series of for self-protection guidance may be
found on our defense.gov website. As the Department assesses
and manages risk to personnel and mission, the capability to
diagnose COVID-19 to better inform treatment decisions and help
track disease spread is vital, and one important factor is
diagnostic testing capabilities. Currently the Department has
13 labs approved to perform COVID diagnostic testing.
The Department is also working quickly to develop
expeditionary lab kits which can be used in the field, military
environment to mitigate risk to the Force and mission.
Finally, as we know there is no vaccine to protect the
Force. There is no antiviral to treat the Force. Therefore, the
Department is working on several vaccine initiatives and an
antiviral treatment to protect and treat the Force. This is in
collaboration with the interagency efforts.
I am grateful for the opportunity to provide further detail
on our efforts to contain and mitigate this outbreak. Thank you
to the members of this Committee for your commitment to the men
and women of our Armed Forces and the families who support
them.
Chairwoman Maloney. Thank you. Mr. Currie, you are now
recognized for your testimony.
STATEMENT OF CHRIS CURRIE, DIRECTOR, EMERGENCY MANAGEMENT AND
NATIONAL PREPAREDNESS, GOVERNMENT ACCOUNTABILITY OFFICE
Mr. Currie. Thank you, Madam Chairwoman, Mr. Ranking
Member, other members of the Committee. As you know, GAO's role
is to provide oversight of other Federal agencies. So, what I
want to do today is I am talking about two things. First is a
report we issued just two weeks ago on the national biodefense
strategy for the Federal Government, and second is to offer
some observations based on decades of work we have done,
looking at past pandemics and outbreaks and public health
preparedness.
For decades, we have been concerned about the U.S.
preparedness for these types of events. Unlike cyber events or
natural disasters, they are rare, which makes it incredibly
difficult to maintain focus on these types of things and avoid
complacency setting in once an outbreak is contained. Also
biodefense is extremely fragmented across the Federal
Government.
There is over two dozen Presidential appointed officials
and agencies that have some sort of roles or responsibilities
in biodefense, and so coordination just at the Federal level is
extremely difficult, let alone state, local, and private level
as well. The good news is the strategy that was issued in 2018,
according to our assessment, is the most comprehensive to date
that we have seen. It does a good job of defining roles and
responsibilities, and steps agencies need to take to better
coordinate.
We did identify some challenges that we were concerned
about. One of those is we still don't see a good mechanism
across agencies to coordinate budgets. DHS, CDC, HHS, USDA,
they all have separate budgets. They can't tell each other what
to do or how to spend their money, and so some sort of
centralized oversight mechanism across that is still critical
and we recommended that they take steps to address that.
I would like to pivot and talk a little bit about the
current outbreak and make it clear that we don't have enough
information to conduct a full out assessment of the response
right in the middle of the response. That is very difficult.
But some of the challenges we are seeing in the public are
highlighted by decades of work we have done over the years and
past outbreaks and frankly things that we have been concerned
about if we had a large domestic outbreak here in the U.S. The
first is roles and responsibilities across the Government.
While I think it is pretty clear upfront that the public
health emergency HHS is the lead, many questions are still
being raised about the roles of other Departments, particularly
as this becomes a bigger domestic issue.
For example, the Department of Homeland Security, questions
have been raised about whether a Stafford Act Declaration
should be brought into play like a natural disaster to bring in
additional funding and authorities that provides who
communicates with the public at the Federal, state, and local
level has been a challenge. This is something we have pointed
out before.
On the issue of testing, you know, we have pointed out that
HHS has provided over $20 billion since 9/11 in preparedness
funding to states and locals. That number has decreased over
the years. I think that, you know, this is a direct correlation
to the investments we make in preparedness.
Again, it is very, very difficult to sustain these given
other priorities when we don't have outbreaks all the time. The
last thing I would just mention really quick is moving forward
as we conduct after action reviews and exercises.
So, there have been after action reviews done after prior
outbreaks. What we see in the emergency management field is
that often the after action reviews are conducted really well
and then once the outbreak is stopped or the disaster is over,
there is no followup on the gaps that are identified in the
years to come.
So, this completes my prepared remarks. I look forward to
your questions.
Chairwoman Maloney. Thank you all for your testimony. I now
recognize myself for questions. I want to ask about testing. I
am being asked over and over again why the United States is so
far behind other countries and why the American people cannot
get tested.
Our first case of Coronavirus was on January 21 and the
U.S. has tested approximately 4,900 people so far. In contrast,
South Korea has already tested almost 200,000 people. They can
test 15,000 people a day. South Korea can test more people in
one day than we tested over the past two months. So, Dr. Fauci,
why are we so far behind Korea in testing and reporting this
crisis?
Dr. Fauci. Thank you very much, Chairwoman Maloney. I
would--I don't like to pass the buck, but Dr. Redfield has the
numbers and a little map that he might want to show you about
that because I don't have that in front of me.
Chairwoman Maloney. OK. Is the worst yet to come, Dr.
Fauci?
Dr. Fauci. Yes, it is.
Chairwoman Maloney. Can you elaborate?
Dr. Fauci. Well, whenever you have an outbreak that you can
start seeing community spread, which means by definition that
you don't know what the index case is and the way you can
approach is by contact tracing, when you have enough of that,
then it becomes a situation where you are not going to be able
to effectively and efficiently contain it. Whenever you look at
the history of outbreaks, what you see now in an un-contained
way--and although we are containing it in some respects, we
keep getting people coming in from the country that are travel-
related.
We have seen that in many of the states that are now
involved. Then when you get community spread, it makes the
challenge much greater. So, I can say we will see more cases
and things will get worse than they are right now.
How much worse it will get will depend on our ability to do
two things, to contain the influx in people who are infected
coming from the outside and the ability to contain and mitigate
within our own country. Bottom line, it is going to get worse.
Chairwoman Maloney. Well bottom line, Mr. Fauci, if we
don't test people, then we don't know how many people are
infected. Is that correct?
Dr. Fauci. That is correct. And as I am sure that Dr.
Redfield will tell you, looking forward right now, as
commercial entities get involved in making a large amount of
test getting variable--when you do two aspects of testing, one
a person comes in to a physician and asks for a test because
they have symptoms or a circumstance which suggests they may be
infected.
The other way to do testing is to do surveillance where you
go out into the community and not wait for someone to come in
and ask for a task, but you proactively get a test. We are
pushing for that and as Dr. Redfield will tell you that the CDC
has already started that in six sentinel cities and will expand
that in many more cities.
But you are absolutely correct. We need to know how many
people, to the best of my ability, are infected, as we say,
under the radar screen.
Chairwoman Maloney. Now, I really want to get to South
Korea and their 50 mobile testing sites that they have set up
where people can just drive up, get a quick swab, get a test
and results in two days. And this is a question to Dr. Fauci
and to Dr. Redfield. These are centers that minimize the
interaction between patients. It helps mitigate the risk. And
why haven't we set up these mobile labs? Are we planning to set
them up? Dr. Fauci and Dr. Redfield?
Dr. Fauci. Well again, I will start by telling you, the NIH
would in no way be responsible for setting that up. So, I can't
tell you what I can do.
Chairwoman Maloney. Dr. Redfield?
Dr. Redfield. Just to say very quickly, CDC's role in this
was--we very rapidly, within almost 7 to 10 days developed a
test from an unknown pathogen once we had the sequence. We did
that because we wanted to get eyes on it, CDC, so that the
Health Departments across this Nation can send samples to us
and we would test them.
Second, we rapidly tried to expand that and scale it up
with contractors so each public health lab in this country
would have that test. During that process of quality control,
we found out one of the reagents wasn't working appropriately
and we had to modify that with the FDA that took several weeks
to get that completed.
But the test was always available in Atlanta, if you sent
the sample to us, and there never was a time when the Health
Department could not get a test. They had to send it to
Atlanta. Now our Health Departments have 75,000 test. Most
Health Departments now, over 75 Health Departments, have the
test.
Chairwoman Maloney. How many tests are we planning to
produce in the United States?
Dr. Redfield. Well from a public health point of view, we
put out 75,000. The other side as Dr. Fauci said, which is
really not what CDC does traditionally, is to get the medical
private sector to have testing for patients. And when the Vice
President brought all the testing companies to the White House
last week, we got enormous cooperation from them all to work
together.
As we sit here today, Quest and LabCorp are now offering
this test in their doctor's offices throughout this country.
But it is not for an individual just to take a test, they need
to go see a healthcare professional, have an assessment to
determine whether a test is indicated, and then get that test.
In New York, just so you know, on February 29, Harold
Zucker, your Health Commissioner, asked if he could use our EUA
to begin to get Wadsworth approved, and the FDA worked with him
within one day and got their test up and running in the state
of New York at the Wadsworth lab.
So, we are working hard to get testing available. My role
is to get it available for the public health system, and is Dr.
Fauci said, start these large surveillance programs, but on the
other side there is a private sector to get it to clinical
medicine. And I think you will see that with LabCorp and Quest
out, those tests are rolling out.
Finally----
Chairwoman Maloney. Will these that private labs be
reporting and are they reporting into CDC their results?
Dr. Redfield. We have set up now a surveillance system.
Chairwoman Maloney. Are they reporting now?
Dr. Redfield. It is being worked as we speak today. The
LabCorp and Quest will--they dump into our national reporting
base.
Chairwoman Maloney. My time has expired and I recognize the
distinguished member--oh, she left. OK. I recognize the
gentleman from the great state of Tennessee, Mr. Green is
recognized.
Mr. Green. Thank you, Madam Chair, and thank the witnesses
for being here. I am incredibly disappointed in the
politicization of this COVID-19 response. The 24/7 criticism
the President is undergoing is unwarranted at a minimum and
absolutely maligns the hard work done over years of our
Nation's doctors and scientists at places like the CDC, the
NIH, the FDA, the HHS, DHS, FEMA, and DOD have prepared for
just such an eventuality.
Make no mistake about it, this virus is a serious problem,
but that concern was immediately shown by our President as
evidenced by his historic response and I would like to take a
second to correct the record. On December 31, Wuhan officials
posted the first notice saying they were investigating a
pneumonia outbreak.
On January 7, the CDC established an incident management
system, just seven days later. On January 17, CDC sent 100 plus
staffers to specific airports in the United States to screen
all people coming from Wuhan. On January 21, just three weeks
after the announcement, the CDC activated its Emergency
Operations Center.
On January the 29, the President established the
Presidential Task Force. On January 30, still less than a month
from the initial announcement, the State Department issued a do
not travel warning to China. January 30, the World Health
Organization announced that the Coronavirus is a public health
emergency of international concern, meaning before the World
Health Organization even announced a global concern, the
Administration was working on its response for almost a month
and had already established a Presidential Task Force.
On January 31, to the cries of racism, President Trump
proactively suspended entry of foreign nationals who had been
to China in the last 14 days. On the 31st, the President issued
quarantines, and through Secretary Azar, a public health
emergency for the entire Nation. On February 11, the World
Health Organization named the virus COVID-19. Let that sink in,
the Administration's first response a week after the Wuhan
announcement.
The virus hadn't even been named by the World Health
Organization yet. It isn't named until day 42. Meanwhile the
CDC, the NIH, and all the agencies of our scientific community
with acronyms that boggle the mind, have been working
feverishly to sequence the RNA of the virus, to get its
proteins, messenger RNA sequence and get a vaccine going. On
February 24, the President unveiled the initial plan.
Yet according to the leadership of the other party, our
President has failed us months of response, and yet they are
accusing our President of failing us. On February 26, the
President appointed the Vice President head of the whole of
Government response. That appointment is in keeping with the
2015 Obama era Blue Ribbon Panel on Biodefense.
On February 29, 60 days after the Chinese announcement,
sadly America lost its first victim to COVID-19. So, 53 days
before American lost a single life to COVID-19, the
Administration was already working diligently to prepare our
country. You have heard the witnesses describe the Herculean
efforts their various departments are taking to protect the
lives and health of Americans.
I want to thank the dedicated men and women of CDC, NIH,
FDA, HHS, DHS, FEMA, and DOD for the years of work that has
gone into preparing for this type of effort, and their tireless
24/7 response since the announcement just 71 days ago.
America will lose lives to this virus, but as was noted by
Obama appointee and former Director of the CDC, Tom Frieden,
had the President not responded so quickly, we would not have
been prepared as we are and more lives would have been lost.
Madam Chairman, I yield.
Chairwoman Maloney. Thank you. I now recognize the
gentleman from Massachusetts, Congressman Lynch. He is
recognized for five minutes and I want to thank him for his
help in preparing this hearing. Thank you.
Mr. Lynch. Thank you, Madam Chair, and thank to the
witnesses. I want to echo the call for unity that was expressed
by the ranking member early in this hearing. I am proud to say
that every single member of this Committee, Democrat and
Republican, voted for $8.3 billion to deal with the
Coronavirus.
We all did so, I think, consistent with your request from
our public health officials. I think America is best when we
have a unity of purpose, a singularity of mission, and we are
all on board. But that much being said, I have to say that the
President's statements from the beginning of this has been
contrary to the direction that you have given us.
The President on March 6 told the people in my district
publicly that the tests were ready. ``Anybody who wants a test
can go be tested. They are beautiful tests, beautiful tests.''
That is not a medical term. So, my constituents went to their
local health centers, went to their hospitals, there were no
tests, zero, zero. I know they are rolling out now, but this
was back on the 6th. That is not a good situation.
He said this in front of some of you at a public hearing at
a press conference and I saw no one step up and say, no, the
President wasn't correct. The tests are not there. They are not
ready. They are not beautiful. They are not available. So, we
need a unity of purpose but we are not going to get that when
the President is telling people that the cases of Coronavirus
are going down not up. They doubled yesterday in my district,
doubled.
I represent part of Boston. Myself and Ms. Presley share
that city. It is not a backwater medically or technically. It
is very advanced. The President has made some bizarre
statements here. And look, I want to be together with my
Republican colleagues but when the President said he has an
uncle who went to MIT in the 1930's and that he has a natural
affinity and ability for this, it has got to raise some red
flags.
We need you to step up. We need--and Dr. Fauci, you have
been great on some of the stuff and pushing back. When the
President said, we are going to get a vaccine fairly quickly, a
matter of months, you know, you were good to step up and say
no, it is going to be a year and a half. But you know, we
really need honesty here.
And when the President is making statements like this, we
need pushback from the public health officials. You know,
standing behind him and nodding silently or an eye-roll once in
a while is not going to get it. We really need--you know, when
I say things that are immediately considered political because
I am a Democrat and I am elected, but you know, you have a
certain level of credibility and honesty that I think that
should be persuasive to the American people.
So, I just ask you to be more forthright when the President
makes statements like this. We need leadership but we need
people to be very much aware of the dangers that are out there.
You know, the cases are not going down. The American people
should be aware of that. You should be forthright in explaining
that.
When the Secretary of the--when the President's economic
director says we got this contained, not quite air tight but
almost there, we need you, we need you our public health
officials to step up and say that is not true. That is hurting
us. That is making the spread of this virus, you know, more
extended, more prolific, and more possible.
The American people really have to step up here and make
sure that, you know, they are aware of the dangers.
Dr. Fauci?
Dr. Fauci. I appreciate your comments, but I can tell you
absolutely that I tell the President, the Vice President, and
everyone on the task force exactly what the scientific data is
and what the evidence is. I have never, ever held back telling
exactly what is going on from a public health standpoint. Thank
you.
Mr. Lynch. Thank you.
Chairwoman Maloney. The gentleman's time has expired. The
gentlelady from North Carolina, Ms. Foxx, is recognized for
five minutes.
Ms. Foxx. Thank you, Madam Chairman, and since our current
ranking member did not use all of his time, I may steal some of
that in mine and since you went over a little also. Thank you.
I want to thank our witnesses for being here and I think the
very fact that we are having these hearings they are being held
all over the Congress and the fact that there are the press
conferences every day disputes what some of our colleagues are
saying that the facts are not getting out there.
I want to thank all of you all for being here and for
telling the facts to the American people because I do think
that is important. And I also want to thank my colleague from
Tennessee for outlining what has been done because we tend to
forget the good actions that have been taken because of the
direct criticism of the President, which I think is totally
unwarranted.
I do think it is helpful that we explain the facts but also
not scare everybody about this problem, but ask them to be
sensible about what they are doing. Dr. Kadlec, I understand
that BARDA amended its contracting process to place all
proposals not related to Coronavirus in a queue until the
threat of this virus subsides.
Nobody has mentioned that but it is really all hands on
deck and a focus totally on Coronavirus. Is that correct?
Dr. Kadlec. Yes, ma'am. We are accepting additional
proposals on other things related to non-corona activities, but
right we are focusing on the immediate concern.
Ms. Foxx. I know that BARDA is a fairly small entity and
not a lot of attention has been paid to it, but we need our
Nation to remain prepared for all threats including biological,
nuclear, and influenza, and that is part of what BARDA does.
So, would you mention what additional personnel authority BARDA
needs to ensure that its response to COVID-19 and its normal
work for biological and nuclear countermeasures is performed as
well as possible?
Dr. Kadlec. Yes, ma'am. Some of those authorities I think
were given during the supplemental direct hiring authority.
There is a proposal that was considered or a consequence of the
21st Century Cures Act, which was creating an innovation
platform and we probably need some relief in terms of Federal
campaign cap waivers there.
But I think quite frankly, what BARDA has been
extraordinary in, in its very short history, is to basically
get 50 approvals for a variety of countermeasures and devices
that are vaccines, therapeutics, diagnostics in its very short
history. It is the little engine that can.
And I think it is one thing that working with NIH, and
working with DOD, has been very successful to advance: things
like, during the Ebola crisis, diagnostics; as well as what
turned out to be the first FDA-approved licensed vaccine for
Ebola.
So, I think with resourcing, BARDA can and is a great part
of the asper team that really, I think, does provide a
significant capability in concert with NIH and with our DOD
colleagues.
Ms. Foxx. What you indicate is that there is a lot going on
that people aren't aware of, groups of people working within
the Government to try to anticipate the kinds of things that
happen with the Coronavirus.
We will never be able to stop all kinds of problems like
this, but at least we have people working very, very
effectively in these areas.
Dr. Redfield, I think Dr. Fauci tossed over to you a few
minutes ago the opportunity to speak about some of the issues
and the concerns about getting the necessary medical supplies
out to people. Would you like to expand on what you weren't
able to talk about earlier?
Dr. Redfield. I would just like to again try to emphasize
the development that we did for the diagnostic test. And again,
I do think we developed that very rapidly so that the public
health community could have eyes on. That test was at CDC. We
rapidly tried to get it to the Health Departments.
During our quality control, we basically found one of the
reagents wasn't working. But as I said today, we got the public
health labs now throughout this country have adequate testing
to do, their public health message and mission. The other side
of the mission is the clinical mission and I think that is the
concern of most American citizens. How do I get evaluated?
And again, that really has to work through the private
sector. It wasn't really the public health lead for CDC to get
the laboratory tests, but I will say that the test we did
develop, we published and let everybody use it. They could
redevelop it.
There was regulatory relief so any CLIA certified lab,
according to the FDA, was given relief. They could develop the
test just like we did and they could use it, and some
universities have done that. We also were--there was relief to
IDT, the manufacturer that made our test for public health
purposes. They were given the regulatory relief to actually
make that test and sell it to hospitals.
That is the 1 million, 3 million tests that people refer to
that are rolling out for that side. But most importantly, and
we really need to give credit to the diagnostic companies of
this Nation. When they met with the Vice President, they didn't
come one company at a time.
They had already agreed as a group they were going to
figure out how to get this diagnostic test as rapidly as
possible for the American public that needed it. And as I said
today, yesterday they began that at both LabCorp and Quest. So,
there should be, again, increase in availability across this
Nation through the private sector.
Ms. Foxx. I worry about what we heard when we discussed
HR3, that were HR3 to become law, that we would lose much of
that ability through the private sector to come up with the
cures that we need to come up with. So, I am very pleased to
see this cooperation with the public-private partnership. And
thank you very much Madam Chairwoman, for your indulgence.
Chairwoman Maloney. Thank you. The gentleman from
Tennessee, Mr. Cooper, is recognized for five minutes.
Mr. Cooper. Thank you, Madam Chair. I am delighted to hear
the bipartisan praise of our public health workers, our
professionals, and I hope that colleagues on both sides of the
aisle will heed your good advice. First question, can U.S.
doctors or patients order some of these tests from South Korea?
Dr. Redfield. Important question when was asked by the
chairwoman about the difference. The difference between the
South Korean test and our test is they would have to go through
our regulatory process in the FDA to get approval to use----
Mr. Cooper. So, the answer is no.
Dr. Redfield. Currently no under the regulatory issue.
Mr. Cooper. OK. What are the names of these South Korean
companies or enterprises that offer these tests?
Dr. Redfield. The basic difference, Congressman, is when we
CDC developed our test, if you give me a second, we developed
to make sure it could work on the platforms that we would put
in all the public health labs. Those platforms were based on
our flu surveillance.
So, we used a technique called thermal cycling, which is
not a high-throughput. What the Koreans have done is they have
used a high throughput platform, which is now being done in New
York at the Wadsworth lab and now is being worked on by LabCorp
and Quest to bring it in.
So, it is a different platform. Roche is really the
company, I think, I am not sure but I can get back to you,
which was the platform that they used. It is a high throughput
that allows many, many tests to be done a single time.
Mr. Cooper. So, the South Koreans used a Swiss company, or
wherever Roche is headquartered, to supply the need?
Dr. Redfield. I will get back to you on the specific, sir.
Make sure I don't misinform you.
Mr. Cooper. So, American doctors or patients will have to
Google this to try to find out because we are not eliciting
this information today.
Dr. Redfield. We will get back to you. But I will tell you
LabCorp and Quest are up aboard and most American doctors
either use one of those two lab services for their clinical
practice.
Mr. Cooper. Well, LabCorp and Quest are wonderful
companies, but still, we are behind South Korea in terms of
making testing available. So, how do we solve this gap?
Dr. Redfield. What is going on right now, rather than the
public health platform that we used--if we had developed a test
on the Korean platform, none of our public health labs could
have done it because they don't have the instrumentation.
So, right now the private sector and certain labs have
begun to transfer that to what we call the high throughput. And
so you are going to see those high throughput, the same
technology, is going to be approved in the United States and
used by different private sector groups.
Mr. Cooper. So, now finally we are turning toward what you
call high throughput. And that maybe from Roche or may be from
somewhere else or maybe at the Wadsworth lab now in New York,
but finally one day we will have it.
Dr. Redfield. I would try not to use the word finally. I
guess I am not making myself clear. In my role to get it in the
public health labs, we build it on a platform that they had the
instrumentation.
Mr. Cooper. What is the name of the company that supplied
the faulty reagent?
Dr. Redfield. Well, it was--we should be careful. The third
control did not perform the way we wanted it to perform. There
is two possibilities. One that that reagent at that time, there
was a contamination, but the other possibility is biologic,
that prime repairs folded on themselves and it didn't perform.
It has been corrected and the new----
Mr. Copper. Substandard, faulty, whatever name you want to
use, what is the name of that company?
Dr. Redfield. Well it was produced by IDT, you know,
initially, and we have worked with them to correct that and CDC
together.
Mr. Cooper. Are there any plans to have drive-thru testing
in America so that we do not panic emergency rooms when people
come in and cough?
Dr. Redfield. Not at this time. I think we are trying to
maintain the relationship between individuals and their health
care providers.
Mr. Cooper. That is very interesting as a response. So, the
professional monetary relationship comes before public health?
Dr. Redfield. No, that was not my point. And maybe Dr.
Fauci wants to comment. My point was, in order to assess risk
and the appropriateness that these individuals get the proper
care, we believe that this is something that still has value to
be dealt with within the setting of clinical medicine. But I
will ask Tony to comment.
Dr. Fauci. It is exactly what you said. It is trying to
preserve--not anything about monetary, that is really not a
consideration at all. It is the trying to get people to at
least on a telephone call basis to be able to phone their
physicians ahead of time and say, I believe I have a situation.
The physician would probably say, stay at home and give
them the instructions of how to get a test. It is the
relationship between the patient and the physician. I have no
indication at all of the financial on that.
Mr. Cooper. Well, most Americans don't really have a
doctor. They rely on the ER to help and people are panicking
ERs apparently. I see that my time has expired. I wish I had
more time. Thank you, Madam Chair.
Chairwoman Maloney. Thank you. The gentleman from Georgia,
Mr. Hice, is recognized for five minutes.
Mr. Hice. Thank you, Madam Chair. Thank each of you for
being here. Dr. Fauci, you said earlier in answer to a question
that you believe the worst is yet to come. I think everyone up
here on both sides, we have been in briefings on this.
Many of us on multiple briefings, and I think everyone up
here would agree with you from the information we are hearing.
I am curious though with the steps that were taken early on
from declaring a public health emergency, restricting travel,
giving each of your organizations freedom to move forward to
try to combat this, and a host of other things, how important
was were those decisions? Would we be in a worse situation, for
example, had there not been some travel restrictions?
Dr. Fauci. I believe we would be in a worse position, sir.
But if I might, with respect, look ahead now, we need to do a
lot more.
Mr. Hice. Oh, there is no question.
Dr. Fauci. And I would like to maybe use just a few seconds
to make a point----
Mr. Hice. Make it quick because I want concise answers
because I want to yield.
Dr. Fauci. I yield back to you.
Mr. Hice. OK. Alright. Thank you. One of the issues, and I
do appreciate the cooperating spirit here today. I know
Schneider and I, we worked together to put together a bill, he
led the way, on trying to make sure medical devices are here if
there is a shortage and I think in that kind of spirit of
cooperation, we all need to address this issue that is critical
to our country. And I am curious specifically on the medical
supplies and medical devices. Are we going to be facing a
shortage?
Dr. Fauci. Yes. I believe that if we have a major outbreak,
we are definitely vulnerable to shortages, but Dr. Kadlec knows
more about that than I do.
Dr. Kadlec. Sir, I would just characterize it at this
point, and again, the FDA has a responsibility to look at the
entire supply chain of pharmaceuticals and drugs in the
country. So, they have had that responsibly.
I am looking at particularly the things that we need for
this outbreak right now, and I just want to highlight the
issues around some protective equipment, much of it is sourced
from overseas.
Some of it is domestically manufactured. And yes, we could
have spot shortages. We are working with different companies
and different sectors to enhance both their increased capacity
here domestically, as well as obtaining supplies from overseas
on affected areas to meet the demand.
The most important to man is with health care workers,
ensuring they have the respiratory protection and barrier
protection so they can see and treat patients without the risk
of getting infected and being lost to the cause.
Mr. Hice. OK, thank you. Dr. Redfield, real quickly if you
would, is there any way that the regulations, rules that are
standing in the way of the FDA from getting tests here, being
purchased, is there any way those regs can be waived in a
National Emergency?
Dr. Redfield. Initially, the regulations were in fact there
and that is why we had to go through and get approval. The
Commissioner actually gave regulatory relief so that any
individual now can go back and----
Mr. Hice. But you just answered a moment ago that we cannot
purchase those tests from South Korea and you said because of
regulatory interference. My question is, can those regulatory
requirements be waived in a National Emergency?
Dr. Redfield. I would have to refer that to the
Commissioner of the FDA.
Mr. Hice. OK, and last question real quickly and I want to
yield to the gentleman from Tennessee. Dr. Redfield, are our
tests better than their tests, more accurate?
Dr. Redfield. I would say our tests are accurate. I am not
going to compare it to theirs.
Mr. Hice. OK. I just want to know if we are talking apples
to apples or something else. So, far as you know, South Korean
tests are accurate as well?
Dr. Redfield. I would assume. I can only comment that our
tests are accurate.
Mr. Hice. Alright. With that, I want to yield to the
gentleman from Tennessee.
Mr. Green. Mr. Hice, thank you. Dr. Redfield, I was on the
phone yesterday with the CDC and the NIH and they suggested
that the South Korean test used only a single IG and not IGG
and IGM. Would you explain to my colleagues here why that
single immunoglobulin test versus ours, which is a two
immunoglobulin test, why our test is so much better?
Dr. Redfield. Congressman, you are referring to the test.
Actually the tests that we are currently using and they are
using to detect acute infection is to measure the antigen that
is in the oral, nasal or pharyngeal space and they are actually
using a molecular test for that. What you are referring to is
the test that we are trying to develop to understand the full
extent of this outbreak.
And that is a serological test. Or they can measure it in
oral and nasal secretions and measure certain like an IGG. CDC
has developed two serological tests that we are evaluating
right now so we can get an idea through surveillance, what is
the extent of this outbreak? How many people really are
infected? And that is being moved out now to do these extensive
surveillance programs.
Mr. Green. Madam Chairman, can I get one more question on
that same line. Or do you--I can wait for someone else to
yield. Thank you.
Chairwoman Maloney. Let's wait for someone else. I want to
try to keep to the five minutes because many members are here
and they all have important questions on both sides of the
aisle. I now recognize the gentleman from Virginia, Mr.
Connolly. He is recognized for five minutes and I appreciate
his help on this hearing.
Mr. Connolly. I thank the Chair. Some of my friends on the
other side of the aisle, including the ranking member, began
sanctimoniously to say we don't want to politicize this issue.
It is too important. Well, we didn't politicize the fact that
the global health and security biodefense desk at the National
Security Council was dismantled by this Administration two
years ago.
We didn't politicize the funding of public health in the
United States at the budget that in fact made critical cuts,
which we restored. We aren't the ones that call the alarm being
raised about this pandemic. That is fake news. That came out of
the President of the United States mouth and no gas lighting is
going to hide that.
And politicization, when the President of the United States
finally did go down the CDC with you, Dr. Redfield, we appeared
wearing this hat. A campaign hat in the middle of a crisis. We
will not be lectured about politicization and all of your words
and sanctimony will not cover up the fact that this
Administration was not prepared for this crisis and it put
lives at risk, American lives at risk.
We didn't have the test we needed. We didn't have a
diagnostics we needed. The President made patently false
assertions, which Dr. Fauci corrected, about the development of
the virus. In fact, he was more concerned about what was
happening on the stock market than he seemed to be concerned
about American public health. That is shameful and you can't
cover that up.
We will not be silent nor will we be intimidated by charges
of politicization in pointing it out because lives are at
stake. Dr. Redfield, you indicated one size does not fit all
and I think that is true. But there is a concern that we don't
have any kind of uniform protocols and guidance for localities
and states.
So, for example, Mr. Cooper's state has decided not to
identify a specific County where a Coronavirus victim may be
present, just a region of the state, whereas in my state we are
being quite precise about where our victim may be identified.
They corrected that today. But again, there is confusion.
Do we close things? Is there a certain number that we are
worried about? When do people get tested? How do they get
tested? What is the guidance about going to an ER as opposed to
seeing your physician? What if you don't have a physician?
There is real concern here about the need for more uniformed
guidance. Granted one size does not fit all, but that doesn't
mean there is no guidance at all and no protocols that states
and localities could refer to. Would you comment?
Dr. Redfield. Thank you. A very important question. First,
we do have very specific guidance for a variety of things that
the CDC has published, really targeting more the business
community, hospitals, long-term care facilities. But the point
you raised, I think, is the most important: what guidance are
we giving public health officials to figure out their
mitigation strategy based on their circumstance?
And I will so say, yesterday we did post for everyone an
algorithm for how they can go through jurisdiction by
jurisdiction for what to do for individuals and families at
home, what to do for schools and childcare, what to do for
assisted living and long-term care facilities, what to do for
the workplace, what to do for community and faith
organizations, what to do for the healthcare setting because I
couldn't agree with you more that we want to give guidance.
We put that out. We are, as we speak today, working with
four jurisdictions to get very specific on exactly what CDC is
recommending in those four situations so that the rest of the
Nation can see how to begin to operationalize it.
Mr. Connolly. And if I could just quickly ask Dr. Fauci,
was it a mistake, Dr. Fauci do you believe, to dismantle the
office in within the National Security Council charged with
global health and security?
Dr. Fauci. I wouldn't necessarily characterize it as a
mistake. I would say we worked very well with that office. It
would be nice if the office was still there.
Mr. Connolly. We have a bill to solve that, a bipartisan
bill. I thank you and I thank the Chair.
Chairwoman Maloney. Thank you. The gentleman from
Wisconsin, Mr. Grothman, is recognized for five minutes.
Mr. Grothman. Thank you. I would like to--I appreciate you
all being here. I bet I have had a chance to talk to you in
maybe five or six different panels since this crisis broke and
I am glad you are all so ready to come to Washington. I am
going to talk a little bit about, I am not sure yet the public
overall is in line with the things you are telling us.
I think in part that is because in the past we have had
crisis around SARS comes to mind in which we expected all sorts
of horrible things to happen. And because maybe all these
horrible things didn't happen, the public, or many members of
the public, are not that alarmed yet. I want to talk a little
bit about the numbers in China and what we expect the numbers
to be the United States.
The things I have here show that right now in China there
been about 3,000 deaths. Do you guys agree that probably the
worst is over in China or do you think that number is going to
continue to escalate or slowly drop?
Dr. Redfield. I think China is a great sign of
encouragement. They had--in the last couple days, they have
really gone down to under 50 cases per day. So, they really
have now got control of the outbreak.
Mr. Grothman. OK. So, in the United States, when you look
at the trajectory of what happened in China and what happened
in the United States based upon what over three weeks a month,
or how far are we into this situation in the United States?
Dr. Redfield. I think that is the critical question, that
for a period of time this outbreak seems to go in a very
arithmetic way and then it goes logarithmic. So, for example,
you can just go back three weeks ago and Italy had hardly any
infections. They had almost 1,800 infections confirmed just
last night. So, we are fighting hard now between our
containment strategy and as Dr. Fauci will say, the expanded
mitigation.
Mr. Grothman. Let's compare to something the average
American understands and that is the common flu. Can you tell
us every year kind of where we start and how much it grows, and
how many new people get the flu every day?
Dr. Fauci. Yes. I can't give you a precise number sir, but
one of the things we are trying to emphasize that the American
people----
Mr. Grothman. Well, I only met five minutes. Can you tell
us about how many people, say, get the flu every year and how
many new people are diagnosed with the flu? I didn't hear you.
Dr. Fauci. Yes, I am sorry. You know, we about five percent
or so to 10 percent of the population, we have about 30,000
deaths. It ranges from 15,000 to about 69,000 to 79,000 per
year.
Mr. Grothman. OK. Based upon the current trajectory, how
many people do you think will get this new virus and how many
people do you think will die?
Dr. Fauci. We cannot predict.
Mr. Grothman. I know you can't predict but there must be,
you know, you have a graph, we have the beginning of a graph.
We know this is going to go up. We have the experience of
China. We have the experience of Italy. Can you can you give us
some projections?
Dr. Fauci. It is going to be totally dependent upon how we
respond to it. So, I can't give you a number. If we now sit
back complacently----
Mr. Grothman. I am not asking to be complacent. I am asking
for a realistic and that is what the public is looking for----
Dr. Fauci. I can't give you a realistic number until we put
into the factor of how we respond. If we are complacent and
don't do really aggressive containment and mitigation, the
number could go way up and involve many, many millions. If we
start the contain, we could flatten it. So, there is no number
answer to your question until we act upon it.
Mr. Grothman. I will give you a question. Now you mentioned
earlier today that I think one of the basketball tournaments, I
think for the Ivy League, they have cutoff their tournament all
together on the other. Nobody talks about--every night they
play a like, I don't know, 8 to 10 NBA games and nobody talks
about shutting them down. Is the NBA under-reacting or is the
Ivy League overreacting?
Dr. Fauci. We would recommend that there not be large
crowds. If that means not having any people in the audience on
the NBA plays, so be it, but as a public health official,
anything that has large crowds is something that would give a
risk to spread.
Mr. Grothman. OK, I will just emphasize again. You said
about 30,000 people die every year from the regular flu. Do we
know the ages of the people so far who are dying of the of the
new flu?
Dr. Redfield. Yes, so for me for the Coronavirus right now,
for example, in Italy the average age of death is over the age
of 80. Most of the deaths that we have seen are over the age of
70.
Mr. Grothman. OK, I will yield. Maybe give Dr. Greene
another chance to ask a question.
Mr. Green. Thank you. Very quickly, Dr. Fauci, you took the
Hippocratic Oath right?
Dr. Fauci. Excuse me?
Mr. Green. You took the Hippocratic Oath?
Dr. Fauci. I did.
Mr. Green. OK. Are you offended by someone suggesting that
you might intentionally not speak out when you are confronted
with something that could harm your patience and violate your
Hippocratic Oath?
Dr. Fauci. Yes, I just made that point a few moments ago.
As I have said, I have always, not only with this
Administration and Madam Chairperson, you said I served four
Presidents, with all due respect to Reagan and George H.W.
Bush, I have served six Presidents and I have never done
anything other than tell the exact scientific evidence and made
policy recommendations based on the science and the evidence.
Chairwoman Maloney. OK. The gentleman from Illinois, Mr.
Krishnamoorthi, is recognized for five minutes.
Mr. Krishnamoorthi. Thank you, Chairwoman. Good morning and
thank you for coming in today. Yesterday, the Governor of
Illinois said I am very frustrated with the Federal Government.
We have not received enough test. I want to understand why.
Director Redfield--Director Redfield over here.
The first Coronavirus case in the U.S. was confirmed on
January 21. At that point CDC began developing a test kit to
diagnose Coronavirus cases. The FDA gave CDC emergency
authorization to manufacture and issue this test kit around
February 4, isn't that right? Unfortunately, however, testing
did not get underway because of the problems with the test
kits.
Specifically CDC's Atlanta manufacturing facility had
quality control problems. On February 24, one month after
Coronavirus was found in America, officials discovered that
CDC's Atlanta facility was contaminated.
Whether it was because of the contamination or biologic
problems, which you had alluded to, test kits coming from that
facility were flawed and had to be replaced, dramatically
slowing down our response.
Dr. Redfield, I know you are investigating the cause of the
contamination in the Atlanta facility. Is the person who
oversaw the Atlanta facility at the time of the contamination
still in charge of the current manufacturing process?
Dr. Redfield. This is currently under investigation at this
point. And I think I am going to leave it there, sir.
Mr. Krishnamoorthi. So, you can't give us assurance that
the person who bungled the production process hasn't been
removed. Recovering from that misstep cost us precious weeks
and now month, sir. Meanwhile the virus spread and people died.
I respectfully disagree with your earlier characterization
that we had an aggressive response and we had an early
diagnosis when one month after the first Coronavirus case was
detected, we still have not shipped manufacturing and we still
not shipped test kits to public labs.
Now, let's currently discuss testing efforts underway in
the U.S. and other countries. You have a copy of this chart
before you. We talked about South Korea and the U.S. Let me
just drill down for a second because this is very instructive.
The U.S. and South Korea both experienced their first
confirmed Coronavirus cases roughly within a day of each other.
The U.S. on January 21 and South Korea on January 20.
Interestingly, both countries developed a test to diagnose
Coronavirus roughly around the same time. The U.S. on February
4 and South Korea on February 7, just three days later, but
then our testing at that point, the activities diverge
dramatically.
Here we have a chart that shows the testing activities of
four countries, the U.S., South Korea, Italy, and the UK on
three separate dates and three paths in the past three weeks.
You see, from 0 till March 10, South Korea tested 4,000 people
for every million persons in its population. Italy in the blue
bar tested 1,000 people for every million people in the
population. UK 400 for every million. Now where is the red bar
representing the United States, Dr. Redfield?
Dr. Redfield. I don't see it on that graph.
Mr. Krishnamoorthi. I don't see it either but I can assure
you that the data is there, it just doesn't show up. It doesn't
show up. It turns out that Korea had tested 4,000 people for
every million of its citizenry and we are at 15 people for
every million people in this country. That is a response.
A testing response is almost three hundred times more
aggressive than what is here in this country. And the problem,
Dr. Redfield, is that when we don't test as rapidly as we
should, the virus spreads and people die. Now let's talk about
the situation going forward. Vice President Mike Pence said on
Monday, ``before the end of this week, another 4 million tests
will be distributed.''
But the real question I submit is not when the test will be
distributed, it is when the tests will be performed on people
so that they can know whether they have contracted Coronavirus.
Now South Korea currently tests 15,000 people per day,
whether it is through high throughput, low throughput, medium
throughput, it doesn't matter. They test 15,000 people per day.
Dr. Redfield, when are we going to be reaching 15,000 people
per day tested in this country?
Dr. Redfield. Well first I would say, Mr. Congressman, it
really does depend on the clinical indication. I think one
thing I would like to point out again. The CDC developed this
test for the United states public health system. We did not
develop this test for all of clinical medicine. The test for
clinical medicine, we count on the private sector to work
together with the FDA to bring those tests to bear. And I
said----
Mr. Krishnamoorthi. So, you are blaming the private sector?
Dr. Redfield. I am not blaming.
Mr. Krishnamoorthi. You are passing the buck to a private
sector. Sir, because of this the virus is spreading, people are
getting sick, people are dying. Thank you.
Chairwoman Maloney. The gentleman yields back. The
gentleman from Kentucky, Mr. Comer, is recognized for five
minutes.
Mr. Comer. Thank you, Madam Chairman, and I cannot think of
a more important Committee hearing that would take place in
Congress this week than the one we are having now. And I was
very glad to see Congress come together last week in a
bipartisan way after we have spent many months in the very
partisan environment here with respect to the impeachment
hearing.
But Congress came together to pass a very important Corona
supplemental that I think everyone would agree is making a huge
difference in America's defense against the Coronavirus
outbreak. But I have been very disappointed to hear some of the
comments by my colleagues on the other side of the aisle.
Chairwoman Maloney mentioned the political spin. Mr. Connolly
mentioned the politicization and fake news.
I just wanted to mention a couple of things that have been
written and said by the press and Democrat leadership. The New
York Times a little over two weeks ago had a headline, ``Let's
call it Trump virus. If you are feeling awful, you know who to
blame'' and then House Majority Whip Jim Clyburn said when
asked if he had confidence in the Administration's response, he
said, ``absolutely not. They are just fooling around.
It just reminds me so much of Katrina.'' I take a bit of
issue with the politicization of something that should be
focused on bipartisanship and working together to save lives
because we have a crisis. Americans are truly and rightfully
concerned and I think that that Congress needs to work hand-in-
hand with the Administration.
I don't believe the Administration has gotten the credit it
deserves, especially with respect to the President's decision
to cutoff the border, which has undoubtedly given the CDC and
health officials time to prepare for this outbreak. I am not
confident the last Administration would have made that decision
for fear of political incorrectness or whatever.
So, I think the President should get a lot of credit for
making that decision. But I want to focus on some things that
are important to people in Kentucky because there is a lot of
concern, there is a lot of misinformation. So, my simple
question would be to anyone on the panel, which are the best
website for concerned Americans to get onto that have factual
information and important tips on how average everyday
Americans can prepare for this?
Dr. Fauci. So, there are two. One is, the core one is
cdc.gov. And within that is Coronavirus.gov. But cdc.gov will
ultimately get you very quickly to anywhere you want to go.
Mr. Comer. So, my next question to anyone on the paddle, in
the era of fake news and social media, how can Americans ensure
that the information that they are sharing on the social media
is accurate information? Is there--do you have any advice on
that?
Dr. Fauci. Yes, I think for the most part, at least from my
experience, social media can often be as detrimental as it is
helpful. That's the reason why, sir, I think the first question
that you asked would be, one to go to the source of that data
CDC--and I am not CDC, but I am saying CDC is a data-driven
organization. And if you really want the facts and the data, I
would just go to cdc.gov.
Mr. Comer. We will make sure. Our office, I am sure. Just
about every office here will start sharing that information. I
want to switch gears in my last minute.
Represent, along with Congressman Green, Fort Campbell
Military Base, Fort Campbell, Kentucky. Kentucky, Tennessee,
but can you tell us what is being done to ensure that there is
not an outbreak, first of all, on our Military bases to protect
our troops? Second, what our Military is doing to be able to be
in a position to help fight this if this is a mass outbreak?
Dr. Rauch. I will I can take that one. Thank you for the
question. So, we have put out a series of for self-protection
guidance that is aligned to the CDC recommendations and we have
tailored those, that guidance for self-protection for Military
Commanders, and particularly for Installation Commanders.
Installation Commanders and Military Commanders have a lot
of latitude between right and left limits within our guidance
that they can command and protect their Military population.
Now, what we are also doing is working with the interagency
efforts to develop vaccines and also to develop antiviral
treatments.
And we are working with the interagency to develop what we
call expeditionary field diagnostic kits because we want kits
that we can push far forward. We have missions all over the
world. We need to get our medical capability distributed.
Mr. Comer. Well, thank you and hopefully Congress can work
with you all in a bipartisan way, we can together and help do
everything we can to protect American lives. With that, Madam
Chair, I yield back.
Chairwoman Maloney. The gentleman from Maryland, Mr.
Raskin, is recognized for five minutes.
Mr. Raskin. Thank you. Dr. Fauci, we have got two enemies
in this crisis, one is the virus and one is he misinformation
about the virus. And I want to quickly clear up a few things
that have been said over the course of this process. One was by
the President in early February when he said it looks like by
April, you know, in theory when it gets a little warmer, it
miraculously goes away. Is there any scientific reason to
believe that?
Dr. Fauci. The basis for any surmising that that might
happen is based on what we see every year with influenza, which
actually as you get to March and April and May, it actually
goes way down, and other non-Novel Coronavirus, but common cold
Coronaviruses often do that.
So, for someone to at least consider that that might happen
is reasonable, but underline but, we do not know what this
virus is going to do. We would hope that as we get to warmer
weather it would go down, but we can't proceed under that
assumption. We have got to assume that it is going to get worse
and worse and worse.
Mr. Raskin. OK, the President predicted that there could be
a vaccine in a few months. I think you contradicted that today
and I think you contradicted that at that time. I just want you
to be very clear. Is there any chance we will have a vaccine in
a few months?
Dr. Fauci. No, I made myself clear in my statement.
Mr. Raskin. OK. Dr. Redfield, the first case of community
spread of Coronavirus took place on February 26. That is
infection of someone who did not have a clear travel history to
China or direct contact with someone who did. Why wasn't the
decision made on February 26 to expand your testing criteria
for anyone displaying Corona-like symptoms at that point
instead of waiting until March 4 to broaden the criteria?
Dr. Redfield. Well, that is a good question, Congressman. I
mean we always left the discretion to do testing to the local
public health groups. If you look, we always had that
discretion. We never refused testing from anybody but we did
give guidance, as you point out, originally to do testing for
individuals that presented with certain clinical scenarios
secondary to travel to China.
Those two cases in California and several others obviously
led us to reconsider those and make it very clear that we
wanted upfront to tell clinicians if they suspect it and if the
Health Department suspected, they should send that sample to
the Health Department or us at CDC.
Mr. Raskin. OK, we have been hearing stories about people
who have had very compelling reasons to get tested but were not
able to. I will give you one example. A nurse in California was
quarantined after treating a patient who had Coronavirus and
then showed symptoms of the disease herself.
On March 5, the day after you brought in the testing
criteria, she put out a statement about her situation, and she
said, ``the public County Officer called me and verified my
symptoms and agreed with testing but the national CDC would not
initiate testing.
They said they would not test me because if I were wearing
the recommended protective equipment, then I wouldn't have had
the Coronavirus. Are you familiar with this case?
Dr. Redfield. No, and I would think that this is a
misunderstanding if it did occur.
Mr. Raskin. OK. So, what is the standing criteria, the
existing criteria for testing now so we have no confusion about
it?
Dr. Redfield. Again, it is the--if a clinical physician, a
physician, a nurse practitioner, a healthcare provider feels a
test is indicated then we----
Mr. Raskin. Based on what?
Dr. Redfield. Based on their clinical assessment.
Mr. Raskin. And that is based on the--does it require that
the person have to have had contact with someone who had been
on a cruise or had been to China?
Dr. Redfield. No. This is their clinical assessment. We are
not going to judge the clinical assessment. We also say, if it
is the clinical assessment of the--if it is the assessment of
the public Health Department, those individuals. And again,
these are decisions.
What happens is in the time when testing was limited to
Health Departments, the local Health Department makes that
decision and then they--but they have followed CDC guidance.
Now if we made it very clear, it is up to the individual
healthcare provider and the individual public health to make
that decision.
Mr. Raskin. OK. Could you make a public service
announcement right now for people who are asking the question
of whether or not they should be tested? I hear from
constituents who are having flu-like symptoms. They want to
know what should they do? What should they do?
Dr. Redfield. Well, as Dr. Fauci said, the first thing I
would do is to tell them to contact their healthcare provider
or their emergency room and tell them they are concerned they
may have Coronavirus infection and then follow their
instructions to where to get the test. Alright, and then
proceed with getting the appropriate clinical evaluation.
Mr. Raskin. OK, so they should call someone before they go
in?
Dr. Redfield. Well, we would like to do that because if you
really think you are infected, we are trying to avoid someone
to walk into a 200-person, 100-person emergency room. First,
just a call in advance and then they will arrange exactly how
they are going to get to test, how they are going to see the
patient. They are going to be prepared when that patient comes
to the emergency room. They are going to be able to isolate
them, get them tested, get them properly evaluated.
Mr. Raskin. OK. Thank you for your work on behalf of the
American people. I yield back, Madam Chair.
Chairwoman Maloney. Thank you. The gentleman from Texas,
Mr. Cloud, is recognized for five minutes.
Mr. Cloud. Thank you, Chairwoman. Thank you all for being
here today. Appreciate your work on this. Dr. Redfield, I
appreciated you talking about the ever changing dynamics of the
situation, especially in the sense that scientists even every
day are learning more and more on how to deal with this and how
to address it.
It has been difficult, of course, to get information out to
the public, especially in a hyper politicized environment. I
like to spend some time trying to clear the record on that as
we try to find the proper balance between creating a proactive,
positive response to real threats as opposed to instigating
overreaction in the public and finding a healthy balance.
Dr. Fauci, can you, by way of comparison, briefly explain
how does COVID-19 compare to other previous health situations,
SARS, H1N1, things like that.
Dr. Fauci. Sure, sir. Thank you for the question. Well SARS
was also a Coronavirus in 2002. It infected 8,000 people and it
killed about 775. It had a mortality of about 9 to 10 percent.
So, that is only 8,000 people in about a year. In the two-and-
a-half months that we have had this Coronavirus, as you know,
we now have multiple multiples of that.
So, it clearly is not as lethal, and I will get to the
lethality in a moment, but it certainly spreads better.
Probably for the practical understanding of the American
people, the seasonal flu that we deal with every year has a
mortality of 0.1 percent. The stated mortality over all of this
when you look at all the data including China is about three
percent. It first started off as two and now three.
I think if you count all the cases of minimally symptomatic
or asymptomatic infection, that probably brings the mortality
rate down to somewhere around one percent, which means it is 10
times more lethal than the seasonal flu. I think that is
something that people can get their arms around and understand.
Mr. Cloud. But less lethal than H1NI or SARS?
Dr. Fauci. Absolutely not. H1N1 is even--the 2009 pandemic
of H1N1 was even less lethal than the regular seasonal flu. It
was a pandemic----
Mr. Cloud. I am trying to help the American people know
where to appropriately set their gauge.
Dr. Fauci. I think the gauge is that this is a really
serious problem that we have to take seriously. I mean people
always say, well the flu, you know, the flu does this, the does
that. The flu has immortality of 0.1 percent. This has
mortality of ten times that, and that is the reason why I want
to emphasize, we have to stay ahead of the game in preventing
this.
Mr. Cloud. OK. Could we speak to the supply chain for a
second, Dr. Kadlec. We are telling people to wash their hands,
sanitation, all that kind of stuff. A lot of this stuff comes
from China. They are going to the stores seeing these dry up.
What are we doing from the, I guess, FDA standpoint to ensure
supply chains, that we have all these--everything we need.
Dr. Kadlec. Sir, you know, I know there has been a run on
Purell but I think water works just as well just in terms of
that case, but it does require people to frequently wash their
hands and maintain good hygiene, cover the cough, covers
sneeze, don't touch your face, and again, ensure that you
continue to wash your hands.
Mr. Cloud. In my understanding in the legislation we just
passed last week too, you know, face mask for health
professionals. Of course, not for every citizen walking around
but for health professionals. Then we have U.S. supplier that
could provide them but we, House leadership didn't put the
legal framework in it necessarily. Is there anything the FDA is
doing to allow U.S. based companies to participate better?
Dr. Kadlec. So, I think one thing the FDA issued was
emergency use authorization about expanding the use of
particular masks, N95 respirators that could be used. There are
two types, one used by industry, one used by the healthcare
industry, and basically making that available for increased so
the numbers will be increased.
There is a high demand for masks, particularly in the
healthcare setting. Depending on what model you use, you may
need up to $3.5 billion. That is a high number. That is a
model. All models are wrong but some are useful, and that
number could be as low as $600 million. And so what we are
doing now is we are trying to increase the amount of masks that
are available both N95 respirators and surgical masks which
could be used in low-risk settings by healthcare workers.
And in that way, we have issued a request for proposal for
500 million masks.
Mr. Cloud. OK, I have time for one more question so----
Dr. Kadlec. Yes, sir, sorry.
Mr. Cloud. Regarding testing Dr. Fauci, we have had people
calling 911 showing no symptoms, asking for an ambulance to
take them to a hospital to be tested. So, who should be tested?
At what point should they be tested? At what point are the test
actually helpful? What about false negatives, those kind of
questions. Who should we really be concerned about?
Dr. Fauci. OK, so very briefly as Dr. Redfield has
responded multiple times on this, there are really two buckets,
if you want to call it. If you have someone who has a reason to
believe that they are infected, either that they have symptoms
or they have come into contact with someone who is either
travel-related or who is in fact documented to have been
infected, are exposed.
That is something that if you go to a physician, you get a
test, and you find that that individual is infected. The other
that was discussed a fair amount over the last several minutes
is this surveillance type where you are not looking to see if
anybody has been exposed, but you want to find what the
penetrance of this particular infection is.
That is a different thing than the physician-patient
relationship. That is trying to get a feel for what is out
there and that is what the CDC is doing now in six sentinel
cities.
They will expand that throughout the country so that we
will be able to, hopefully very soon, to get an idea,
forgetting the people think they might be infected, who
actually is infected.
Chairwoman Maloney. The time has expired. The gentleman
from California is recognized for five minutes.
Mr. Rouda. Thank you, Madam Chair. Like all of the members
up here, we are getting constant communication from our
constituents wanting more information and I applaud all of you
for being forthright with the American public. That is exactly
what we need. In times like this, communication is so
important.
And if you are going to err on one side or the other, over-
communication is clearly more important than under-
communication. Dr. Kadlec, I had the fortunate opportunity to
be with you earlier this week and see firsthand the work that
you are doing to help address this issue as well as your peers.
I want to talk about one of the slides you shared with me
and it was a bell curve that showed what would happen across
United States as far as the spread of this disease if
mitigation efforts were not taken by the American public and
your agencies versus mitigation efforts to basically flatten
that bell curve.
And I think the primary purpose of that is so that our
healthcare facilities and physicians, as well as the supplies,
are not for lack of a better term overrun by a steep bell
curve. Am I correct in making that statement?
Dr. Kadlec. Yes, sir.
Mr. Rouda. And I think another way to say it too is not a
question of if, it is a question of when the virus continues to
spread across the United States, but we want to pace it out as
long as possible. Is that a correct statement as well?
Dr. Kadlec. Yes, sir.
Mr. Rouda. Thank you. One of the issues in helping to
address this is the fact that we do not have enough test kits.
We know that many individuals, as my fellow member to the right
of me, Mr. Raskin, pointed out, there are individuals who have
requested test kits and have not been able to access.
My understanding is as late as last Saturday, ground zero
in King County, Washington, the healthcare professionals from
that facility still did not have access to test kits. Mr.
Redfield, do you know if that is true or not?
Dr. Redfield. We have provided test kits to the Health
Department. The University of Washington has developed their
own tests----
Mr. Rouda. Were those test kits available last Friday?
Dr. Redfield. Yes, sir.
Mr. Rouda. Thank you. And without test kits, is it possible
that those who have been susceptible to influenza might have
been miscategorized as to what they actually had, that it is
quite possible that they actually had COVID-19?
Dr. Redfield. The standard practice is the first thing you
do is test for influenza. So, if they had influenza, they would
be positive for----
Mr. Rouda. But only if they were tested. But if they
weren't tested, we don't know what they have?
Dr. Redfield. Correct.
Mr. Rouda. OK. And if somebody dies from influenza, are we
doing post-mortem testing to see whether it was influenza or
whether it was COVID-19?
Dr. Redfield. There is a surveillance system of death from
pneumonia that the CDC has. It is now in every city, every
state, every hospital.
Mr. Rouda. So, we could have people in the United States
dying for what appears to be influenza when in fact it could be
the Coronavirus or COVID-19?
Dr. Redfield. Some cases have been actually diagnosed that
way in the United States today.
Mr. Rouda. Thank you. I want to turn a little bit to the to
the CDC website because I really appreciate the information
that you are putting out and it is so important to the American
public, but I also want to make sure that they fully understand
it. On the CDC website, there is a published a guide called,
``Framework for mitigation actions for protect communities from
COVID-19.''
In that graph, it provides three levels of transmission.
None, in other words you are in a community where there is no
reports of any cases whatsoever. The second area is minimal to
moderate. And the third is substantial. Dr. Redfield, how many
cases of Coronavirus are considered to be, ``minimal to
moderate''?
Dr. Redfield. Right now when we see basically transmission
cases, particularly if they are not linked, we are looking at
cases in the 25 to 50 range to see that groups begin to move
into the moderate range, sir.
Mr. Rouda. OK. Thank you. That is helpful. I would suggest
that the CDC put that on their website so that the average
American can read it and understand exactly the precautions
they should take. So, then substantial, I would assume, is when
you have 50 cases or more in your community, you can consider
it substantial?
Dr. Redfield. Yes, sir.
Mr. Rouda. OK. Thank you. And I would go back to Dr. Fauci,
you talked about this is serious. We are seeing activities
across the Nation, school closing, sporting events being
discussed about having them held in other places, major events
being canceled or rescheduled.
This would suggest this is a really serious issue and I
share the thoughts of the member from Wisconsin that I think we
are concerned that we are not getting the full understanding or
modeling that has taken place that would suggest the true
impact of this virus across the United States as well as
potential models for deaths.
Can you elaborate a little bit--and I get that there is no
perfect model, but can you be helpful in helping us understand
what we are really looking at here?
Dr. Fauci. Yes, if you look at the curves of outbreaks,
historically, that is similar to this, the curve looks like
this and then it goes up exponentially, and that is the reason
why it depends on how you respond now. So, if we wait till we
have many, many more cases, we will be multiple weeks behind.
You know, I use the analogy at the press conference
yesterday and I will use it today. It is the old metaphor, the
Wayne Gretzky approach. You know, you skate not to where the
puck is but to where the puck is going to be. If we don't do
very serious mitigation now then what is going to happen is
that we are going to be weeks behind and the horse is going to
be out of the barn.
And that is the reason why we have been saying, even in
areas of the country where there are no or few cases, we have
got to change our behavior. We have to essentially assume that
we are going to get hit. And that is why we talk about making
mitigation and containment in a much more vigorous way. People
ask, why would you want to make any mitigation, we don't have
any cases. That is when you do it because we want this curve to
be this, and it is not going to do that unless we act now.
Mr. Rouda. Thank you, doctor. Madam Chair, I yield back.
Chairwoman Maloney. Thank you. Thank you so much. The
gentleman from Ohio, Mr. Gibbs, is recognized for five minutes.
Mr. Gibbs. Thank you, Madam Chair, and thank you all for
the work you are doing. The huge challenge and I know the
stress you must be under and could never thank you enough
because I think CDC and all our agencies are doing the best
they can in this unprecedented circumstance. I also was glad to
see Governor Newsom, California come out and say some good
things the Administration is doing and the help, and I think
the Government in Washington should do the same.
You know, just talking about politicization which shouldn't
happen. We should be together on this. But one thing that
really astounded me was all the talking heads and some Members
of Congress criticizing Vice President Mike Pence take the lead
on this, head this up because he is not a medical professional.
I would think when I look at this that a person at that
that office, that level, that office that helps bring the
agencies together, whether maybe help clean out some of the red
tape and bureaucracy, would you concur that that has been
helpful to have that level--our top level our Government
involved at that level for your working relationship when you
are especially working between agencies?
Dr. Fauci. Yes, sir.
Dr. Redfield. Absolutely.
Mr. Gibbs. I just make that point because I hear that
criticism and I think that they are either being political or
they don't know what the heck they are talking about. Probably
a little of both. I also think it is amazing, and I want to
praise the CDC has done to develop a test in one week. Is that
unprecedented to develop a test----
Dr. Redfield. I am going to have my friend, Dr. Fauci,
answer.
Dr. Fauci. I mean, obviously the technologies of today,
being able to develop a test as quickly as that, the same way
as we were able to use the sequence to get a vaccine started at
least in the trial----
Mr. Gibbs. And I fully understand the vaccine because you
have got all the testing of a good safety, efficacy, and all
that, but we are relatively close to an anti-viral----
Dr. Fauci. You know, you say relatively close but we don't
know if it works so I don't want to promise anything. We are
testing them. If they are effective, they will be distributed
but you don't want to do that unless you know they are
effective.
Mr. Gibbs. I do want to talk a little bit about the
timeline. You know, it broke in China and then South Korea,
Japan, Italy, and the United States, and you know elsewhere.
As you say, it has really mushroomed. Seems to me when the
next four weeks for us are really critical because it is--can
we kind of maybe think we are getting information on China. I
know sometimes it is not reliable. But also, we are seeing it
happen in South Korea and Japan. And maybe they peaked a little
bit? Maybe they are on the better side that curved now?
Dr. Redfield. I think, you know, I think you are right
Congressman. Clearly China has got controlled of the outbreak.
They had 20 cases in the last 24 hours. Where our real threat
right now is Europe. That is where the cases are coming in for.
So, in a way if you want to just be blunt, Europe is the new
China.
Mr. Gibbs. OK. I praise you, Dr. Fauci, talking about doing
as much mitigation as we can. It is critical but would you
concur that my assessment, the next the rest of this month and
next four weeks, is the really critical time for us?
Dr. Fauci. It is critical, yes. And it is critical because
we must be much more serious as a country about what we might
expect. We cannot look at and say, well, they are only a couple
of cases here, that is good, because a couple of cases today
are going to be many, many cases tomorrow.
Dr. Redfield. We would like all Americans to take a good
look at that mitigation strategy, as Tony said. We have zero,
but they need to be fully engaged in that mitigation strategy
as well as those with moderate and more severe. This is a time
for everyone to get engaged. This is not just a response for
the Government and the public health system, it is a response
for all of Americans.
Mr. Gibbs. I understand that. Another thing that is not
really being reported because it doesn't--it is not as you
know, raises the ratings, everybody is talking about it, the
number of cases and the number fatalities, but also I have seen
the reports worldwide. We have better than 50 percent recovery
rates, is that right?
Dr. Redfield. Right now we would say it's probably about 85
percent, sir.
Mr. Gibbs. No, 85 percent of people affected are----
Dr. Redfield. Are recovering. 80 to 85--about 15 to 20
percent----
Mr. Gibbs. OK. I was just looking at the John Hopkins real
time chart and there are like 120,000 confirmed cases and about
60,000 or something like that----
Dr. Fauci. Any times when you look at the chart it is about
half. But at the end of the day, if you look at historically,
for example the experience we have had with China, about 80
percent of them have the disease that makes people sick but
they ultimately recover without substantial medical
intervention. It is 15 to 20 percent that have the serious
disease and high mortality.
Mr. Gibbs. And the bulk of them have been people with
underlying health conditions and over 70, right?
Dr. Fauci. The elderly as well as people with underlying
conditions like heart disease, lung disease.
Mr. Gibbs. I am out of time. I just want to say I think we
need to do what we need to do, be vigilant, but we also need to
be responsible and not lose our heads on this because I think
we are going to get over this with time, with the great work
you are doing. Thank you. I yield back.
Chairwoman Maloney. Thank you. The gentleman from
California, Mr. Khanna, is recognized for five minutes.
Mr. Khanna. Thank you, Madam Chair. First, let me thank
you, Dr. Fauci. I have known you, worked with you, and I have
complete confidence in your leadership and appreciate your
service.
And Dr. Redfield, I think it is important to realize that
you have served our country in the Army, you serve this
Nation--we need to be focused not on personalizing this but
figuring out what we can do to solve the issue. Now, one of the
things that I think they should teach us as a country with all
the anti-Government rhetoric, why do we need Government,
Government is the problem.
How about we consider how inadequately we have been funding
Government and public health. The CDC budget is $11 billion,
1.5 percent of our defense budget, $738 billion. Dr. Redfield,
do you think our country would have been safer if let's say we
had twice the CDC budget, if we had put that three percent of
our national defense budget in our capacity?
Dr. Redfield. Thank you, Congressman. I think it is
important to realize that for, you know, decades we have
underinvested in the public health infrastructure of this
Nation. As many of you know, CDC's funding that we get from
Congress, about 70 percent of it goes out to local and state,
territorial and tribal Health Departments. They are the
backbone of our health system.
And if anything, I think you can look, I would rather see
during my legacy to help over prepare our Nation's public
health system with what I call the core capabilities of data
modernization and predictive analysis, laboratory capacity at
the local, public health labs, making sure we have the human
personnel and the public health communities, the rapid response
fund that we are very appreciative that Congress gave us, and
build a global health security platform for the 2030, 2050----
Mr. Khanna. And Dr. Redfield, while you have the country's
attention, how much would that cost? Because right now we are
spending--I think most people realize this is a national
security issue and we are putting 1.5 percent into the CDC of
the defense budget.
The NIH budget is $41 billion which is less than five
percent of National Security. I mean, why isn't there
bipartisan call to double these budgets, triple these budgets.
I mean, what would you ask the American people and Congress to
prepare?
Dr. Redfield. I appreciate the opportunity Congressman and
I would have to get the back to you with an exact estimate of
all that.
Mr. Khanna. Dr. Fauci, do you have a view----
Dr. Fauci. Yes, I mean we have been well funded at the NIH
but I think that we need to continue to have a consistent well
funding. What happens is that there is inconsistency at times
but luckily over the last four or five years the Congress has
been quite generous with us.
Mr. Khanna. One question I do have is the WHO had tests and
some of the other countries use these tests. Why shouldn't we
be using these tests?
Dr. Redfield. I think it is important to understand about
the key for proving test in this country from other countries.
They can go ahead and apply through the FDA and get
registration and be dispersed.
Obviously, one of the reasons we developed the test that we
developed was to try to make it as available as rapidly to the
American public health. So, I would defer that question to the
Commissioner at what the exact hoops are for the foreign
companies to get their test approved.
Mr. Khanna. Do you think we need to look at streamlining
these types of crisis approval for things like WHO testing,
which 60 other countries are using or there are stories in the
New York Times about how leading scientists have come up with
tests in Seattle that weren't approved. I mean is there has got
to be a better way of getting these tests out there.
Dr. Redfield. I will say that when this was recognized when
I was practicing in the Army, I could develop a test and then
use it in clinical medicine. Somehow between then and now there
was not regulatory discretion for us to do laboratory developed
tests. The Commissioner did though, I think it was on February
29, issue regulatory discretion. So, the University of
Washington or say Columbia could actually develop their own
tests and actually use it, rather than have to file what we
call an emergency use authorization. They could start using
their test and file that 15 days later.
Mr. Khanna. Let me ask one final question. I genuinely
believe that we have the most brilliant scientists and
entrepreneurs in the world in the United States, and the
question is if we want to come up with an antiviral treatment,
vaccine treatment, what it is--and I want both Dr. Fauci and
Dr. Redfield to answer. What is it more that you need from
Congress? Because no one cares about us lecturing people. No
one cares about what we have to do. What are the resources that
you need so the scientists and the technology and the
entrepreneurs can solve this?
Dr. Fauci. From the NIH standpoint, it is the consistency
of funding which thankfully you have been able to do. You go
back to 1998 to 2003, you doubled the NIH budget. Then we went
through a very, very flat long period of time which actually
was very difficult because it discouraged young investigators
from getting involved. For the last few years, we have had a
good consistent increase. What you can do is to continue to
give the kind of investment in medical research that is
consistent and predictable.
Dr. Redfield. I would say first and foremost, the most
important thing that you already have done is the establishment
of the rapid response fund. You know, prior to that, we would
have to go to our foundation, and ask them to raise money for
us to respond to an emergency. The more flexibility you can do,
enabling CDC to have a rapid infectious disease response fund,
I think is really one of the most important tools we have right
now. And you all have started to do that already and we are
very thankful.
Chairwoman Maloney. So, thank you for that important point.
The gentleman's time has expired, and let me intervene here. I
have been told that our witnesses need to leave now. I don't
know what is going on at the White House. The White House is
telling reporters that this meeting is not an emergency. They
are saying it was scheduled yesterday. However, that is not
what your staff has told us.
Your staff said the White House did not tell them about
this sudden meeting until this morning, right before our
hearing. There seems to be a great deal of confusion and a lack
of coordination at the White House. I hope this does not
reflect on the broader response to this crisis. We have asked
your staff if you can come back and resume this hearing at 2
p.m. after your meeting at the White House. They have not
responded to our request.
And I am not going to adjourn this hearing. I am going to
recess it. We haven't even gotten through half of our members,
either side--excuse me. I will finish in a second. You haven't
even gotten through half of our members. We will continue to
work with your staff to have you back to finish the hearing and
answer the rest of the questions from our members.
Finally, let me close with this, this Committee sent you a
request for information a week ago. We asked for basic
information about the crisis and your plans for the response,
but you have not provided us with anything. We understand that
you are incredibly busy but a lot of this information should be
at your fingertips.
We need this information because we keep getting sometimes
misinformation from the White House and we have an independent
obligation to the American people. So, I have one last
question, will you commit to producing the information we
requested at least regarding testing, Dr. Fauci?
Dr. Fauci. Madam Chairperson, I am not sure what
information referring to that we did not provide. Are you
talking about the National Institute of Allergy and Infectious
Diseases?
Chairwoman Maloney. We sent a letter with all the
Subcommittee chairs and myself requesting information to every
Department, yours, the CDC, FDA.
Dr. Fauci. I will check this immediately after to find out
what the issue is.
Chairwoman Maloney. Thank you. Thank you very much.
Mr. Roy. Madam Chairman, may I interject you for one
second. I have got timely issue. I know you all need to go down
to the White House----
Ms. Schultz. Madam Chair, I do as well. I have a very
specific District related question. There are people in
danger----
Mr. Roy. Madam Chair, I just--I have got the floor here----
Chairwoman Maloney. Please, please, we will yield to the
ranking member and then to the gentlelady from Florida for the
last question--regular order. We are going to go to a recess
after I recognize the ranking member for his closing statement.
Mr. Roy. Well, I appreciate the Chairwoman. We all
recognize the importance of what is going on here. And I think
it is important to have level heads about what is happening and
that we want to make sure that you guys can go do your work but
it is important that you come back. It is extremely important
that you come back. We do have urgent questions.
I believe that the gentlelady from Florida has extreme
concerns of urgency to the people that she represents. I can
tell you that I do representing San Antonio. I sent a letter,
Dr. Rauch, to the Department of Defense two and a half weeks
ago and I have not received a response because I am troubled
about the lack of response from the Department of Defense in
helping us deal with the fact that we have people who have
tested positive who are being held at an Air Force base in San
Antonio and we don't have a plan on what to do with them.
I want answers to these questions and I want to be able to
have you all respond to those questions when we come back. And
I hope that will be this afternoon regardless of whatever is
needs to be discussed at the other end of Pennsylvania Avenue.
I think there are very serious concerns that some of us
want to have addressed and I think that right now we have got
380 evacuees heading to a base in San Antonio yet I have got an
email right here from city council mayor and leadership in San
Antonio saying they don't have adequate plans on what to do
with those who have tested positive.
So, I expect you all to come back down here today in
accordance with what the Chair is asking so that we can have
those questions answered. Thank you.
Chairwoman Maloney. Well, responding to the ranking member,
will you all be back at 2 p.m. today?
Dr. Fauci. We are going to have to see--the reason I am
saying that, Madame Chairperson, is that we have a Task Force
meeting at--what time is it? We have a task force meeting at
3:30 p.m. in the White House. I will get myself down here at 2
p.m. if you would like me down here, but I would have to be at
the Task Force meeting at 3:30 p.m. in the White House. I don't
know how we are going to work that.
Chairwoman Maloney. We will continue discussion. We will
stand at recess so that you can get to this meeting. We are in
recess. Thank you.
[Recess.]
Chairwoman Maloney. The Committee will come to order. I
want to thank some of our witnesses, Dr. Kadlec, Dr. Rauch, and
Mr. Currie for coming back. We are deeply appreciative for your
time and your service. I have an update on our scheduling.
Before I do that, I want to point out two critical
developments just since we recessed this morning. First, the
World Health Organization has now officially declared the
Coronavirus outbreak to be a pandemic.
Second, the number of confirmed cases has skyrocketed to
938. Just four days ago, it was 164. That is more than fivefold
increase just this week. In terms of resuming our hearing
today, we have been informed that Dr. Fauci and Dr. Redfield
have been unavoidably detained at the White House. We don't
know what is going on, but they cannot come back.
As a result, we will resume this hearing tomorrow,
Thursday, at 11 a.m. We have been informed by the agencies they
will all be here and we hope to have enough time to finish all
of our members' questioning. Therefore, the Committee will
stand in recess until 11 a.m. tomorrow.
[Whereupon, at 2:43 p.m., the committee recessed, to
reconvene at 11 a.m., Thursday, March 12, 2020.]
CORONAVIRUS PREPAREDNESS
AND RESPONSE
(Day 2)
----------
Thursday, March 12, 2020
House of Representatives
Committee on Oversight and Reform
Washington, DC.
The committee met, pursuant to notice, at 11:05 a.m., in
room 2154, Rayburn House Office Building, Hon. Carolyn B.
Maloney
[chairwoman of the committee] presiding.
Present: Representatives Maloney, Norton, Clay, Wasserman
Schultz, Sarbanes, Welch, Kelly, Plaskett, Pressley, Gomez,
Tlaib, Porter, Haaland, Jordan, Higgins, Norman, Roy, Green,
and Keller.
Chairwoman Maloney. The committee will come to order. I
thank all of our witnesses for returning this morning. We
appreciate the recognition of our interest and our oversight
responsibilities.
This is a crisis that is evolving quickly. Since our
hearing yesterday, the World Health Organization declared the
coronavirus outbreak a global pandemic.
CDC has now reported that we have almost 1,000 confirmed
cases. That is up from 100 reported cases a week ago, a 900
percent increase.
Americans are worried. They are scared. It is essential
that we are able to hear directly from the health officials
leading this effort with just the facts.
I am going to go to the Republican side first, which is
where we left off. Before I do that, without objection, the
following three letters we sent on March 3 to HHS and CDC
requesting basic information including about testing are
entered into the record.
Chairwoman Maloney. We have not gotten any response to
those letters and, with that, I recognize Mr. Higgins.
Mr. Higgins. Thank you, Madam Chair.
Dr. Fauci, gentlemen, thank you for returning today and let
me ask Dr. Fauci, do you lead the Executives Task Force
regarding our Nation's response to coronavirus?
Dr. Fauci. No, I don't, sir.
Mr. Higgins. Your status is what on the task force?
Dr. Fauci. No, I don't--I don't lead the task force. The
task force is led by the vice president of the United States--
--
Mr. Higgins. Yes. Understood. But you are the lead
scientist is my question.
Dr. Fauci. We have several scientists. We have myself. Dr.
Redfield. We have Dr. Burkes. We have Dr. Kadlec. We have
several scientists.
Mr. Higgins. Right. The scientists I have spoken with in
committee see you as the lead man and I believe most of America
does, and we greatly respect you and these gentlemen being here
today.
However, let me clarify for America watching that according
to the rules of this committee, members have the opportunity to
submit our questions in writing, and given the nature of this
challenge and the president's announcements of last night, with
all due respect, Madam Chair, I believe that this hearing
should have been canceled or postponed and these gentlemen
should be able to go and do their work. There is a time--there
is a time in battle when you need your front-line men on the
front line, not in the rear with the gear.
And these gentlemen showed us great respect to be here
today, and the oversight role is incredibly important. But you
gentleman have work to do. I will be submitting my questions in
writing and my office will publish those questions and your
answers in a press release at a later date.
Madam Chair, I urge you to consider adjourning this hearing
and I yield the balance of my time to the ranking member.
Mr. Jordan. I thank the gentleman for yielding.
I would now yield to the--if it is appropriate the chair
would yield to the gentleman from Tennessee, Mr. Green.
Mr. Green. Thank you, Mr. Ranking Member and Mr. Higgins.
My first question is for Mr. Kadlec. I want to talk a
little bit about PPE, if I could, and a concern about liability
and the liability protections that might be very important for,
you know, the fact that this is such a catastrophic event and
we are--we are pushing to the extreme our stocks on PPE.
If you could comment about that and, specifically, the
liability issues.
Dr. Kadlec. Yes, sir. You are correct that there is a great
demand for personal protective equipment, particularly
respirators--N95 respirators. There--we have a limited supply
in our Strategic National Stockpile.
Annually, about 350 million respirators are used. Only a
small percentage of that is used by the health care industry,
about 35 million, and we believe that the demand for that could
be several hundred million to up to a billion in a six-month
period. So, it is a very high demand item.
There has been a strategy to basically, and CDC had
provided guidance on reuse--how can we use them longer. We have
gone to the manufacturers in how they can surge more and many
of them are doing that, and domestically, even though some of
their sources for product--finished product--is from overseas
like China.
And then the third thing is is what can we do to basically
use masks that haven't been used for the medical area.
Nonmedical N95s could be used in that fashion, and FDA is
basically certified through an emergency use authorization. The
N95 respirators used in manufacturing and in mining and in
construction could be used in health care settings.
They are very similar but not the same, but could be used
that way. And the only thing that is keeping a lot of
manufacturers from selling those masks to the broader health
care population is because of liability provisions or lack of
liability protections.
There is the Public Readiness Emergency Preparedness Act
that was passed in 2005 that basically indemnifies
manufacturers, distributors, and users of these masks or,
pardon me, of users of products that are defined as a device or
as a covered countermeasure.
When we--so I happened to be on the staff that did that
legislation in 2005. We did not consider a situation like this
today. We thought about vaccines. We thought about
therapeutics.
We never thought about respirators of being our first and
only line of defense for health care workers. So, we think that
is a very important capacity and capability is to include
language or modify the PREP Act to include language to include
respiratory protective devices for that purpose and that is a
significant critical pass now item.
Mr. Green. Thank you very much for that--for that answer.
Dr. Redfield, I had a bunch of constituents ask me after
yesterday's hearing what is the difference between a public
health lab and a commercial health lab?
Now, everybody in this room kind of understands that. But
what you, for the record, and for the folks that are watching
on TV make the clarification between those in the few seconds I
have left?
Dr. Redfield. Thank you very much. We have a series of
public health labs throughout this country whose primary
purpose is to do surveillance to kind of get eyes on what is
going on in the community, and CDC has worked cooperatively
with them.
As you know, about 70 percent of our funding that we get
from you all is then distributed to the state and local,
territory, and tribal health departments, including their
public health labs.
There is also clinical medicine--the practice of clinical
medicine, the private sector, that actually tries to provide
diagnostics so we can diagnose diabetes or anemia, lots of
different diseases and it is really the engagement of the
private sector to get these tests into clinical medicine, which
is--it is a partnership between the private sector. CDC usually
develops the test first, gets it out into the health
departments to do surveillance, and then the private sector
comes in to provide the clinical tools we need to basically
diagnose patients, not the surveillance of a community.
Mr. Green. OK.
Chairwoman Maloney. OK. Thank you.
The gentlelady from Florida, Ms. Wasserman Schultz, is
recognized for five minutes.
Ms. Wasserman Schultz. Thank you, Madam Chair.
Dr. Redfield, yesterday my colleague, Mr. Raskin, asked you
about a nurse in California who was quarantined after treating
a patient with coronavirus and showing symptoms of the disease
herself. She couldn't get tested, if you recall, even though
her local public health department recommended one.
She said this, and I quote, ``The public county officer
called me and verified my symptoms and agreed with testing. But
the national CDC would not initiate testing. They said they
would not test me because if I were wearing the recommended
protective equipment then I wouldn't have the coronavirus.''
Dr. Redfield, when you were asked about this yesterday you
said this, and I quote, ``This is a misunderstanding, if it did
occur.''
You testified that, quote, ``The test was always available
in Atlanta, where CDC is located. If you sent the sample to us
and there was never a time when a health department could not
get a test, they had to send it to Atlanta.''
You claimed that CDC's testing criteria never placed
restrictions on who got tested. Rather, that that was only
guidance and, quote, ``We always left the discretion to do
testing to the local public health group.''
So, the committee staff reached out to National Nurses
United, the union representing this nurse who was not able to
receive a test and they sent us the following statement last
night, and Madame Chair, I ask unanimous consent that this
Statement be entered into the record.
Chairwoman Maloney. So, granted.
Ms. Wasserman Schultz. According to National Nurses United,
``In recent weeks our union has been made aware of multiple
circumstances''--and the statement is up on the screen--
``multiple circumstances in which health care workers have been
exposed to a 0919 infection and have not received COVID-19
tests, despite requests for testing.''
They continue, ``There have been too many cases where
exposed health care workers have been refused testing for this
to be considered a misunderstanding.
Further, members of our union across the country have
reported countless cases in which testing has been refused to
patients when clinicians have recommended it.''
Dr. Redfield, the national union that represents nurses
across this country just issued a statement publicly
contradicting your testimony yesterday before this committee.
So, I ask this question, will you admit that there is a
serious problem in this country with individuals, even health
care workers, obtaining access to testing for coronavirus?
You have to turn your mic on.
Dr. Redfield. Thank you for your question, Congresswoman.
Ms. Wasserman Schultz. You are welcome.
Dr. Redfield. I am going to be looking into this in depth,
as I said yesterday. Clearly, we need to protect the health
care workers on the front lines. In general, these are local
decisions on which health care workers need to be tested and
exposed by the----
Ms. Wasserman Schultz. OK. But these are workers that--
these are people who contacted CDC and it is CDC that they say
turned them down and said that they couldn't be tested.
Dr. Redfield. And I will look into that in detail and get
back to your office in--as soon as I can.
Ms. Wasserman Schultz. Well, as soon as you can, hopefully,
will be today. There are countless more examples of problems
with people getting access to tests all across the country
including in my home state of Florida.
We need to have someone in charge of making sure that as
many people as possible across this country have access to
getting tested as soon as possible.
Who is that person? Is it you? Is it the vice president?
Can you give us the name of who can guarantee that anyone but
especially health care workers who need to be tested can be?
Dr. Redfield. As I tried to explain to Congressman Green,
from the CDC perspective----
Ms. Wasserman Schultz. OK. I am asking for a name. Who is
in charge of making sure that people who need to get tested,
who are indicated to be tested, can get a test? Who?
Dr. Redfield. Yes, I was trying to say that the
responsibility that I have at CDC is to make sure all the
public health labs have it and they can make the judgment on
how they want to use it.
Ms. Wasserman Schultz. But they are referencing people who
have been advised to be tested to you and they have been turned
down. So, is it you?
Dr. Redfield. As I said, I am going to look into the
specifics there for----
Ms. Wasserman Schultz. I know that. So, basically, you are
saying--reclaiming my time. Basically, you seem to be saying,
because you can't name anyone specifically, that there is no
one specifically in charge that we can count on to make sure
that people who need to be tested, health care workers or
anyone else. There is not one person that can ensure that these
tests can be administered. Yes or no?
Dr. Fauci. My colleague is looking at me to answer that.
Here we go.
Ms. Wasserman Schultz. OK.
Dr. Fauci. All right. So----
Ms. Wasserman Schultz. And I do have another question so if
we can kind of get to hear the question.
Dr. Fauci. So, very quickly, the system--the system does
not--is not really geared to what we need right now, what you
are asking for. That is a failing.
Ms. Wasserman Schultz. And--a failing, yes.
Dr. Fauci. It is a failing. Let us admit it. The fact is
the way the system was set up is that the public health
component that Dr.--that Dr. Redfield was talking about was a
system where you put it out there in the public and a physician
asks for it and you get it.
Ms. Wasserman Schultz. OK.
Dr. Fauci. The idea of anybody getting it easily the way
people in other country are doing it we are not set up for
that. Do I think we should be? Yes. But we are not.
Ms. Wasserman Schultz. OK. That is really disturbing, and I
appreciate the information.
Madam Chair, if I can just, quickly, as my other question,
which is the question I wanted to ask yesterday.
We have four--in my home county we have four positive Port
Everglades workers who were tested positive for coronavirus.
These employees, according to our State Department of
Health, likely contracted the virus with interactions with
infected passengers on ships that they were working at the time
during their shift, ships that held--six to eight ships that
likely held upwards of 50,000 passengers.
The people on these ships who were potentially exposed
should have been notified so they could have taken swift steps
to protect themselves and others. They deserve to know that
they had been exposed to someone with the virus.
Yet, when I asked our Department of Health what steps were
being taken to determine who came in contact with these
employees--when I asked the port, the cruise lines yesterday,
the State Department of Health, the department was not
forthcoming, didn't direct the cruise lines to notify the
passengers.
Instead of being forthcoming with me, the public and those
passengers, I couldn't get a straight answer from the
Department of Health and they said that they were going by CDC
guidelines.
So, Mr. Redfield, what--Dr. Redfield, what are the CDC
guidelines for notifying people who have potentially been
exposed to a confirmed coronavirus case and shouldn't
passengers on the relevant ships worked by the Port Everglades
employees who have coronavirus been notified in a timely manner
so they can take precautionary measures? They still haven't
been notified.
Dr. Redfield. Thank you very much, again, for both your
concern and your question. I know you got a chance to speak to
Admiral Rendon I think yesterday about that.
Ms. Wasserman Schultz. Yes.
Dr. Redfield. And CDC last night spoke with the Princess
Cruise staff about this situation. They agreed to send a notice
to all passengers on the ship where the greeters have worked.
We are, obviously, in contact today with the Florida Health
Department.
We would concur that individuals that have been exposed,
particularly in a cruise setting, should be notified. I think
the controversy here, Congressman, is its--I think the state
actually thinks they may have gotten infected in the community.
But I think we should err on the side of concern and get these
passengers notified.
Ms. Wasserman Schultz. The state--respectfully, the State
Department of Health specifically said in the epidemiological
study that they did they had not--these employees had not
traveled internationally, and they had not had contact in the
community with anyone with coronavirus.
So, now days and days have gone by. Thousands of passengers
floated around the ocean with people who had coronavirus likely
on the ship they were on and days and days have gone by with no
notification, no precautions that those--that those passengers
should have taken and they could be out there spreading
coronavirus right now.
And today, to this day, the cruise lines still have not
been notified and urged by any public health entity to notify
their passengers to make sure that they can figure out whether
they have been exposed.
Dr. Redfield. My only comment was after you brought this to
Admiral Rendon's attention we did have that conversation and
the Princess Cruise ships----
Ms. Wasserman Schultz. It is not just Princess. This is
the--this is the----
Chairwoman Maloney. The member's time has expired but the
witness may answer the question.
Ms. Wasserman Schultz. Thank you. Thank you.
Dr. Redfield. I just said that based on that the company
with the cruise ship staff agreed to send a notice to all
passengers that were on a ship in which any of these greeters
worked.
Ms. Wasserman Schultz. Madam Chair, I just want to point
out it was not just Princess Cruise Lines. This is the second
largest cruise port in the world and there is more than just
Princess Cruise Lines that these--that these employees worked.
Dr. Redfield. We will followup to see what the state--that
any ship that had passengers that these individuals could have
exposed will be notified.
Ms. Wasserman Schultz. Thank you, and I deeply appreciate
the members' indulgence.
Chairwoman Maloney. OK. The gentleman from South Carolina,
Mr. Norman, is recognized for the equivalent time.
Mr. Norman. A point of order. Do I get seven minutes?
Chairwoman Maloney. Yes, you do.
Mr. Norman. Thank you so much.
I just want to thank each and every one of you for coming
here. I agree with my--Congressman Higgins that, you know, you
all need to be on the front lines. I admire you for coming in
here.
There is nobody watching across this country that has
listened over the last few days that doesn't recognize you are
doing all you can do. There are certain people, certain groups,
that want to find every fault.
We are in uncharted waters here. You all are drinking not
from a fire hydrant but from a tidal wave. I respect and admire
what you are doing.
So, please know the majority of the country understands why
we weren't aware of--I mean, we didn't--we didn't anticipate
this. You all are handling it and we do appreciate it.
First question, what--I just met with a company, a Fortune
500 company who is looking at testing their employees as they
come in the door and, yet, their concern was, one, frivolous
lawsuits, class action suits by trial lawyers, HIPAA
violations, health--you know, you just can't take temperatures
of people without all type--getting into all type of issues.
What would--for any of you, what would you say for them to
do?
Dr. Redfield. CDC has published our guidance for
businesses. I encourage them--I heard the first day it got over
500,000 downloads. I would like people to really look at that
guidance carefully.
Second, there are complexities, as we already spoke, about
testing--probably most importantly, the number of people who
could actually have this virus and actually have no symptoms.
The other reality is when the test turns positive after you
actually are infected is still a scientific question. I can
defer to Dr. Fauci.
So, at this stage, we really would like to see the tests
provided to those individuals that feel they were exposed in
the clinical setting as we--as we continue to try to expand
that, those individuals that, obviously, are presented with
flu-like symptoms in the hospitals.
Obviously, we want to see the tests used for broader public
health surveillance. I think that is the stage we are in. But I
would like to see if Tony wants to add something.
Dr. Fauci. No, it is. There are two types of situations.
Dr. Redfield described one, which was the classic tried and
true CDC-based situation where it is based on the doctor-
patient interaction where a doctor has a patient who wants to
get tested for cause.
They are sick. They have been exposed or what have you.
That works well. The system right now as it exists of doing a
much broader capability of determining what the penetrance is
in society right now is not operational at all for us. And what
the CDC is doing now is that they are taking various cities--
they started with six and then they are going to expand it--
where they are not going to wait for somebody to ask to get
tested.
They are going to get people who walk into an emergency
room or a clinic with an influenza-like illness and test them
for coronavirus. If you do that on a broader scale throughout
the country, you will start to get a feel for what the
penetrance is and that is a different process.
Unfortunately, our system from the beginning was not set up
to do that and that is the reason why we are not able to answer
the broader questions of how many people in the country are
infected right now. We hope to get there reasonably soon, but
we are not there now.
Mr. Norman. What is your opinion on the question I was
asked by this employer, do I give--do I take the risk of when
you walk in that door with no symptoms, you just see what--
whether it is the temperature or whether it is asking
questions, they are petrified of the--of the outcome if they do
that.
They are also petrified of somebody having the virus when
they walk in the door and then being held liable if they
infect. And this company has 500 employees. They do shifts,
working three shifts. What would you--what is your advice?
Dr. Redfield. You know, at this point, our strongest advice
is that people that are sick need to stay home. Those companies
that are in areas where we are having significant cases, if
they can, you know, telework we are recommending that.
Those companies that are aware with cases we are asking for
social distancing. We are not asking for everybody to come at
the lunch time and sit at the same table. We put out a series
of guidelines.
But what we are not advocating, you know, and, obviously,
individuals that just returned from Italy or France or Germany
we would like them to stay home for 14 days.
But we are not advocating the use of these tests in a broad
way in the absence of a relationship with a physician or public
health official to make that determination.
Mr. Norman. Second question. We have got probably 80 people
in this room. The questions that I am getting asked, what are
the--in this room today, what are the likelihood--I don't know
what who--I don't know who has got what in this room.
Walk me through the likelihood of any one of us in this
room getting the virus, assuming somebody here has the
symptoms.
Dr. Redfield. Again, still the real risk in general right
now--and this is why the president took the action he did last
night--within the world now over 70 percent of the new cases
are linked to Europe and in the United States I think it was
now 30 states in our country--30 of our--30 states or more were
linked actually to cases of Europe.
Europe is the new China and that is why the president made
those statements. Clearly, we can only continue to emphasize
the basics that we have all said about washing your hands,
obviously, staying away from people who are sick, learning how
to cough correctly, don't touch your face, although we all know
it is very complicated, you know, to try to not touch your face
during the day.
But I think it is really important that we also are moving
quickly with broader mitigation strategies based on the virus,
and Tony may want to add to this.
So, some of that is really encouraging social distancing in
the workplace, really encouraging social distancing in
restaurants, really encouraging social distancing at sporting
events.
So, Tony, you want to add?
Dr. Fauci. Yes. So, sir, it is a great question because you
are right, everybody is asking it and the issue is in the
spirit of staying ahead of the game right now we should be
doing things that separate us as best as possible from people
who might be infected and there are ways to do that. You know,
we use the word social distancing, but most people don't know
what that means.
For example, crowds. We just heard that they are going to
limit access to the Capitol. That is a really, really good idea
to do. I know you like to meet and press the flesh with your
constituencies. I think----
Mr. Norman. Not now.
Dr. Fauci. I think you need--I think you need to really
cool it for a while because we should--we should be practicing
mitigation even in areas that don't have a dramatic increase.
I mean, everyone looks to Washington State. They look to
California. They are having an obvious serious problem. But
their problem now may be our problem tomorrow.
So, we have got to act like there is going to be a problem
and that means doing everything you possibly can to do the
guidelines that the CDC puts up which sound very simplistic but
they are really important.
Mr. Norman. Common sense.
Dr. Fauci. Common sense. Yes.
Mr. Norman. Finally, I know when this first became public,
we--I think this country had test kits out in an effort to find
a vaccine to those willing, I guess, to be tested. Where are we
on that?
Dr. Redfield. I want to just sort of stress the complexity
of getting tests, as we have heard from a number of your
colleagues, is not just about having the reagents that CDC
originally made for a test.
You, obviously, need that test kit and we have put out in
the public health system over 75,000. So, the public health
labs have that.
But the public health labs actually have to have the people
to do the test and what is their capacity to do the test. They
have to have the equipment to do the test and what is the
capacity of the equipment they have.
They have to have some of the early reagents that they
need. Not to get too technical, but you got to extract nucleic
acid in order for the test to go into our kit.
So, there is a whole system that we can see that there is
different, you know, limitations as we expand, expand, expand.
CDC--I tried to explain why we used the system we did,
which is, you know, a thermocycler system, which is not a
system that you can do, you know, tens of thousands of tests
very easy. You are really limited at some labs between, say,
20, 50. CDC can do between 300 and 350 a day. OK.
There is other systems that can do, really, thousands, OK,
and those systems are what are coming online with LabCorp and
Quest, and actually New York State, really, recently got
approved to put their system online.
So, I want people to sort of understand that, you know,
that whole--that whole scenario in terms of actually--and then,
you know, one of the great things about LabCorp and Quest
coming in is they already have the distribution system, the
collection system.
So, the more they get into the clinical marketplace the
faster the American public are going to get access to this.
Mr. Norman. Well, I just want to thank you.
And, Madam Chairman, I appreciate you letting me have eight
minutes. Thank you so much. Thank each one of you.
Chairwoman Maloney. I hear--getting some good questions and
good answers.
The gentleman from Vermont, Mr. Welch, is recognized for
five minutes.
Mr. Welch. Thank you very much.
You know, the question for us now is what can we do and how
best do we do it, and if I understand--and this is directed to
Dr. Fauci and Dr. Redfield--is that the two essential things
are testing and the social distancing or quarantine or
separation, keeping us apart from one another, is that more or
less correct?
Dr. Fauci. Yes. I would put the social distancing and other
issues of preventing infection ahead of the testing. But the
testing is very important. Don't get me----
Mr. Welch. All right. And let me go on the testing, because
I heard two different emphasis from each of you.
Dr. Redfield, you were, as I understood it, focusing on the
doctor-patient relationship and the doctor triggering the test
in response to a request from a patient.
Dr. Fauci, what I understood you to be saying is that
surveillance testing is very useful, and we are seeing that
with drive-through testing. Am I correct in describing a
difference?
Dr. Fauci. Yes, there is a difference, but we should be
doing both.
Mr. Welch. Well, that is what I am saying then.
Dr. Fauci. Yes. Right.
Mr. Welch. Do you agree with that, Dr. Redfield?
Dr. Redfield. Yes. The CDC is--you know, we have multiple
surveillance systems for respiratory disease and flu. I think
we have, you know, multiple different systems we use----
Mr. Welch. We don't want to hear about that. We got to----
Dr. Redfield. No, but we are----
Mr. Welch. This is right now with this virus. What----
Dr. Redfield. We are moving----
Mr. Welch. Should we be having our states like Vermont be
doing surveillance testing and figure out how to do that in the
next question?
Dr. Redfield. What I was trying to say is we are now moving
our--the COVID-19 into that system. We started with the six. We
are going to expand jurisdictions. We put----
Mr. Welch. All right. So, yes or no, should we----
Dr. Redfield. Yes.
Mr. Welch [continuing]. In addition to be doing----
Dr. Redfield. Yes.
Mr. Welch [continuing]. The individual testing the
surveillance testing?
Dr. Redfield. We should be doing--we should be doing both.
I agree with Dr. Fauci.
Mr. Welch. OK. So, information, data, is power, correct?
Dr. Fauci. It is critical and that is what I have said, I
think, at the last part of the hearing and now.
Mr. Welch. You did.
Dr. Fauci. The system was geared for the individual doctor-
patient.
Mr. Welch. Right.
Dr. Fauci. What we are going through now transcends that.
We need to do more than that.
Mr. Welch. Right. There is a public health issue. So, a
person who presents has got a problem but it is a problem that,
unfortunately, that individual is going to share with a lot of
other folks indirect.
Dr. Redfield. Yes, and when that individual is confirmed it
triggers the public health response around that individual.
Mr. Welch. Let me keep going. Because one of the things we
have to get here all of us represent folks who are going to be
getting sick.
So, this is a--not a red state blue state type of deal. We
are all in this together and, in fact, if we are not in it
together, we will all get sick together.
So, on this question of travel, which is one of the big
issues, you know, the president is banning travel from a number
of European countries. Does it make sense to exclude a single
country, Great Britain?
Dr. Redfield, is there a medical reason to do that?
Dr. Redfield. We were looking at the extent of new cases in
different areas and the reason that Schengen area, because
there is no borders----
Mr. Welch. I don't have that much time.
Dr. Redfield. OK.
Mr. Welch. I will tell you, I am mystified. If you have a
number of European countries where there is a travel ban I can
accept that if that is a medical recommendation about how to
combat this.
But then you have one country that is singled out for
exemption, even though the cases in that country are higher
than a number of others. How does that medically make sense? I
will ask you, Dr. Fauci.
Dr. Fauci. Well, I will do it quickly, hopefully. So, when
we were looking at the pure public health aspect of it we found
that 70 percent of the new infections were coming from--of the
new infections in the world were coming from Europe, that
cluster of countries, and of the 35 states 30 out of 35 of them
who were more recently getting infections were getting them
from them. That was predominantly from Italy and from France
and from Germany.
Mr. Welch. OK. Thank you.
Dr. Fauci. So, when did this--no, there is an answer to
your question.
Mr. Welch. Go ahead. OK.
Dr. Fauci. So, when the discussion was why don't we just
start off and say banned from Italy, we were told by the State
Department and others that in fact you really can't do that
because it is sort of like one country, the whole European
thing. And the reason I believe that the U.K. was left out was
because there is a difference between----
Mr. Welch. All right.
Dr. Fauci [continuing]. The ease of transportation between
the European countries and the U.K.
Mr. Welch. Well, that is Brexit. Thank you. But let me go
on to my last question.
My understanding is that the best preparation is advanced
preparation. I mean, it turns out we don't have the tests that
we need. There is a lot of confusion about it.
If before this virus hit us, we had those tests in place,
we had systems and backup plans in place, that is where you get
the head start to keep that curve lower.
I am going to ask you, Mr. Currie, as the head of the GAO,
was it helpful in our advanced preparation to have disbanded
the National Security Team Global Health Security and
Biodefense Directorate?
Mr. Currie. No, sir. I don't think it was. I mean, we and
others have recommended for years that there has to be some
sort of central coordinator above the departments and agencies
because the departments and agencies can't tell each other what
to do.
Mr. Welch. All right. I am going to finish.
That is one thing that is on the administration. I don't--
Mr. Roy, I agree with you, but I say we ought to put that back
in place. We got to be prepared in advance and I hope we could
work together to do that.
I yield back.
Chairwoman Maloney. Gentleman's time has expired.
And the gentleman from Texas, Mr. Roy is recognized.
Mr. Roy. I thank the gentlelady.
If I might reserve my time for a minute. I do want to make
one observation, that--first of all I want to thank the chair.
I think it is important that the witnesses come back today, and
I would respectfully disagree with my colleague from Louisiana.
I think it is important that we hear this because you have
got 435 Members of Congress who, importantly, have to go home
and explain to our constituents what is going on.
So, I think this is very important that we have this
hearing and continue to have it and thank the gentlemen for
being here to do that.
And second, I would observe that when we have these six-and
seven-minute intervals, the gentlelady from Florida was able to
explore the questions long enough to get responses and to have
a back and forth and I think these--that is important.
I think we ought to have that kind of a dialog instead of
we get these short increments and we are firing away in order
to get our camera time and ask our questions.
So, I appreciate having that flexibility. I think that is a
good thing is all I am saying to the chair and I appreciate it.
Chairwoman Maloney. OK. Thank you.
Mr. Roy. Back to--so on my time I would say, first of all,
thank you to Dr. Kadlec, Dr. Rauch. Thank you for your time
yesterday. You addressed the issue that we were dealing with in
San Antonio. I think that is a good example of how the
administration can respond and deal with these kinds of issues
and I appreciate you doing that. We resolved that. Thank you.
Or at least I think we have.
Second, our job as leaders is to present, in my view, calm,
resolve, focus on the facts, and to go through this so that--so
that the American people know that we are on top of this. And I
believe that we are on top of this, but we are trying to move
forward positively.
I think we need to--we know now we need to minimize social
engagement while, importantly, maintaining commercial activity.
Our lives depend on vibrant commercial activity. So, we have a
responsibility to talk about this in a rational and sane way so
that we maintain commerce, the very commerce that will save
lives, the very commerce that will allow us to be able to
produce wealth and opportunity and create jobs and be able to
pay for things while having the kind of social distancing that
the gentlemen are referring to. We have got to come up with
ways to do that.
Last night, I spoke on the phone with Dr. Shuren at the FDA
and got some updates on some of the testing information because
I wanted to talk to somebody at the FDA, and my understanding
in response from them--and he is not here to testify, so I want
to validate this--was that he talked about upwards of 2 million
tests--those aren't individual test kits but the ability to
test 2 million times were coming to availability this week, 3
million more in the next week and that we have got a rather
large and robust testing ability coming to market shortly, that
we have got private enterprises producing these tests.
We have got universities, state public officials that have
the ability to test and that we are now getting to the place of
scalability to ramp up and have a fairly sizable large amount
of testing ability in our robust Federal system.
Would you agree, Dr. Redfield, that that is the trajectory
of where we are headed?
Dr. Redfield. Since March 2, there has been, I have been
told, over 4 million tests now to have entered the market. But
what I want to say the test isn't the whole answer.
Mr. Roy. Right.
Dr. Redfield. You need people to do the tests, laboratory
equipment to do the test. You need some of the reagents that
actually now are in short supply to prepare the test. You need
the swabs to take the test.
So, we are working very hard with the FDA to make sure all
these different pieces--you know, right now the actual test to
do this coronavirus test I think we have the test in the
marketplace.
The question is how do you--how to actually operationalize
them and I think that is what Tony and I are saying is the big
challenge right now.
Mr. Roy. Well, and I appreciate that because that goes to
the heart of--there is a lot of rhetoric flying around both
sides of the aisle, all over the place, about tests, test kits,
testing, and what we can do.
We have a significant amount of scalability in this country
that we have got to leverage for our benefit but also recognize
we have 330 million people. That is compared to 50 million in
South Korea.
We have different--we have a Federal system. We have
states. We have to navigate through that, and we need to make
sure that we have the right tests and the tests are effective.
There are some questions, as I talked last night, about
whether the Korean test was as effective as we might prefer.
There is some debate about that.
So, is that a fair statement about making sure that we are
working through to make sure we have got the right tests while
we are working to make sure we have got all the materials, by
the way, remembering that we have got supply chain issues we
have got to deal with, given the worldwide connection and the
supply chain.
Dr. Redfield. Yes. A critical regulatory role that the FDA
really holds, which is important that we have tests that
actually work, and we actually can be assured of that.
I can tell you that the tests that are currently being put
out both by--to the public health labs and by LabCorp and the
private labs they actually work.
The challenge is really, and this is what I want to really
emphasize, we focus so much on the actual kit of the test.
Mr. Roy. Right.
Dr. Redfield. We have to focus now on the whole--the whole
system to get that testing really rolled out both for
surveillance, which is CDC's main job, and to clinical
medicine.
Mr. Roy. That assertion was made a little bit earlier or a
question was raised about who is in charge, right. One of the
difficulties of a Federal republic like ours, right, is that
there isn't one person in charge of making all of this happen,
right.
But isn't that also--you know, some people might say that
is a bug versus a feature. Some might argue that it is a
feature with 50 laboratories of democracy, with 50 states and
universities and labs being able to produce different ways of
coming up with testing and navigating this and our markets
being able to scale up and produce that that is something,
again, keeping in mind that the American people are listening
and that we are trying to explain how this system works, that
there isn't a singular top-down approach in our country to
doing this.
But that is the same America that has, you know, stomped
out Nazism, that has put a man on the Moon, that has cured
polio, that has gone through and done the things that were
reacted in 9/11, built and rebuilt southern Manhattan, that
this is the America that rises up to deal with these kind of
solutions and I think it is important that we talk about that
in its complexity and its wholeness.
Dr. Redfield. I would like to make one comment because Bob
Kadlec is here, and he is in charge of our overall what we call
incidence management structure. Maybe he would like to comment.
Mr. Roy. I would appreciate that, Dr. Kadlec.
Dr. Kadlec. Well, thank you, sir, and thank you, Dr.
Redfield.
Very simply, given the nature of our system and
particularly the Federal Government where there are health
components across the domain, Department of Defense, VA,
Department of Homeland Security, the responsibilities fall to
my position to basically manage and integrate and synchronize
those efforts so we can kind of come with a unified response
most importantly to support state and local authorities in
disasters.
Mr. Roy. Right. Thank you, Dr. Kadlec.
Madam Chair, I appreciate it.
Chairwoman Maloney. Thank you. Thank you.
The gentlewoman from Illinois, Ms. Kelly, is recognized.
Ms. Kelly. Thank you, Madam Chair, and thank all of you for
being here. I know you have been working very hard, and I have
seen you multiple times myself.
I am the chair of the congressional Black Caucus Health
Braintrust and also my district is urban, suburban, and rural.
When I hear you talk about there is 30 states that have been
affected so far but within those states do you see it more
urban or is it a mixture?
And I know--and I am talking about the people that have it
by no obvious means, not the people that were in Italy and
where they go back to live, but just the people that are
getting it by not an obvious means.
Dr. Redfield. Yes. Just for clarification, when Tony and I
were mentioning the 30 out of 35, it was really at a time for
the analysis that comes from Europe. As of this morning now we
have 44 states and the District of Columbia that have reported
at least one case.
And I will say that I am not going to comment in the
distribution. I can get that exact information for you. But it
is--you know, we are seeing more and more jurisdictions report
their initial case across the country now.
I think this is one of the big reasons why the president
made the decision. We need to use our efforts right now to
really continue to try to contain this outbreak with the cases
we have and let the public health system focus on that around
those clusters, do aggressive mitigation.
But if we continue to have individuals coming in that seed
new communities all through the country, it will be very hard
for us to get control of this and that is why this is sort of
an integrated multi-layered public health approach right now.
But don't underestimate the importance of our local public
health system to do their public health job. It still is
something we shouldn't give up on.
Ms. Kelly. Yes. Well, I won't, but my concern also is in
underserved communities. They have a lack of access to, you
know, some of the public health or health care.
Dr. Redfield. I will say it is our concern, too. I mean, we
are trying to look at strategies now for homeless populations.
We really are concerned for really all of America.
Ms. Kelly. Mm-hmm. The other thing is, a doctor I know told
me that she received a fax and the fax said that she could--I
am trying to think for her exact words--work around or go
around the CDC and get tests herself and swab the nose like you
talked about, and then Quest Lab would pick up the test.
Is that correct? She is in New Jersey.
Dr. Redfield. Yes, that is correct. Getting the--again, the
spirit of America. When the vice president met with all of the
major diagnostic companies they didn't come there as individual
companies.
They said, we are in this together. How can we step up. And
they are all moving up, Quest and LabCorp being the biggest.
They are all--they are activated their entire system and they
are beginning to phase those tests in.
The real kick will come when they are able to transfer the
platform from the platform that we developed to what we call
this high through-put platform which I am told should happen
soon.
They are working hard to validate that with the FDA so they
can go to the high through-put platform, like New York State
was validated yesterday, Chairwoman. So, they are up and
running with the high through-put platform now.
Ms. Kelly. And then also quarantine is for those exposed
but not yet sick. But if someone in quarantine gets sick do you
switch them to isolation onsite or move them to a private
hospital? What happens?
Dr. Redfield. Yes. If they do get sick and then we--of
course, someone's in self-isolation or self-quarantine at home,
they are being monitored for symptoms, if they--if they do
become symptomatic they get a comprehensive medical evaluation
and then, obviously, either return to home isolation if that is
the medical appropriate decision for them--that it is just a
sore throat--or if they look like they need medical attention
they are going to get hospitalized and managed in isolation.
Ms. Kelly. And then how are those costs covered for a
private hospital? Does CDC cover their out-of-pocket cost or
how does that work?
Dr. Redfield. Well, the department has the authority to
reimburse those, OK. CDC has the authority. The department has
authority. The department--we are working now to determine the
best way to accomplish that.
Ms. Kelly. And have you--maybe someone asked you this--
looked over the legislation that we will be considering today?
Have you?
Dr. Redfield. I haven't seen the legislation.
Ms. Kelly. OK. Thank you. I yield back.
Chairwoman Maloney. Thank you.
The gentleman from Pennsylvania, Mr. Keller, is recognized
for five minutes.
Mr. Keller. Thank you, Madam Chair, and thank you to the
panel for being here again today.
I know there has been a lot of things that have happened
and we have actually been trying to--I know we did the
supplemental appropriation and made the funds available, also
communicating with many Federal and state agencies to make sure
we get information out to our constituents.
So, that is a lot of what we have done. Even this morning
had a couple briefing, a bipartisan briefing in the Capitol
Visitors Center, also on the phone with the White House and
some other--some other people.
In addition to that, in Pennsylvania our secretary
general--physician general, excuse me--Physician General of the
Commonwealth, Dr. Rachel Levine, actually had a call with all
members of our delegation and members of the Pennsylvania
General Assembly to go over what the Wolf administration is
doing.
So, there has been a lot of activity as far as what I have
seen trying to make sure people are informed. I know we talk
about social distancing. So, maybe I can just cover that
because I know one of my colleagues had a question about that,
too.
You mentioned social distancing. But what does that mean
for--I know we talked about a lot of sporting events and
schools, but are there any other private events where people
might want to think about social distancing and what might
those places be?
Dr. Redfield. I will have Tony add. But we are giving out
guidance in terms of the size of events that should happen, you
know, and really discouraging people from having large events.
Now, it is different in different communities by the
kinetics of the outbreak right now. I mean, we are looking at
each community to develop it. That is why we put our matrix out
there. Social distancing is we want people to stay six feet
away or more.
Mr. Keller. OK.
Dr. Redfield. So, if you--if you can have an event and keep
people outside and they can stand 10 feet away from each other,
you know, that is how we refer to social distancing.
But you see--we really are, you know, in a mode that this
is time for big events like March Madness, big events like
these big sports arena things to take a pause for the next four
to six to eight weeks while we see what happens with this
outbreak in this Nation.
Mr. Keller. OK. Thank you.
And, again, I am going to reference back what the physician
general had said so far because I know there has been a lot of
questions about testing and Dr. Levine said so far in
Pennsylvania in every case where a doctor deemed a COVID-19
test to be medically necessary that test was performed.
So, that is according to Dr. Rachel Levine. She later went
on to say that the state has the capacity to do the number of
tests per day that they need to or that they can do their
capacity and mentioned actually LabCorp and Quest Diagnostics
are now able to provide the tests in Pennsylvania.
These companies will report any positive results to the
state and they will be made public. So, it appears like
Pennsylvania--you know, the fifth largest state by population
in the Nation and the world's eighteenth largest economy--has
sort of figured this out because she goes on to say, we will
meet the--we will meet the demand for testing and we are
following the guidelines to do that.
So, Pennsylvania is able to do that. What things might have
happened in Pennsylvania that we could put in place in other
parts of the country if they are having trouble with testing?
Dr. Redfield. Thank you, Congressman.
I think the big issue is just effective communication
because, you know, Quest and LabCorp is really in all of the
states in the country.
Moving forward, we have gotten--all the public health labs
have gotten the resources from CDC. I was told by the head of
the American Public Health Labs in the last 24 hours that he
has gone through all the public health labs and not a single
lab lacks the kit, the reagents, the capacity to do testing
right now.
So, I do think a lot of it is just effective communication.
Mr. Keller. Well, it seems--it seems like Dr. Levine and
the people of the Pennsylvania Department of Health seem to be
headed in the right path. So, I am glad for that and I am
just--I am just hopeful that we can replicate that.
Dr. Redfield. I would just like to add my congratulations
to them. I mean, I know Rachel well. They are a very serious
health department and they have stepped up.
Mr. Keller. Thank you.
Dr. Fauci, what can we do as Congress to continue to work
with the Trump administration and state health agencies to
ensure that the public health experts and private sector health
care providers have what they need to continue to respond to
COVID-19?
Dr. Fauci. I believe you have already done that in--to a
big extent by the supplement that you have done, the $8.3
billion supplement, which really allowed us to do the kinds of
things. Each of us are responsible for different aspects of the
response.
I know, speaking for myself and my agency, the NIH, the
amount that we got from that supplement--that we will get from
that supplement--will allow us to really accelerate what we
have done in the arena of therapy as well as the development
and acceleration of vaccines.
So, I want to thank you for that. That is probably the most
important thing.
The other thing I think is important is what you are doing
right now to have the opportunity to come before you within
reasonable--now, I don't want to come every day but to come
enough to be able to really get the American public to really
hear from us because this is an evolving situation. It is not
static. It is not one off and you are done. It is going to just
evolve over the next several weeks.
Dr. Redfield. I just want to add one point. It has been so
important. CDC just announced that we are going to award over
$560 million to the front lines of this response. That is the
local, state, and territory health departments.
Mr. Keller. Thank you.
Chairwoman Maloney. Does the gentleman yield back?
Mr. Keller. I yield back.
Chairwoman Maloney. Thank you.
The gentlelady from the Virgin Islands, Ms. Plaskett, is
recognized for five minutes for her--such time as you may
consume.
Ms. Plaskett. Thank you. Well, let us not do that. I could
talk for a long time.
But thank you very much, Madam Chair, and I want to thank
you gentlemen. I was there at the briefing that you had this
morning. I know that you went over to the Senate. You were here
yesterday, and you have come back. And so your openness is
really appreciated and the information that you are sharing
with us that we will get out to the American people to try and
make sure that the right information is there.
One of the things that I just want to mention that I am
concerned about is as we are doing this containment and we
close schools, there is a digital divide in this country where
young people will have issues with keeping up with work.
In some of the areas, the urban areas that my colleague,
Ms. Kelly, was talking about, in the Virgin Islands we have the
highest broadband capacity in the United States outside of New
York City but the lowest rate of connectivity to homes. And so
these are the things that I think we also need to be concerned
about.
We are looking at supporting economies but just our
children alone as well as the issues of health and nutrition
that I think many kids will face if they are restricted from
going to school when so many of them rely on school lunches and
breakfasts for their nutrition.
But I wanted to ask you about isolated areas like the
Virgin Islands. We are concerned right now. We have an
individual of interest that has been isolated. But, like
ourselves and Puerto Rico--like Puerto Rico is like us--we have
not fully recovered from the hurricanes of 2017.
We have seven hospital beds available between the two
hospitals for a population of over 100,000. That is very
troublesome as to what is going to happen to us. So, I am glad
that you said, Dr. Redfield, that you have the funds, you
believe, in place now to do a response.
Can you tell me, one, in terms of personnel what--Dr.
Kadlec, I think you would be the appropriate person. How do we
get these out? How do you get your personnel out? Because along
with the shortage of beds we also have a shortage of personnel.
Dr. Kadlec. Thank you, ma'am, for the questions. I mean,
there are two elements to our ability to response to these
kinds of scenarios and one is through our National Disaster
Medical--Disaster Medical Assistant Teams, or DMATs, and those
are intermittent Federal employees who work across the Nation
at some of the premier hospitals and medical institutions
around the country--Mass General, Stanford, the like.
And so, obviously, in a scenario when there is a potential
event of this nature where it can happen anywhere and
everywhere in the country, we have to be very selective in how
we do that and we have been deploying those assets to respond
to events.
So, that is one part of it. The other part of it is with
the Public Health Commission Corps, who are a vital member of
our, if you will, team. They belong to the assistant secretary
for health. There are several thousand of them.
I think the intent of Admiral Giroir, though he is not here
today, is to expand their expeditionary role to serve in these
kinds of capacities.
Today as we speak in Seattle in the nursing home that is
being afflicted by the COVID virus, there are almost two dozen
Public Health Commission Corps officers that are working to
assist health care workers there.
Ms. Plaskett. So, now, are you able to bring people to
locations that are in need and how do you prioritize what those
locations are?
Dr. Kadlec. Well, obviously, it is going to be based on the
need and based on what the capabilities are domestically or in
that area.
So, based on our conversation before this hearing, I have
already contacted my principal deputy about your situation and
our intent to find ways that we can augment or support what is
needed for your constituents.
Ms. Plaskett. Great.
Mr. Currie. Ms. Plaskett, can I mention something really
quick?
Ms. Plaskett. Yes, please. Mr. Currie?
Mr. Currie. Sorry, I can't help myself because I do work on
disaster recovery for FEMA and I have been to the Virgin
Islands after Hurricane Irma. And I would suggest that you talk
to FEMA as well because, you know, they do have an open--still
an open disaster declaration on the island. You know, I have
been to the hospital in St. Croix. I know it is destroyed. I
know they have a temporary hospital. So----
Ms. Plaskett. Well, we don't have a temporary hospital. It
has been approved.
Mr. Currie. Not yet. Right.
Ms. Plaskett. Two years later.
Mr. Currie. So, I suggest you contact FEMA because they
have a lot of people on the ground there and in Puerto Rico----
Ms. Plaskett. Sure.
Mr. Currie [continuing]. And check with them on what they
can do under the--under the umbrella of the current recovery.
Ms. Plaskett. Sure. I mean, I have found that FEMA has been
great in disaster initial recovery, but the aftermath and
rebuilding is a little slower. The fact that we still two years
later do not have our mobile unit for a hospital shows that
there are gaps in FEMA as well.
So, I do understand. You know, there is a question of
should all of these kinds of things--is this a disaster and
should this be all within one umbrella so that we are not
talking to disparate agencies at the same time. But I agree
with you and I believe our Governor is having that discussion.
The other thing I wanted to bring up very quickly is cruise
ships, and you talk about containment. We know that individuals
coming off of a cruise ship cannot be tested immediately.
So, when you have individuals who--places like the Virgin
Islands which rely heavily on tourist populations, what is your
advice to us in terms of ensuring that we contain ourselves so
that we do not have a spread of this?
Dr. Kadlec. Well, ma'am, one thing that is ongoing is that
the cruise industry is trying to advance what would be healthy
kind of practices for their own--for their own cruise ships so
they can monitor people.
Naturally, they have submitted a proposal to the U.S.
Government kind of outlining what their approach is. I think
one of the things they include there is actually monitoring,
doing surveillance of their passengers, being able to do
testing of their passengers on the boat, having medical
referral capacity to medivac them if they have to and even
having quarantine capabilities.
So, that is an ongoing dialog between the cruise industry
and the U.S. Government. So, I think it is--they see it as an
important responsibility to their customers and to their
passengers and we agree as well.
Ms. Plaskett. Mr.--Dr. Redfield, did you want to add
something?
Dr. Redfield. Well, we have definitely put out our guidance
that we are strongly advising individuals with serious medical
conditions, especially the elderly, that they should reconsider
all cruise travel at this point.
Ms. Plaskett. Now, that supports the passengers that are
there from being infected by others. But what about those who
are passengers infecting individuals when they come off of the
cruise ship?
Dr. Redfield. So, again, this is why it is so important--
the surveillance. As we know, there is, I think, 12 cruise
ships across the world right now that have been looked at for
potential COVID-19.
As Dr. Kadlec said, there is very active discussions right
now going on to what decisions should be made about the cruise
industry at this time.
Tony, I don't know if you want to add anything.
Dr. Fauci. There was a meeting with the cruise ship
executives, the CEOs, to tell them they really got to come
forth with a plan to tighten up the protection of people who go
on as well as what happens when they go off.
So, that is--that is--they have been given the mandate to
fix it and if they don't fix it then they are going to maybe
get some regulations that they don't like.
Ms. Plaskett. Thank you. Thank you very much.
I yield back.
Chairwoman Maloney. The gentlewoman from Massachusetts, Ms.
Pressley, is recognized.
Ms. Pressley. Thank you--thank you, Madam Chair, and thank
you to our esteemed witnesses for returning to day.
You know, since the beginning of the COVID-19 outbreak we
have seen not only the spreading of the virus but also a rapid
spreading of racism and xenophobia. We have witnessed at the
highest levels, in fact, of the Republican Party fanning
irresponsibly these flames. One colleague tweeted that
``Everything you need to know about the Chinese coronavirus,''
unquote.
My district is home to nearly 32 percent foreign-born
residents with more than a quarter immigrating from Asia. This
painful rhetoric has consequences. Restaurants across Boston's
Chinatown have seen up to an 80 percent drop in business and I
believe this has everything to do with the rapid spread of
misinformation and paranoia.
It is critical that we stand against these inciteful
messages and assuage fear in our communities, and we do that by
dispelling untruths and misinformation. We can only do that by
sharing the facts and that is why I am grateful to have you
here today so that we can get to the truth about this virus.
Thirty thousand residents across my district are uninsured
and lack access to health insurance coverage. Many of these
people are low wage hourly workers, food service staff, nursing
aides, hotel workers. A day off from work due to illness could
mean losing a month's worth of groceries.
The CDC's website advises people experiencing symptoms
related to coronavirus to stay home and seek out medical care.
But it doesn't really address the realities of living
uninsured.
Dr. Redfield, if I am a symptomatic hotel worker who is
pre-diabetic, uninsured, and lacks the savings to cover the
cost of testing and treatment, what specific guidance do you
have for me?
Dr. Redfield. A very important question. Obviously, we want
you to be able to stay at home and this, I think--I don't know
exactly where it is, Tony, but I think there is, clearly, a
great recognition of this issue by the White House Task Force
and I don't know where it is in the--as far as it is, you know,
in getting its way to you. But I can tell you, we have
addressed this as a critical public health component.
We need these individuals to be able to do their 14 days at
home and not have to sneak out for an hourly job because they
have to pay for their cost of living. So, I can tell you that
the White House task force is addressing this.
Tony, do you want to add any----
Ms. Pressley. Well, Dr. Redfield, if I might. Will the cost
of testing be covered?
Dr. Redfield. Cost of testing will be covered.
Ms. Pressley. And what about treatment?
Dr. Redfield. Cost of treatment will be covered.
Ms. Pressley. OK. And so--and I appreciate that these
conversations are happening. In terms of information that is
public facing and accessible to the general public, as of this
hearing neither the CDC's portal for coronavirus or its FAQ--
frequently asked questions--page has information about what the
tests cost, who will cover it, and whether uninsured people can
be tested.
And so this has contributed to the confusion and the panic.
So, can you please make a commitment today to add this
information to the website?
Dr. Redfield. We will--we will do our best to clarify.
Related to costs, particularly for LabCorp and Quest, they
haven't really defined it. But they have shown their leadership
in rolling it out independent of that.
But I will get as much information as I can on that website
and keep it updated.
Ms. Pressley. OK. So, I can take that as an affirmative, a
yes. OK.
Dr. Fauci, I am uniquely concerned about people with
autoimmune disorders and those dealing with underlying health
conditions like HIV or lupus.
Briefly, is there any specific guidance for how these
vulnerable groups can protect themselves?
Dr. Fauci. They fall into the--that is a great question,
Ms. Pressley. Thank you for asking it.
They fall into the category of those that I have been
saying multiple times at this hearing and other places--are in
that category that if they get infected likely many of these
people are on immunosuppressant drugs, particularly people with
autoimmune disease, that they need to take extra special
precaution.
In other words, they are vulnerable and they need to help
protect themselves and society needs to help to protect them.
In other words, keep people who are sick away from them.
Keep them even more stringently apart from crowds. Don't
travel unless it is necessary on long trips and, above all,
stay away from cruise ships.
Ms. Pressley. OK. All right.
So, I want to turn to another issue. One group we haven't
heard much about are the 2.3 million people who are in prison
or jail.
Mr. Redfield, about 10 percent of federally incarcerated
people are over the age of 60. Many of these people have
underlying health conditions and, based on your own criteria,
are most at risk for severe complications due to infection from
the coronavirus. These individuals often lack access to
alcohol-based sanitizer, hand soap, warm water, and regular
showers.
Dr. Redfield, yes or no, has the CDC offered guidance to
the Federal Bureau of Prisons about the coronavirus?
Dr. Redfield. Let me get back to you with the specifics of
what we have done. I know we have guidance to the correctional
system in general. But rather than answer or give you a half
answer, let me get back to you and I will do that today.
Ms. Pressley. OK. So, not a yes or a no, unsure----
Dr. Redfield. I just want to be accurate. OK.
Ms. Pressley. OK. All right. So, you know, certainly,
prisons can be incubators for infectious disease and that puts
those in prison at risk as well as those who are employed
there.
What recommendations and protocols has the CDC provided to
Federal, state, and local corrections systems about preventing
or responding to an outbreak?
Dr. Redfield. And, again, Congresswoman, I want to--I will
get back to you today. I want to be accurate with my response.
Ms. Pressley. OK. So, you will get back later today?
Dr. Redfield. I will.
Ms. Pressley. All right. Thank you, Doctor.
And just because the administration has touted and
expressed commitment to criminal justice reform as a priority,
you know, this president has granted less commutations than the
prior administration.
However, with overcrowding the Federal corrections system
is a breeding ground for deadly outbreak.
Dr. Fauci, has the president or any member of the task
force raised clemency power as a method of preventing a
potentially devastating outbreak?
Dr. Fauci. To my knowledge, no. But I--you know, they may
have done it not in my presence but to my knowledge they have
not.
Ms. Pressley. OK. All right. thank you, and I yield.
Chairwoman Maloney. The gentlelady yields back.
The gentleman from Ohio, Ranking Member Jordan, is
recognized for five minutes.
Mr. Jordan. Thank you, Madam----
Chairwoman Maloney.--for as much time as he may consume.
Mr. Jordan. Thank you, Madam Chair. I appreciate our
witnesses being here today. I am going to yield again to Dr.
Green and let him ask some followup.
Mr. Green. Thank you, Mr. Jordan.
I want to make a couple points and then ask some questions.
The first point I wanted to make is on the 2015 Biodefense
Study that was done under the Obama Administration.
The Trump administration has followed that. That
recommended that the vice president be the person in charge of
the task force and President Trump's administration has
followed the recommendations of the Obama Administration on
that and I just want to be clear about that because there has
been some criticism.
On the South Korean tests, we have had a lot of comparisons
of how they have done testing much faster than us. I have a
letter from the FDA that says the South Korean tests--I want to
make sure this is on the record--the South Korean test is not
adequate.
A vendor wanted to purchase it and sell it and use it in
the United States and the FDA said, I am sorry, we will not
even do an emergency use authorization for that test. So, I
have that letter if anybody wants to see it.
Dr. Rauch, I would like to ask you a question about the DOD
and their--as I understand it, they have assessed field
hospital resources. They have their ICU beds and ventilators.
You have got the count. Can you tell us a little bit about what
the DOD is prepared for or has looked into should we exceed
private hospital bed capacity?
Dr. Rauch. Yes, thank you for that--for that question. We
have done a current assessment of our military treatment
facilities. We know the number of beds. We know the amount of
staff per bed.
We know the amount of occupied beds. We know the ICU
capability and we know our alternatives for increasing the
number of beds and increasing the staff for those--for those
beds. We also know the inventory of our personal protective
equipment for the medical force. So, that is for the--that is
for the MTFs.
We also have done an assessment and we know the current
capability--the current status of our military operational
deployable medical assets. So, we have that for ready to
respond--we stand ready, you know, to respond to the commander
in chief's needs.
Mr. Green. As the Nation needs. Thank you.
I want to ask, and I think the question might be best for
Dr. Fauci. You know, we--most of the people on this panel we
are not scientists.
I consider myself to have the equivalent of an orange belt
in this, you know. I know just enough to get myself in trouble.
But, you know, the rapidity, the speed with which you guys have
gotten this vaccine up and, you know, ready to go into stage
one is unprecedented.
It is breaking records and I want you to just brag a little
bit on yourselves. Tell us how hard that is and why we should
all be very grateful for the folks that have put that together.
Dr. Fauci. Well, why don't I just describe what it is
instead of self-congratulating?
[Laughter.]
Mr. Green. OK. That is fine. That is fair.
Dr. Fauci. All right. So, it really is the culmination of a
lot of basic research over the years and we thank the
committee, as always, for the--you know, the kind of support
that Congress has given the NIH, which not only does research
ourselves but funds investigators throughout the country and
the world.
The platform that we use, and we are not--this isn't the
only one. There are more than a handful of vaccines going. But
the ability to use technologies that we never had before to
take the sequence--so the Chinese didn't have to send us the
virus.
They just published the sequence on a public data base. We
knew the gene that would code for the protein that we wanted to
make our vaccine. So, all we did was pull the information right
out of the data base.
We made it--synthesized it very easily overnight, stuck it
into our platform and started making it, and we said at that
point that it would take, I would say, two to three months to
have it in the first human.
I think we are going to do better than that and I would
hope within, you know, a few weeks we may be able to make an
announcement to you all that we have given the first shot to
the first person.
Having said that----
Mr. Green. Wow.
Dr. Fauci [continuing]. I want to make sure people
understand, and I say that over and over and over again, that
doesn't mean we have a vaccine that we could use.
Mr. Green. Right.
Dr. Fauci. We mean it is record time to get it tested. It
is going to take a year to a year and a half to really know if
it works.
Mr. Green. Right. I really did want to be clear on that,
too, and thank you.
If I could ask or make one other quick statement, Madam
Chairman, and I will be very fast.
Chairwoman Maloney. You have got to be fast because we are
being told that they have been--this is their third meeting of
the day and we have to go back to a strict five minutes because
they have to leave soon.
Mr. Green. Real--I will be real quick.
Chairwoman Maloney. OK.
Mr. Green. Over the weekend, the cruise ship--I had a
constituent call. There were meds that she had run out of
because the ship was still at sea. I called HHS.
They found somebody at Coast Guard. They flew that woman's
medications out to the ship. You guys are doing great work.
Thank you very much.
Chairwoman Maloney. Thank you very much. The gentleman
yields back.
And the gentlelady from Michigan, Ms. Tlaib, is recognized
for five minutes.
Ms. Tlaib. Thank you. I am sorry that I am all the way in
the corner here. But I really think this is an important
conversation about the extent and making sure we have access to
information for our residents at home.
You know, earlier this week, Congress's attending physician
told the Senate that he expects between 70 to 150 million
people to eventually contract the coronavirus in the United
States.
Dr. Fauci, is he wrong?
Dr. Fauci. Who was it that said? We have to be----
Ms. Tlaib. It is Congress's attending physician.
Dr. Fauci. Yes. I think we really need to be careful with
those kinds of----
Ms. Tlaib. Sure.
Dr. Fauci [continuing]. Predictions because that is based
on a model. So, what the model is--all models are as good as
the assumptions that you put into the model. So, if you say
that this is going to be the likely percent of individuals----
Ms. Tlaib. So, what can we do to define it? Is it testing?
Dr. Fauci. No. No. It is unpredictable. So, testing now is
not going to tell you how many cases you are going to have.
Ms. Tlaib. Mm-hmm.
Dr. Fauci. What will tell you what you are going to have
will be how you respond to it with containment and mitigation.
So, I just want make a point that I hope the public gets.
When people do models, they say this is the lower level,
this is the higher level, and what the press picks up is the
higher level and they will say you could have as many as.
Remember, the model during the Ebola outbreak said you could
have as many as a million. We didn't have a million. OK.
Ms. Tlaib. Oh, that is great. OK. So, I spoke to federally
accredited clinics in my district and one of the things that
they are noticing is capacity regarding their front line kind
of health care workers and various hospitals that rely on
about--one hospital in my district relies on a thousand
Canadian nurses from Canada that come across.
I think the total for the whole state of Michigan is 3,000.
So, they are very worried about borders being closed and not
getting access to those really front line communities that need
help.
I do want to air it for folks, and this could be a question
to Dr. Kadlec. I am really concerned about this because one of
the federally accredited clinics said, you know, that is her
biggest worry is that folks are not going to be able to come
back to work and what are we doing to prepare those
individuals.
In the meantime, while you do this, I do want to just
submit for the record congressional doctor predicts 70 to 150
million U.S.
Ms. Tlaib. So, and this is important because I think we
need to continue with the sense of urgency and not try--because
the more we do that I think the more important it is that my
colleagues understand the supplemental bill that now is being
told to be hold up for two weeks for help to communities like
ours around the country, is now being held up and politicized
when this is really--there is no R or D next to this
coronavirus.
It needs to be able to move forward so we can--but, Mr.
Kadlec, can you answer the question? Because this is exactly
what I heard from the hospital, two of the hospitals and two of
my federally accredited----
Dr. Kadlec. Well, ma'am, two parts, to deconstruct your
question. One is about the question about whether or not border
crossings would be inhibited, and I would have to refer to the
Department of Homeland Security.
But the other one, there are some work practices that have
to be evaluated. There have been others who have questioned
about whether or not the issues of furloughs are necessary for
people who have been exposed or potentially at risk for
coronavirus and how that works.
I mean, in the state of Washington, for example, there are
health care workers who are actually working. They are
coronavirus positive but asymptomatic and they are continuing
to work on coronavirus patients so that they don't pose a
hazard to someone who is not ill with coronavirus.
So, there are some issues that have to be sorted out there.
But I will have to go back and--for your question about the
border control issue. I would have to make that reference to
DHS.
Ms. Tlaib. Yes, and I will followup as well. I mean, my
last thing is, Dr. Redfield, you know, I think it is really
important for this body and I think both of my colleagues on
both sides of the aisle would want you to commit to providing
the committee the current plan of how many tests that you can
produce right now, what the plan is, whether they are expected
to be ready and how many people they will cover.
And I don't know if you can do that, and make sure you work
with our chairwoman in getting that information to us by the
end of this week.
Dr. Redfield. I can tell you that we are trying to stand up
a national reporting mechanism that is going to put not just
the CDC's test, not just the public health lab tests, but the
LabCorp tests, the Quest tests, and the individual hospital
labs so that we can have a single site where people can say how
many tests have been done, how many tests are positive, and
behind that we are trying to look at least in the public health
system where, you know, what is our current inventory in the
public health system.
And I can, obviously, relate that to my colleagues to see
if there is a way for us to do that in the clinical system.
Ms. Tlaib. Yes. Yes.
Dr. Redfield. But we will have--we will--we have it now,
but it is incomplete because if the states truthfully lag in
their reporting because they are actually trying to do----
Ms. Tlaib. Yes. I don't know if that is a yes or no. But
get us the plan. That would be great. I think one of the
things, too, is, you know, I caution us because we are all so
worried about the commercialized economy stopping.
But we shouldn't be risking our lives for corporate greed.
We should really be taking care of our families. And when we
don't pass a supplemental that has been worked on hard from
front line people of various departments of making sure we
have, you know, people that have to not go to work.
I mean, I am telling you one of my state agencies right now
where you go get your IDs closed down because people didn't
show up to work because they want to make sure they are getting
protection, that they are being able to get access to testing
and all those things, and I think it is really critically
important that we understand that urgency because on the ground
offices are being closed, businesses are being closed right
now, not just large events.
Chairwoman Maloney. OK. OK. Thank you.
The gentlelady from California, Ms. Porter, is recognized
for five minutes.
Ms. Porter. Dr. Kadlec, for someone without insurance, do
you know the out-of-pocket costs of a complete blood count
test?
Dr. Kadlec. No, ma'am. Not immediately.
Ms. Porter. Do you have a ballpark?
Dr. Kadlec. Out of--with a co-pay, ma'am?
Ms. Porter. No, the out-of-pocket. Just the typical cost.
Dr. Kadlec. I do not, ma'am.
Ms. Porter. OK. The CB--a CBC typically costs about $36.
What about the out-of-pocket costs for a complete metabolic
panel?
Dr. Kadlec. Ma'am, I would have to pass on that as well.
Ms. Porter. Do you have any idea? Do you want to take a
ballpark?
Dr. Kadlec. I would say $75.
Ms. Porter. OK, $58.
Dr. Kadlec. Getting closer.
Ms. Porter. How about Flu A? The Flu A test?
Dr. Kadlec. Ma'am, again, I would take a guess at about
maybe $50.
Ms. Porter. $43. Flu--this is like ``The Price is Right.''
Flu B?
Dr. Kadlec. Too high again. I would--I would probably say
$44.
Ms. Porter. That is good. How about the cost of an ER visit
for someone identified as high severity and threat?
Dr. Kadlec. I am sorry, ma'am. What was the question again?
Ms. Porter. How about the cost of an ER visit for somebody
identified as having high severity or high threat?
Dr. Kadlec. High severity--ma'am, that is probably about
$3,000 to $5,000.
Ms. Porter. OK. That is $1,151.
Dr. Kadlec. Too high again.
Ms. Porter. This all totals up to $1,331. That is assuming
they aren't kept in isolation. Isolation can add up for one
family already $4,000, and fear of these costs are going to
keep people from being tested, from getting the care they need,
and from keeping their community safe.
We live in a world where 40 percent of Americans cannot
even afford a $400 unexpected expense. We live in a world where
33 percent of Americans put off medical treatment last year,
and we have a $1,331 expense, conservatively, just for testing
for the coronavirus.
Dr. Redfield, do you want to know who has the coronavirus
and who doesn't?
Dr. Redfield. Yes.
Ms. Porter. Not just rich people but everybody who might
have the virus?
Dr. Redfield. All of America.
Ms. Porter. Dr. Redfield, are you familiar with 42 CFR
71.31--30, excuse me? 42 CFR 71.30. The Code of Federal
Regulations that applies to the CDC. 42 CFR 71.30.
Dr. Redfield. I think if you could frame the--what it talks
about that would help me. I don't----
Ms. Porter. OK. Dr. Redfield, I am pretty well known as a
questioner on the health and--for not--not tipping my hand. I
literally communicated to your office last night and received
confirmation that I was going to be asking you about 42.7--42
CFR 71.30.
This provides the director may authorize payment for the
care and treatment of individuals subject to medical exam,
quarantine, isolation, and conditional release.
Dr. Redfield. That I know about and----
[Audio malfunction in hearing room.]
Ms. Porter [continuing]. Commit to the CDC right now using
that existing authority to pay for diagnostic testing free to
every American regardless of insurance?
Dr. Redfield. Well, I can say that we are going to do
everything to make sure everybody can get the care they need.
Ms. Porter. No. Not good enough. Reclaiming my time.
Dr. Redfield, you have the existing authority. Will you
commit right now to using the authority that you have vested in
you under law that provides in a public health emergency for
testing, treatment, exam, isolation without cost? Yes or no.
Dr. Redfield. What I am going to say is I am going to
review it in detail with CDC and the department----
Ms. Porter. No. I am reclaiming my time.
Dr. Redfield, respectfully, I wrote you this letter, along
with my colleagues Rosa DeLauro and Lauren Underwood--
Congresswoman Underwood and Congresswoman DeLauro. We wrote you
this letter one week ago.
We quoted that existing authority to you and we laid out
this problem. We asked for a response yesterday. The deadline
and the time for delay has passed.
Will you commit to invoking your existing authority under
42 CFR 71.30 to provide for coronavirus testing for every
American regardless of insurance coverage?
Dr. Redfield. What I was trying to say is that CDC is
working with HHS now to see how we operationalize that.
Ms. Porter. Dr. Redfield, I hope that that answer weighs
heavily on you because it is going to weigh very heavily on me
and on every American family.
Dr. Redfield. Our intent is to make sure every American
gets the care and treatment they need at this time of this
major epidemic and I am currently working with HHS to see how
to best operationalize it.
Ms. Porter. Dr. Redfield, you don't need to do any work to
operationalize. You need to make a commitment to the American
people so they come in to get tested. You can operationalize
the payment structure tomorrow.
Dr. Redfield. I think--I think you are an excellent
questioner, so my answer is yes.
Ms. Porter. Excellent. Everybody in America hear that. You
are eligible to go get tested for coronavirus and have that
covered regardless of insurance.
Please, if you believe you have the illness follow
precautions. Call first. Do everything the CDC and Dr. Fauci,
God bless you, for guiding Americans in this time.
But do not let a lack of insurance worsen this crisis.
Dr. Redfield. And I would just like to echo what you said.
It is a public health--a very important public health that
those are--those individuals that are in the shadows can get
the health care that they need during this--the time of us
responding to this outbreak.
Chairwoman Maloney. Well, thank you. And the Gentlelady
from New Mexico, Ms. Haaland, is recognized for five minutes.
[Audio malfunction in hearing room.]
Ms. Haaland. Thank you, Madam Chair, and thank you,
gentlemen for being here today. We really appreciate you
answering our questions. Dr. Redfield, I want to start with you
first. The first four cases of Coronavirus have been found in
New Mexico, my state. We had a conference call with Governor
Lujan-Grisham yesterday. She mentioned one of two of the cases
is a couple that lives in in Segura, New Mexico. Small town of,
you know, seventy-thousand people perhaps. And they were on a
cruise ship themselves. They came back to New Mexico. Nobody
notified the state or the health department about them being on
a cruise ship where coronavirus was found. So, they were in New
Mexico just doing their normal, everyday life for ten entire
days before the governor or the state was alerted to have them
tested and it turned out they were positive. So, I am, you
know, we're of course worried in a small town like that the
virus could spread pretty rapidly. And so I want to, a lot of
attention has been paid to testing. Will we have adequate
testing? And I, I'd like to know, this adequate testing, I have
to believe it will reveal an exponential number of cases
throughout the country. How, what is the responsibility to
just, make sure that we're getting this information out to
people. People on a cruise ship where coronavirus was known to
be found shouldn't be walking around for ten whole days before
we're alerted to that fact.
Dr. Redfield Thank you very much Congresswoman.
Obviously, the complexity of tracking down people, whether
it is ships or planes, is a complicated issue. First, you have
to have accurate contact information and I can tell you one of
the things with the interim Federal rule we recently did for
airlines, in the past maybe 20 to 30 percent of the information
we would get would be actually actionable.
I am happy to say now we are probably over 90 percent. We
are getting the manifests from cruise ships and working with
local health departments to try to track down these individuals
when we do have a confirmed case.
And this is why Dr. Fauci and all of us have now really
weighed heavily this is not the time to be cruising. We really
do realize that these are environments that can really amplify
transmission.
Ms. Haaland. Thank you. Thank you, Dr. Redfield. Thank you.
I want to turn our attention--I think you have mentioned--
you know, all of you have mentioned several times today that
big crowds need to be avoided. Is that correct?
And I want--first of all, I want to just talk about our
president for a moment. On March 8, he tweeted that fake news
media is doing everything possible to make us look bad. On
February 28, he called the coronavirus a Democratic hoax in
the--in front of a huge rally, which was on national TV.
A Brazilian official who was--who met with President Trump
at Mar-a-Lago has just tested positive for the virus, and he
has just boasted recently about his March 25 rally in Florida
that it is all sold out and he has yet to cancel it.
And this behavior--this is the behavior that our country
has to contend with. He is our president. He is the leader of
our country.
You have been sitting here for hours and yesterday telling
us that we need to avoid big crowds. And I am going to tell you
that I have Republicans in my district who I care deeply about.
I don't want them getting infected.
Every single one of us here have constituents all over our
districts who we don't care who they support for president--we
don't want them getting sick.
And I applaud my Governor, Michelle Lujan Grisham, who just
canceled all mass gatherings in our state, and I almost feel
like saying the president can do whatever he wants. He is an
adult.
He can be careless with his own health if he wants to. That
is his choice. But the millions of Americans who would go to a
rally because he has told them that it is a hoax, they don't
know the truth, apparently, and it is up to all of us to make
sure that they do know the truth.
And I understand the position you are in. If you can't tell
the president to his face stop all your rallies, cancel every
single rally that you have planned because American lives are
at stake, then I implore you to give that message to every
Governor of every state in this country.
We have to--we have to stop this where it is, and I
appreciate you being here.
And thank you, Madam Chair. I yield.
Mr. Clay.
[Presiding.] The member's time has expired.
The gentleman from Maryland, Mr. Sarbanes, is recognized
for five minutes.
Mr. Sarbanes. Thank you, Mr. Chairman. Thanks to the panel.
Dr. Fauci, I have been trying to sort of distill the
testing issue against the backdrop of moving from containment
to mitigation in my mind and I would like you to maybe just
comment on it very briefly.
Our failure to get the testing done early in effect means
we missed the containment window and now have to move rapidly
to the mitigation stage of this thing.
In other words, you have kind of been intimating don't wait
for the surveillance testing. Don't wait for the person to
person testing to make a judgment about what we have to do. We
are past containment, well past it.
There might have been a moment when we could have had an
effective strategy around there if the testing had been
deployed better. But we now got to go straight to mitigation in
anticipation of the fact that whatever testing will now happen
will show us that the community spread has been happening for
weeks and so forth.
Is that a fair characterization?
Dr. Fauci. With all due respect, sir, it is not totally
fair and let me, very briefly, try and integrate what you said,
part of which was true but part of which I think is maybe a
little misleading.
First of all, clearly, we have said many times and I have
said publicly we had a problem with the testing and if we
needed the kind of surveillance we are not there yet.
I don't think you can draw a direct line to that lack of
having it in the beginning to the fact that we are now doing
mitigation.
No. 2----
Mr. Sarbanes. Fair enough. Fair enough.
Dr. Fauci [continuing]. We don't--you don't necessarily
give up containment when you go to mitigation. You can do some
containment at the same time you are doing mitigation.
But I would emphasize, and I am glad you are giving me the
opportunity to state it yet again because you can never state
it too much, is that right now all of us, regardless of what
testing is going on, need to be doing the kind of distancing,
avoiding crowds, teleworking where possible.
I said it many times and I will say it again, this is not
business as usual. If you live in a state or a region where
there are just a few or no cases, it doesn't matter. You really
need to do the----
Mr. Sarbanes. Let me ask you--thank you. That is a very
good clarification.
Let me ask you a science question----
Dr. Fauci. Sure.
Mr. Sarbanes [continuing]. Just so I understand. If
somebody got the virus three, four weeks ago, just thought they
had the flu or a bad cold or something, recovered from it, they
are now essentially immune from getting the virus again. Is
that correct?
Dr. Fauci. We haven't formally proved it. But it is
strongly likely that that is the case.
Mr. Sarbanes. OK.
Dr. Fauci. Because if this acts like any other virus, once
you recover you won't get reinfected.
Mr. Sarbanes. And if they then came down with another cold
not related to coronavirus--thought maybe it was coronavirus,
got tested--would that test show that they had gotten the
coronavirus or not?
[Audio malfunction in hearing room.]
Dr. Fauci. If you do an antibody test, if you wait weeks
and months after you have recovered, the antibody test will
tell you whether that person was formally infected with
coronavirus.
Mr. Sarbanes. OK. Following up on that, if somebody has the
immunity and in that sense is not a carrier, they could still
transmit, right, if they were in a space where they got the
virus somehow on their skin or something else so they could
still put someone else at risk even though in their mind they
are thinking, I am now immune and therefore I am safe to move
around, in a sense. Is that true? No?
Dr. Fauci. Absolutely not.
Mr. Sarbanes. OK.
Dr. Fauci. Thank you for asking the question.
So, let us say I get infected and whether I get sick or not
I clear the infection from my body. I do two tests 24 hours
apart, which is the standard to say I am no longer infected.
A month and a half from now you do an antibody test and
that test is positive, I am not transmitting to anybody because
my body has already cleared the virus.
So, even though my antibody test says you were infected a
month or two ago, right now, if there is no virus in me, I am
not going to be able to transmit it to anyone.
Mr. Sarbanes. Asking a slightly different question, I am
going to run out of time so I will come down maybe or I will
ask you offline so I understand that better.
I did, in the last 25 seconds here, though, just want to
say that I would like to followup Dr. Kadlec, I believe, in
terms of the Federal Government's plans around telework
because, obviously that is going to be critical in terms of
continuity of operations.
A lot of folks are already doing that on a discretionary
basis. But I am going to be interested in what the agency wide
response is there.
I do--I do have something I would like to enter into the
record, Madam Chair, which is a--is testimony from AFTE in part
relating to the importance of telework and what they would like
to see in that space, and I would ask unanimous consent to
submit that for the record.
Thank you.
Mr. Clay. The gentleman from California is recognized for
five minutes.
Mr. Gomez. Thank you, Madam Chair.
Thank you all for being here. Last night, President Trump
announced that starting on Friday at midnight he is suspending
all travel from and to Europe to the United States for the next
30 days. Only the United Kingdom and appropriately screened
Americans are exempted from this ban.
The CDC previously recommended that all Americans avoid
travel to China, Iran, South Korea, and Italy. It has
recommended that older adults or those with chronic medical
conditions propose postpone travel to Japan.
Dr. Fauci, will a travel ban like this have significant
impact on reducing the community spread of the coronavirus--
that is, cases that are already in the United States?
Dr. Fauci. Yes, that is the--the answer is a firm yes and
that was the reason, the rationale--the public health rationale
why that recommendation was made.
Because if you look at the numbers it is very clear that 70
percent of the new infections in the world are coming from that
region, from Europe, seeding other countries. Firs thing.
Second thing, of the 35 or more states that have
infections, 30 of them now or most recently have gotten them
from a travel-related case from that region. So, it was pretty
compelling that we needed to turn off the source from that
region.
Mr. Gomez. Can I--let me--so I have been in a lot of the
briefings. I have been listening to you very carefully. What
changed between, you know, when you were here to last night
when it--to all of a sudden impose this ban, this travel ban?
Dr. Fauci. Yes. Well, we, as you probably know, as I
mentioned, we meet physically once a day every day, conference
calls and telephone calls during the day between briefings, and
what happens is that things evolve as you see the cases and
when you look at the data all of a sudden we had China being
the seed, and we did that with China.
And then as the days and weeks get by it became clear it
wasn't China anymore. It was another region.
Mr. Gomez. So, something changed, right? So, this was
always an option that was always on the table.
Dr. Fauci. Yes. But the dynamics of the outbreak changed.
It shifted from a China to the rest of the world to Europe to
the rest of the world.
Mr. Gomez. And you yesterday quoted Gretzky. You want to be
where the puck is.
Dr. Fauci. Right.
Mr. Gomez. Not where it is at. Where the puck is going to
be.
Dr. Fauci. Yes.
Mr. Gomez. Do you expect that the administration will issue
additional travel restrictions in the future?
Dr. Fauci. I think if, in fact, the dynamics of the
outbreak mandates that, they would seriously consider that. I
can't say yes or no. But I can tell you it would be seriously
considered.
Mr. Gomez. OK.
Dr. Redfield, what other countries is the CDC watching for
similar recommendations?
Dr. Redfield. Well, as Dr. Fauci said, you know, clearly,
it was Korea and Italy and Iran that really became our next
epicenters. Unfortunately, because Italy spread to the region,
now we really have a major regional outbreak now in Europe.
We are continuing to really watch the whole world. At this
point in time, it really is Iran, Korea, and the mainland
Europe that are the epicenters right now and with Europe
driving the global outbreak for sure for the last couple of
days.
Mr. Gomez. OK. One of the things that has been expressed is
that the president also warned older Americans to avoid
nonessential travel to crowded places. CDC has recommended that
vulnerable individuals avoid travel to--such as long plane
rides and, in particular, avoid cruises.
I know that this means older adults with chronic health
conditions. What are older adults? How do you define that?
I mean, that is not a loaded question. I am just----
Dr. Fauci. The reason I laugh, my standard answer is
anybody older than me.
[Laughter.]
Dr. Fauci. But that is not a good answer. You know,
generally, it is 60, 65 years old.
Mr. Gomez. In here in Congress--young and I am 45. So, what
does that tell you?
Dr. Fauci. That is the general. But I think----
Mr. Gomez. What is the age?
Dr. Fauci. Generally, people refer to it as 60, 65 years
old as elderly. However, the thing we need to point out that is
important is that there is numerical age and there is
physiological age.
There is a great deal of variability in the vulnerability
of a person based purely on their age. You could have a 75-
year-old person who is vigorous and has a really robust immune
system.
You can have somebody that is 60, 65 not nearly good. It
isn't linear based on just your age.
Mr. Gomez. The reason why is--the reason why we are asking
these questions is that the constituents really want specifics,
right. Like, if I am above 60 and I am a marathon--you know, I
am 60 and I am out of shape then maybe I shouldn't be
traveling. Now, if I am 70 or older and I am a marathoner and I
do X, Y, and Z and, like, everything looks great, then it might
not be as severe, correct?
Dr. Redfield. Yes, I was just going to say this is driven
by the mortality of this infection. Clearly, individuals that
are under 30, under 40, under 50, we have seen these
individuals may get a really severe cold and they recover or
they may be asymptomatic.
When you look at the mortality in Italy, the average age of
death was somewhere between 82 and 84. When you look at the
overall mortality that we are seeing across China and
everything, it is really in the 70's.
So, we are really trying to get the most vulnerable out of
an environment where they may catch this virus.
Chairwoman Maloney.
[Presiding.] The member's time has expired.
Mr. Gomez. Thank you.
Chairwoman Maloney. The gentlelady from the District of
Columbia, Ms. Eleanor Holmes Norton, is recognized for five
minutes.
Ms. Norton. Thank you, Madam Chair.
Gentlemen, we are here in the Nation's capital where a
state of emergency has been declared by the mayor of the
District of Columbia.
This is a tourist Mecca. Millions come from all over the
world and all over the country. I am concerned about our health
care providers and our first responders.
Social distancing is not really an option for them. They
are, in a real sense, the last line of defense. For example, in
New York we heard of doctors and nurses who have reportedly
been exposed to the virus.
Let me ask you, Dr. Redfield, can any medical provider who
wants to be tested today be tested?
Dr. Redfield. Again, I think that would be a decision that
the hospital would make and the individual's physician. But
your point, the importance of protecting our providers with the
proper infection control procedures is critical. We put out
guidance and we need to continue to do that.
Ms. Norton. So, there needs to be some prioritization of
who--obviously, people who have been exposed. But if we get
beyond that, people who expose themselves, it seems to me,
ought to be given first priority.
Mr. Kadlec, let me ask what HHS is providing--is advising
providers to do to ensure that there is not a shortage of
medical staff.
Dr. Kadlec. Yes, ma'am. And I think that is a critical
issue here in terms of evaluating not only the personal
protective posture of physicians who are managing patients with
this particular virus but also those that are working in
emergency rooms and in other areas where there is a risk they
could be exposed in that setting.
A couple areas that are being considered are what are the
particular work-related rules as would require people to be
furloughed from work if they were exposed. There was a question
earlier about someone being in an appropriate protective
posture, exposed, and then there was a question whether they
would even be furloughed.
And, again, it gets back to your possible question of
testing. If that is an appropriate intermediate means to keep a
health care worker on the job in lieu of that kind of absence
or excuse from work.
Ms. Norton. We awoke this morning to find that the World
Health Organization had officially declared this to be a
pandemic. I am worried about personal protective equipment. I
guess I should ask you, Mr.--Dr. Kadlec.
Will shortages of personal protective equipment like face
masks and gloves, et cetera, hamper public health response?
What priority is given to who gets these--this vital equipment?
Dr. Kadlec. Well, ma'am, that is a great question because,
quite frankly, there is a potential risk. Much of what we get
is sourced from overseas.
We are working actively with manufacturers and distributors
to make sure two things happen. One is that supply chains are
uninterrupted. The second thing is that allocations go
preferentially to health care workers over others.
Ms. Norton. Is the--is the Health and Human Services
Department taking any steps here in the United States to boost
production of these supplies----
Dr. Kadlec. Yes, ma'am, they are.
Ms. Norton [continuing]. Of these supplies so that people
are--I mean----
Dr. Kadlec. Yes, ma'am. Yes, ma'am.
Ms. Norton [continuing]. Who is manufacturing these
supplies? Is that continuing?
Dr. Kadlec. Yes, we are and, basically, we are--we have
released a request for proposals for a half a billion N95
masks. To boost production, we are working with manufacturers
to make sure that they have the raw materials which are sources
to the United States so they can surge and many of them----
Ms. Norton. So, all the people who make----
Dr. Kadlec. Yes, ma'am.
Ms. Norton. All these supplies, the gloves and--they are
all boosting?
Dr. Kadlec. Yes, ma'am. They are--they are boosting them
and looking to source it from the--one thing that I mentioned
earlier was, again, the importance for liability protection for
some of these manufacturers, particularly around N95 masks.
Ms. Norton. Then that should be in our bill then that we
are working on that?
Dr. Kadlec. Yes, ma'am. That is a must pass bill because
that is critical to enable more----
Ms. Norton. Well, we will be sure that--because we are
working on a bill as I speak, trying to make it a bipartisan
bill.
Finally, let me ask you, with--about Italy, because Italy
is the worst case scenario that can educate us about what is--
what could happen to us, and I understand that doctors
anticipate hospitals running out of beds within a week in Italy
if the spread continues.
If the rates continue here--or let me ask you, are we doing
anything to keep the United States from running out of beds,
for example, in Washington State?
Dr. Kadlec. Yes, ma'am. In fact, we are doing a couple
things there and the state is working with HHS and doing things
on their own.
But they are using alternate care facilities to offload
some of the--some of the people who were moderately ill and
putting them in settings that segregate them from regular
hospitals, so it won't----
Ms. Norton. And what kind of facilities?
Dr. Kadlec. Motels, for example. And the same thing is
happening in the state of California. HHS is working with the
state there to basically identify alternate care facilities for
low acuity patients.
The one thing that is a concern is whether or not high
acuity beds, intensive care beds, could be at risk and we are
monitoring that very carefully.
And, again, looking for alternative solutions that we could
use to make sure that we can take care of anyone who has this
virus but, more importantly, take care of people who don't have
the virus but who have other medical needs.
Chairwoman Maloney. Gentlelady's time has expired.
And the gentleman from Missouri, Mr. Clay, is our last
member to question today.
Mr. Clay. Thank you, Madam Chair, for this hearing. And
yes, I am batting cleanup. So, I would like to ask about a
story that broke yesterday.
According to Reuters, since mid-January the NSC has ordered
HHS to classify top-level discussions related to the
coronavirus. The topics of these discussions have reportedly
included, and I quote, ``the scope of infections, quarantines,
and travel restrictions.''
Dr. Kadlec, is it true that HHS has been holding classified
coronavirus hearings?
Dr. Kadlec. So, we are holding them in a classified room.
But the nature and the content of those conversations are not
classified.
So, we have been doing secure video conferencing across the
interagency and that requires going into a classified space. I
could see how it would be misinterpreted as such. But the
nature of the conversations are unclassified.
Mr. Clay. And so how many meetings since mid-January have
been held in those----
Dr. Kadlec. Too numerous to count, honestly.
Mr. Clay. Too numerous----
Dr. Kadlec. The--we are meeting several times a day if not
more at different levels of the organization to basically
address critical questions as it relates to the safety and
health of Americans, the adequacy of supplies, the adequacy of
our health care system.
Mr. Clay. Yes, but it is my understanding that some
officials are left out because they don't have the correct
level of security clearance.
Dr. Kadlec. Sir, that is an administrative challenge
sometimes because these secure places are administered by
classification rules that have nothing to do with the content
of the conversation but just the physical access to the place.
Mr. Clay. Really?
Dr. Kadlec. So, these individuals have to be escorted in
and, again, the nature of the conversations have to remain
unclassified in those settings and they are unclassified by the
virtue of the content.
Mr. Clay. Does that inhibit our ability in any way to get
the expertise we need into the room?
Dr. Kadlec. No, sir. I think in the case of the White House
situation room, which is the highest level of classification
you can have, we have all the appropriate people in the room to
make those decisions, including individuals who have no
clearance--security clearance at all.
Mr. Clay. According to one official, because these meetings
have been held in SCIF, critical government experts have been
then excluded in these discussions and this practice, quote,
``seemed to be a tool for the White House, for the NSC to keep
participation in these meetings low.''
Are you familiar with 28 CFR Section 17.22?
Dr. Kadlec. Well, sir, I would have to--sir, if you would
hum a few bars I could probably guess it. But I worked on the
Senate Intelligence Committee and I have to admit I believe it
is related to the security practices in these----
Mr. Clay. Here is what the section describes. The
information shall not be classified in order to conceal an
efficiency violations of law or administrative error to prevent
embarrassment to a person, organization, or agency, to restrain
competition or to prevent or delay release of information that
does not require protection in the interests of national
security.
Information that has been declassified and released to the
public under proper authority may not be reclassified.
Do you know that we have discussed at length today the need
for our government agencies to be transparent with the American
people and they deserve answers to be able to protect
themselves and their families from this pandemic?
Is the information being discussed in these meetings all
actually classified under the definition of classified security
information?
Dr. Kadlec. They are totally unclassified and I think it
has been the intent of Secretary Azar and our department to be
radically transparent, to make sure that anything that we can
share and I will allude to my colleagues on the right of me,
Dr. Fauci and Dr. Redfield, who have been participants, to
offer their observations as well.
Mr. Clay. Go ahead, Doctor.
Dr. Fauci. Totally--I totally agree with Dr. Kadlec. There
really is no function or classification. It is merely an access
thing, and there are people that we need are in there and there
is nothing that we say in there that we are not--that we are
afraid to say to you right here.
Mr. Clay. OK. And so you would be willing to share that
information with us that----
Dr. Fauci. We have been. In fact, all the questions we have
asked are reflective of what has gone on in that room.
Mr. Clay. Well, and I appreciate that. Appreciate your
openness and transparency, and I look forward to working
together to resolve the issues that we face as a Nation.
And with that, I yield back, Madam Chair.
Chairwoman Maloney. The gentleman yields back. And I just
want to thank all of you for testifying.
Would you like to make a statement, Mr. Redfield?
Dr. Redfield. Chairwoman, I----
Chairwoman Maloney. Doctor--Dr. Redfield.
Dr. Redfield. That is all right. I would like to just make
two clarifications, one of which I did yesterday and one of
which I did today, if I could have a second to----
Chairwoman Maloney. Absolutely.
Dr. Redfield. So, yesterday, I want to clarify that when I
was asked about manufacturing of the tests, the original tests,
I just want to clarify that CDC did manufacture the original
CDC test that we used at CDC and we also manufactured the
initial test we sent out to states, and IDT manufactured the
kits after that. So, I just want to get that on the record.
Second, in my comments today I wanted just to clarify that
we are currently examining all avenues to try to ensure that
the uninsured have access to testing and treatment, and we are
encouraging the use of the federally qualified health centers
that can do this at reduced or free, and we will continue to
update both the Congress and the public on all available
resources for this population.
Chairwoman Maloney. Thank you for clarifying that.
Yes, uh-huh?
Dr. Kadlec. Madam Chairman, I do have one errata from
yesterday. I misspoke. When talking about BARDA I mentioned
they had 53 FDA approvals I was incorrect. It is actually 54.
Chairwoman Maloney. That is very accurate. Would anyone
else like to make a statement?
Well, I want to thank all of your for testifying today. We
realize that this is the third testimony, third meeting that
you have taken today. We appreciate it. We appreciate you
coming back. Thank you for your public service, your hard work,
your dedication.
And particularly, I want to thank Dr. Fauci for serving six
presidents. Six presidents. And speaking so truthfully and
honestly to the public as all of you have. I can't tell you how
many people have contacted me that they now understand more
about it.
They feel better about it. You have truly performed an
incredibly important public service by speaking really to the
American people, as you are today, on this panel.
We thank you so, so very much. And I do want to say a very
special thank you to Mr. Jordan. This is his last day as
ranking member of this committee.
We all thank him for his service. He will be moving to
ranking member on the Judiciary Committee but not leaving the
committee. So, we can continue working together.
And I understand that you will be taking your staff with
you. So, I want to thank them for their excellent hard work and
also my own staff that has really worked on this hearing and on
all of the matters before it.
I just also understand that you will be going next door, as
I understand it. So, I am wondering if you would--I yield to
you. I am very sorry you are leaving, quite frankly, and I have
enjoyed working with you.
Mr. Jordan. Same here, Madam Chair. That was very nice and
I appreciate those kind words. I am not going far. I will be
sitting right here, so I would just be one seat further. But
thank you for your--for your work and it has been a pleasure to
work with you.
Thank you to our witnesses again and for the work you are
doing for the American people.
Chairwoman Maloney. The American people are very grateful.
Without objection, all members will have five legislative
days within which to submit additional written questions for
the witnesses to the chair, which will be forwarded to the
witnesses for their response.
I ask our witnesses to please respond as promptly as you
are able. This hearing is adjourned.
[Whereupon, at 12:56 p.m., the committee was adjourned.]
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