Dr. Fauci and Other CDC & NIH Officials Testify on Coronavirus – March 11

Maloney: (00:00)
(silence)

Maloney: (00:00)
Can I start or should I wait? What?

Maloney: (06:11)
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 to 10 and testimony and questions from 10 to 1. 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.

Maloney: (06:50)
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.

Maloney: (07:08)
At 11:45 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.

Maloney: (07:44)
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’s what we all want on a bipartisan basis. Unfortunately, when we look at the last three months, subjectively 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.

Maloney: (08:14)
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 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 through testing, but people here in the United States can’t even get tested by their own doctors.

Maloney: (09:09)
This is the United States of America. We’re 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’s 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 a million tests and we’ll be distributing four million by the end of this week, but that’s 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 you 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.

Maloney: (10:49)
Over and over again, we’ve heard blatant misstatements that consistently diminished 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 advisor, Larry Kudlow who made this incredible statement two weeks ago and I quote, “We have contained this, I won’t say airtight, but pretty close to airtight. The business side, the economic side. I don’t think it’s going to be an economic tragedy at all. The numbers are saying the U.S. is holding up nicely.” End quote.

Maloney: (11:40)
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.

Maloney: (12:29)
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 national security subcommittee held a hearing last week on our nation’s biodefense capacity and he paved the way for today’s hearing. Chairman Kirsten [Worthe 00:12:50] of the economic and consumer policy subcommittee has been focused on the effects of this crisis on consumers and chairman Conley of the government operations subcommittee has been working with states and localities on the front lines of our response efforts.

Maloney: (13:06)
I now recognize our distinguished ranking member. I would like to express my regret that he is moving to chair yet another committee ranking member Jordan.

Jordan: (13:17)
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. We pray for those families. We must continue to support the Trump administration. It’s worked 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.

Jordan: (14:02)
It’s important for all Americans to follow the best practices to maintain good hygiene. Number one, 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.

Jordan: (14:31)
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 threat started to emerge from China, which is ground zero for this virus, President Trump recognized the importance in limiting exposure from those who had traveled there to the American people. That decisive action brought our public health professionals important time to get a headstart in preparing for the virus here at home. Since that time, we’ve seen clusters of community spread.

Jordan: (15:04)
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.

Jordan: (15:42)
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 a million test kits have been sent out to date. Today 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.

Jordan: (16:12)
Lastly, I want to say that oftentimes 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 wellbeing of every American. We should not play politics with the coronavirus. We should not use it as a reason to advance partisan objectives. Now’s 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.

Maloney: (16:51)
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, 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 and Mr. Chris Currie is the director of emergency management and national preparedness for the government accountability office. Thank you for being here.

Maloney: (17:48)
I will begin swearing the witnesses in and if you will all please rise and raise your right hand. Do you swear or affirm that the testimony you’re about to give is the truth, the whole truth and nothing but the truth, so help you God. 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 now recognized to provide your testimony.

Dr. Fauci: (18:27)
Thank you very much. Chairwoman Maloney, ranking member Jordan, 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 or how these viruses work, but also in developing counter measures. Given the limited time, I would like to have my remarks refined to two aspects.

Dr. Fauci: (19:03)
One is the development of vaccines, what’s the realistic expectation and the other is the development of countermeasures in the form of therapeutics. With regard to vaccines, as I’ve 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’s 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 one 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 at various stages of development.

Dr. Fauci: (19:48)
The one that we’ve 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 one 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.

Dr. Fauci: (20:15)
So we go into phase one, it’ll take about three months to determine if it’s safe. That’ll bring us three or four months down the pike. And then you go into an important phase called phase two, 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’ve heard me say we would not have a vaccine that would even be ready to start to deploy for a year to a year and a half, that is the timeframe.

Dr. Fauci: (20:59)
Now anyone who thinks they’re going to go more quickly than that I believe will be cutting corners. That would be detrimental. What does that tell us? That tells us now the next month, the next several months we’re going to have to rely on public health measures to contain this outbreak. And I’d 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’re 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.

Dr. Fauci: (21:46)
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 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’m hoping that we do get a positive signal. If we do, then we may and I underline may so that it doesn’t get misinterpreted, have therapy that we could use, but that needs to be proven first.

Dr. Fauci: (22:23)
So in summary, the work that’s being done at the NIH is involved both in the development of a vaccine in the long term and in development hopefully of therapies in the shorter term. I’d be happy to answer questions after all the presentations. Thank you.

Maloney: (22:41)
Dr. Redfield. You’re now recognized for your testimony. Thank you.

Dr. Redfield: (22:44)
Thank you very much. Good morning Chairwoman Maloney and ranking member Jordan and members of the committee. Thank you for the opportunity to share CDCs role and the U.S. response to this novel coronavirus. CDC is a science-based data-driven organization, science and data drives our decision making 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 how best to prepare for eventual disruptions to their daily life and the potential risk to their families.

The administration’s inner agency 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 25th 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 widespread person to person transmission in South Korea, Iran and Italy and long before the first case of community 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 confined to one province, the Hubei province. Today there’s more than 110,000 confirmed cases worldwide and yesterday 99% 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 70,000 individuals with this infection and found that 85 or 80% of the patients actually develop mild illness and recovered, while 15 to 20% developed serious illness. Children and young people’s seem not to get sick. This disease disproportionately affects older adults and particularly those with serious underlying health conditions.

Two months ago, Chinese science 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’s 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. 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’s 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 and 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.

Maloney: (27:31)
Thank you, Dr. Radley, you’re now recognized for your testimony.

Dr. Kadlec: (27:35)
Thank you Chairman Maloney, ranking member Jordan and 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-Hazard Preparedness Act [inaudible 00:28:16] Innovation Act and finally the Public Readiness Emergency Preparedness Act.

Dr. Kadlec: (28:21)
All these tools that you have given us have been vital in confronting this virus and this current outbreak and also want to acknowledge the role that additional monies 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.

Dr. Kadlec: (28:47)
As far as my role in this activity, at this point in time, I have four principle 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 #8 for medical and public health preparedness and response.

Dr. Kadlec: (29:21)
I also basically support the healthcare system through the hospital preparedness program and our regional disaster response network that we’ve created with your support. And then thirdly is basically work with NIH, with FDA, with our DOD colleagues to rapidly develop, accelerate the development of therapeutics, diagnostics and vaccines that can be used in this outbreak.

Dr. Kadlec: (29:46)
And finally providing direct support to state and local entities. And during this most recent event with the Grand Princess that is now docked in Oakland, we’re working directly with the state of California, the city of Oakland, and with our inter agency partners to safely disembark all those passengers, American and non-American. And manage the crew to ensure that they’re safe return to their homes, but more importantly, protecting the communities that will be receiving these individuals. So with that I’ll yield the remainder my time back to you, Madam Chairman and thank you.

Maloney: (30:22)
Thank you very much. Dr. Rauch you’re now recognized for your testimony.

Dr. Rauch: (30:28)
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 it for self protection guidance beginning early in the outbreak and continue to issue a series of guidance as the situation evolves. That 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 health protection, the department issued 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.

Dr. Rauch: (31:33)
The guidance also listed the CDC travel advisory level for China and refer 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 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.

Dr. Rauch: (32:19)
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 2nd, 2020. It’s specified actions by the service member during their restriction movement to reduce the potential spread of disease. The guidance recommended the DOD civilian employees and contractor personnel and family members returning from China follow existing CDC guidance. On February 25th, 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.

Dr. Rauch: (33:11)
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.

Dr. Rauch: (34:02)
As we know, there is no vaccine to protect the force. There’s 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 NRA agency efforts. I’m 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.

Maloney: (34:40)
Thank you. Mr. Currie, you’re now recognized for your testimony.

Mr. Currie: (34:43)
Thank you, Madam chairwoman. Mr. ranking member, other members of the committee. As you know, Geo’s role is to provide oversight of other federal agencies and so what I want to do today is talk 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’ve done looking at past pandemics and outbreaks, and public health preparedness. For decades, we’ve been concerned about the US’s preparedness for these types of events.

Mr. Currie: (35:16)
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 a once an outbreak is contained. Also, biodefense is extremely fragmented across the federal government. There’s over two dozen presidentially 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.

Mr. Currie: (35:47)
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.

Mr. Currie: (36:12)
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.

Mr. Currie: (36:28)
I’d 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’s very difficult, but some of the challenges we’re seeing in the public are highlighted by decades of work we’ve done over the years and past outbreaks and frankly things that we’ve been concerned about. If we had a large domestic outbreak here in the US.

Mr. Currie: (36:52)
The first is roles and responsibilities across the government. While I think it’s pretty clear up front 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 the additional funding and authorities that that provides.

Mr. Currie: (37:22)
Who communicates with the public at the federal, state, and local level has been a challenge. This is something we’ve pointed out before. On the issue of testing, 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 this is a direct correlation to the investments we make in preparedness and again, it’s very, very difficult to sustain these given other priorities when we don’t have outbreaks all the time.

Mr. Currie: (37:54)
The last thing I just mentioned 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’s 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.

Maloney: (38:26)
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 21st and the US has tested approximately 4,900 people so far.

Maloney: (38:53)
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: (39:20)
Thank you very much, Chairwoman Maloney. 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.

Maloney: (39:33)
Okay. Is the worst yet to come, Dr. Fauci?

Dr. Fauci: (39:36)
Yes, it is.

Maloney: (39:37)
Can you elaborate?

Dr. Fauci: (39:38)
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 it is by contact tracing. When you have enough of that, then it becomes a situation where you’re not going to be able to effectively, efficiently contain it. Whenever you look at the history of outbreaks, what you see now in an uncontained way, and although we are containing it in some respects, we keep getting people coming in from the country that are travel-related.

Dr. Fauci: (40:11)
We’ve seen that in many of the States that are now involved and 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 will get will depend on our ability to do two things: to contain the influx of people who are infected coming from the outside and the ability to contain and mitigate within our own country. Bottom line, it’s going to get worse.

Maloney: (40:45)
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: (40:53)
That is correct and as I’m sure that Dr. Redfield will tell you as the looking forward right now as commercial entities get involved in making a large amount of tests getting variable. When you do two aspects of testing, one, a person comes in to a physician and ask for a test because they have symptoms or a circumstance, which suggests they may be infected.

Dr. Fauci: (41:19)
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 test, but you actively, 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 we’ll expand that in many more cities. But you’re absolutely correct. We need to know how many people to the best of our ability are infected as we say under the radar screen.

Maloney: (41:54)
Pardon me? I really want to get to South Korea in their 50 mobile testing sites that they’ve 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 Dr Redfield. These centers minimize 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: (42:24)
Well, again, I’ll 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.

Maloney: (42:31)
Dr. Redfield.

Just to say very quickly a CDCs role in this was we very rapidly, within almost seven to 10 days, developed a test from an unknown pathogen. Once we had the sequence. And we did that because we wanted to get eyes on at CDC, so the health departments across this nation can send samples to us and we would test them.

Secondly, we rapidly tried to expand that and scale up with a contractor, so each public health lab in this country would have that test. During that process of quality control, we found that 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.

So there never was a time when a health department could not get a test, they had to send it to Atlanta. Now our health departments have 75,000 tests. Most health departments now, over 75 health departments have the test, but the other side-

Maloney: (43:26)
How many tests are we planning to produce in the United States?

Well, from a public health point of view, we’ve 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 for the mall to work together. And as we sit here today, Quest and LabCorp are now offering this test in their doctor’s offices throughout this country. But it’s not for an individual just to take a test. They need to go see a healthcare professional, have an assessment determine whether a test is indicated and then get that test.

In New York, just so you know, on February 29th, 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’re working hard to get testing available. My role is to get it available for the public health system and as Dr. Fauci said, start these large surveillance programs, but on the other side there’s a private sector to get it to clinical medicine and I think you will see that with LabCorp and lab Quest out, those tests are rolling out. Finally-

Maloney: (44:48)
Will these private labs be reporting and are they reporting into CDC their results?

We have setup now a surveillance system.

Maloney: (44:58)
Are they reporting now?

It’s being worked as we speak today at the LabCorp and Quest will dump into our national reporting base.

Maloney: (45:06)
My time has expired and I recognize the distinguished member. Oh, she’s left. Okay. I recognize the gentleman from the great state of Tennessee, Mr. Green is recognized.

Mr. Green: (45:18)
Thank you, Madam chair and thank the witnesses for being here. I’m 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 as 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.

Mr. Green: (45:47)
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’d like to take a second to correct the record. On December 31st, Wuhan officials posted the first notice saying they were investigating a pneumonia outbreak.

Mr. Green: (46:06)
On January the 7th, the CDC established an incident management system just seven days later. On January the 17th, CDC sent a 100 plus staffers to specific airports in the United States to screen all people coming from Wuhan.

Mr. Green: (46:21)
On January the 21st, just three weeks after the announcement, the CDC activated its emergency operations center.

Mr. Green: (46:28)
On January the 29th, the president established the presidential task force.

Mr. Green: (46:34)
On January the 30th, still less than a month from the initial announcement, the state department issued a do not travel warning to China.

Mr. Green: (46:41)
January the 30th, 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 the 31st, to the cries of racism, President Trump proactively suspended entry of foreign nationals who’d been to China in the last 14 days.

Mr. Green: (47:11)
On the 31st, the president issued quarantines and through Secretary Azar a public health emergency for the entire nation.

Mr. Green: (47:19)
On February the 11th, the World Health Organization named the virus COVID-19.

Mr. Green: (47:23)
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, get its proteins, messenger RNA sequenced and get a vaccine going.

Mr. Green: (47:53)
On February the 24th, 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’re accusing our president of failing us.

Mr. Green: (48:17)
On February the 26th, the president appointed the vice president the head of WHO government response that appointment is in keeping with the 2015 Obama era blue ribbon panel on biodefense.

Mr. Green: (48:28)
On February 29th, 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.

Mr. Green: (48:47)
You’ve heard the witnesses describe the Herculean efforts their various 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 they’re tireless 24/7 response since the announcement just 71 days ago.

Mr. Green: (49:11)
America will lose lives to this virus, but as was noted by Obama appointee and former Director of the CDC, Tom Friedman, 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.

Maloney: (49:34)
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.

Congressman Lynch: (49:46)
Thank you, Madam chair and thank you 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 requests from our public health officials. I think America is best when we have a unity of purpose, a singularity of mission, and that we’re 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 6th told the people in my district publicly that the tests were ready. Anybody who wants a test can go be tested. Their beautiful tests, beautiful tests, that’s not a medical term. So my constituents went to their local health centers, went to their hospitals. There were no tests. Zero, zero, and I know they’re rolling out now, but this was back on the sixth that’s 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’re not ready. They’re not beautiful. They’re 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 and I represent part of Boston, myself and Ms. Presley share that city. It’s not a backwater medically or technically, it’s very advanced. The president has made some bizarre statements here. 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 1930s and that he has a natural affinity and an ability for this, it’s got to raise some red flags.

We need you to step up and Dr. Fauci, you’ve been great on some of this stuff and pushing back when the president said, “We’re going to get a vaccine fairly quickly, a matter of months.” You were good to step up and say, “No, it’s going to be a year and a half.” But we really need honesty here. And when the president is making statements like this, we need pushback from the public health officials standing behind him and nodding silently or are an eye roll once in a while is not going to get it.

When I say things, they’re immediately considered political because I’m a Democrat and I’m elected. But you have a certain level of credibility and honesty that I think that should be persuasive to the American people. I just ask you to be more forthright when the president makes statements like this. We need leadership, but, but we need people to be very much aware of the dangers that are out there. The cases are not going down. The American people should be aware of that. You should be forthright in explaining that.

When the president’s economic director says, “We got this contained, not quite airtight, 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 more extended, more prolific, and more possible.” The American people really have to step up here and make sure that they are aware of the dangers. Dr. Fauci.

Dr. Fauci: (54:05)
Mr. Lynch, 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.

Thank you.

Dr. Fauci: (54:27)
Gentleman’s time has expired. The gentle lady from North Carolina, Mrs. Foxx is recognized for five minutes.

Mrs. Foxx: (54:34)
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 I may also. Thank you. I want to thank our witnesses for being here. And I think the very fact that we’re having these hearings, they’re 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.

Mrs. Foxx: (55:05)
And 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’s 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.

Mrs. Foxx: (55:32)
I do think it’s helpful that we explain the facts but also not scare everybody about this problem, but ask them to be sensible about what they’re doing. Dr Kadlec, I understand that BARDA amended its contracting process to place all proposals not related to coronavirus in queue until the threat of this virus subsides. Nobody has mentioned that, but it’s really all hands on deck and a focus totally on coronavirus. Is that correct?

Dr. Kadlec: (56:08)
Yes ma’am. And though we are accepting additional proposals on other things related to non-corona activities, but we are focusing on the immediate concern.

Mrs. Foxx: (56:18)
Yeah. 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’s part of what BARDA does. So would you mention what additional personnel or authority BARDA needs to ensure that its response to COVID-19 and it’s normal work for biological and nuclear countermeasures is performed as well as possible?

Dr. Kadlec: (56:52)
Yes ma’am. And 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 a federal pay cap waivers there.

Dr. Kadlec: (57:10)
But I think quite frankly, what BARDA has been extraordinary in its very short history to basically get 53-50 approvals for a variety of countermeasures and devices that are vaccines, therapeutics, diagnostics in it’s very short history. And it’s the little engine that can, and I think it’s one thing that working with NIH, working with DOD 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.

Dr. Kadlec: (57:43)
So I think with resourcing BARDA can and it’s 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.

Mrs. Foxx: (57:56)
What you indicate is that there’s 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’s happened with the coronavirus. We’ll never be able to stop all kinds of problems like this, but at least we have people working very, very effectively in these areas.

Mrs. Foxx: (58:19)
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?

I’d 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’ve got that public health labs now throughout this country have adequate testing to do their public health mission.

The other side of the mission is the clinical mission and I think that’s the concern of most American citizens. How do I get evaluated, and again, that really has been worked through the private sector. It wasn’t really the public health lead for CDC to get the laboratory test, 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.

Was also relieved to IDT, the manufacturer that made our tests for public health purposes. They were given the regulatory relief to actually make that test and sell it to hospitals. And that’s the one million, three million tests that people referred 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.

Dr. Redfield: (01:00:08)
When they met with the vice president, they didn’t come one company at a time. They had already agreed as a group, they’re going to figure out how to get this diagnostic test as rapidly as possible for the American public that need it. And as I said today, yesterday, they began that both LabCorp and Quest. So there should be, again, increasing increase in availability across this nation, through the private sector.

Mrs. Foxx: (01:00:29)
And I worry about what we heard when we discussed H.R.3 that were H.R.3 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. And so I’m very pleased to see this cooperation with the public-private partnership. And thank you very much Madam chairman, for your indulgence.

Maloney: (01:00:58)
Thank you. The gentleman from Tennessee. Mr. Cooper is recognized for five minutes.

Mr. Cooper: (01:01:02)
Thank you, Madam chair. I’m 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 US doctors or patients order some of these tests from South Korea?

Important question when was asked by the chair woman about the difference. The difference between the South Korean test and our test is they would have to go through our regulatory process and the FDA to get approval to use that.

Mr. Cooper: (01:01:36)
So the answer is no.

Currently, no under the regulatory issue.

Mr. Cooper: (01:01:41)
Okay. What are the names of these South Korean companies or enterprises that offer these tests?

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’d 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’ve used a high throughput platform, which is now being done in New York at the Wadsworth Lab and is now beginning, it’s being worked on by LabCorp and Quest to bring it in. So it’s a different platform. Roche is really the company I think. I’m not sure, but I can get back to you, which was a platform that they used. It’s a high throughput, allows many, many, many tests to be done in a single time.

Mr. Cooper: (01:02:31)
So the South Koreans used a Swiss company or wherever Roche is headquartered to supply the need.

I’ll get back to you on the specific, sir to make sure I don’t misinform you.

Mr. Cooper: (01:02:41)
So American doctors or patients will have to Google this to try to find out, because we’re not eliciting this information today.

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: (01:02:57)
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?

What’s 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 the high, what we call the high throughput. And so you’re 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: (01:03:37)
So now finally we’re turning toward what you call high throughput. And that may be from Roche, it may be from somewhere else, or maybe at the Wadsworth Lab now in New York. But finally one day we will have it.

Yeah, I would try not to use the word finally. I guess I’m 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: (01:03:59)
What’s the name of the company that supplied the faulty reagent?

Well, you should be careful. The third control did not perform the way we wanted it to perform. There’s two possibilities. One that that reagent at that time there was a contamination, but the other possibility is biologic. That these primer pairs folded on themselves and it didn’t perform. It’s been corrected and the new tests were-

Mr. Cooper: (01:04:24)
The standard, faulty, whatever name you want to use. What’s the name of that company?

Well, it was produced by IDT initially and we’ve worked with them to correct that and CDC together.

Mr. Cooper: (01:04:34)
Are there any plans to have drive through testing in America so that we do not panic emergency rooms when people come in and cough?

Not at this time. I think we’re trying to maintain the relationship between the individuals and their healthcare providers.

Mr. Cooper: (01:04:52)
That’s very interesting as a response. So the professional monetary relationship comes before public health.

No, that was not my point. And maybe Dr. Fauci wants to comment. My point was in able to assess risk and the appropriateness that these individuals get the proper care, we believe that this is something that’s still has value to be dealt with within the setting of clinical medicine. But I’ll ask Tony to comment.

Dr. Fauci: (01:05:19)
It’s exactly what you said. Not anything about monetary. That’s really not a consideration at all. It’s to try and 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. So it’s the relationship between the patient and the physician. I have no indication at all of financial on that.

Mr. Cooper: (01:05:49)
Well, most Americans don’t really have a doctor. They rely on the ER to help and people are panicking. ER is apparently. I see that my time has expired. I wish I had more time. Thank you Madam chair.

Maloney: (01:06:04)
Thank you. The gentleman from Georgia, Mr. Hice is recognized for five minutes.

Mr. Hice: (01:06:07)
Thank you Madam chair. Thank each of you for being here. Dr Fauci, you said earlier in an answer to a question that you believe the worst is yet to come. I think everyone up here, both sides, we’ve 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’re hearing.

Mr. Hice: (01:06:29)
I’m curious though, with the steps that were taken early on from declaring a public health emergency, the restriction to travel, giving each of your organizations the freedom to move forward to try to combat this, and a host of other things. How important were those decisions? Would we be in a worse situation for example, had there not been some travel restrictions?

Dr. Fauci: (01:06:56)
I believe we would be in a worst position, sir. But if I might with respect, look ahead now. We need to do a lot more.

Mr. Hice: (01:07:04)
Oh, there’s no question.

Dr. Fauci: (01:07:05)
And I would like to maybe use just a few seconds to get a point-

Mr. Hice: (01:07:09)
Make it quick because I want concise answers, because I want to yield.

Dr. Fauci: (01:07:12)
I yield back to you, all right?

Mr. Hice: (01:07:13)
Okay. All right. Thank you. One of the issues and I do appreciate the cooperating spirit here today. I know Brad Snyder and I, we’ve 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’s critical to our country. And I’m curious specifically on the medical supplies and medical devices, are we going to be facing a shortage?

Speaker 1: (01:07:49)
We have.

Dr. Fauci: (01:07:53)
Yeah. 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. Fauci: (01:08:03)
… Which is, but Dr. Kadlec knows more about that than I do.

Dr. Kadlec: (01:08:04)
Sorry, 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. And so, they have had that responsibility. I’m looking at particularly the things that we need for this outbreak right now, and I just want to highlight the issues around personal protective equipment. Much of it is sourced from overseas, some of it is domestically manufactured. And yes, we could have spot shortages. We’re working with different companies in different sectors to see to enhance both their increased capacity here domestically, as well as obtaining supplies overseas, from overseas unaffected areas to meet the demand. The most important demand is with healthcare 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: (01:08:53)
Okay, 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?

Initially the regulations were in fact there, and that’s why we had to go through and get approval. The commissioner actually gave regulatory relief, so that any individual now can go back and [crosstalk 01:09:24]-

Mr. Hice: (01:09:24)
But you just answered a moment ago that we cannot purchase those tests from South Korea. So, and you said because of regulatory interference. My question is, can those regulatory requirements be waived in a national emergency?

I would have to refer that to the commissioner of the FDA.

Mr. Hice: (01:09:40)
Okay, 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?

I would say our tests are accurate. I’m not going to compare it to theirs.

Mr. Hice: (01:09:53)
Okay, I just want to know if we’re talking apples to apples, or something else. So far as you know, the South Korean tests are accurate as well?

I would assume. I can only comment that our tests are accurate.

Mr. Hice: (01:10:05)
All right. With that, I want to yield to the gentleman from Tennessee.

Mr. Green: (01:10:09)
Congressman 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?

Congressman, you’re referring to the test, actually, the test that we’re currently using and they’re using to detect acute infection, is to measure the antigen that’s in the oral, nasal or pharyngeal space. And they’re actually using a molecular test for that. What you’re referring to is the test that we’re 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’re evaluating right now, so we can get an idea through surveillance, what’s the extent of this outbreak? How many people really are infected? And that has been moved out now to do these extensive surveillance programs.

Mr. Green: (01:11:23)
Madam chairman, can I get one more question on that same line? I can wait for someone else to yield, thank you.

Maloney: (01:11:30)
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 00:01:11:41]. He’s recognized for five minutes, and I [crosstalk 01:11:44] appreciate his help on this hearing.

Congressman Lynch: (01:11:45)
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. Too important. Well, we didn’t politicize the fact that the global health, and security and bio defense desk at the National Security Council was dismantled by this administration two years ago. We didn’t politicize the funding of health, public health in the United States in budget after budget, that in fact, made critical cuts which we restored. We aren’t the ones that called the alarm being raised about this pandemic as 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 to the CDC with you, Dr. Redfield, he 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 tests we needed, we didn’t have the diagnostics we needed. The president made patently false assertions, which Dr. Fauci correctly 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. And that’s shameful, and you can’t cover that up, and 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’s 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 01:14:11] 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 a victim may be identified.

Speaker 2: (01:14:28)
They corrected that today.

They corrected [crosstalk 01:14:30] that today, but again, this confusion. Do we close things? Is it a certain number that we’re worried about? When do people get tested? How do they get tested? What’s the guidance of 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 uniform guidance, granted one size does not fit all, but that doesn’t mean there’s no guidance at all and no protocols that states and localities could refer to. Would you comment?

Thank you, a very important question. First, we do have very specific guidance for a variety of things the CDC has published. Really targeting more business community, hospitals, longterm 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 say, yesterday we did post for everyone a 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 longterm care facilities, what to do for the workplace, what to do for community and faith organizations, what to do for the health care setting. Because I couldn’t agree with you more, that we want to give guidance and we’ve 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 this.

And if I could just quickly ask Dr. Fauci, was it a mistake that, Dr. Fauci, do you believe to dismantle the office within the National Security Council charged with global health and security?

Dr. Fauci: (01:16:17)
Well, 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.

Well we have a bill to solve that, a bipartisan bill. I thank you and I thank the chair.

Maloney: (01:16:31)
Thank you. The gentleman from Wisconsin, Mr. [Grothman 01:16:34] is recognized for five minutes.

Mr. Grothman: (01:16:37)
Thank you. I’d like to … I appreciate you all being here. I bet I’ve had a chance to talk to maybe five or six different panels since this crisis broke, and I’m glad you’re all so ready to come to Washington. I’m going to talk a little bit about, I’m not sure yet the public overall is in line with the things you’re telling us. I think in part that’s because in the past we’ve 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 is not, 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 in the United States. The things I have here show that right now in China, there have been about 3,000 deaths. Do you guys agree that probably the worst is over in China, or do you think that number’s going to continue to escalate or slowly drop?

I think China is a great sign of encouragement. They had, in the last couple of days, they’ve really gotten down to under 50 cases per day. So they really have now got control of their outbreak.

Okay. 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 were three weeks, a month, or how far are we into this situation in the United States?

Yeah, I think that’s 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. So they had almost 1,800 infections to confirm just last night.

Right.

So we are fighting hard now, between our containment strategy and as Dr. Fauci will say, the expanded mitigation.

Right, let’s compare it to something the average American understands, and that’s 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: (01:18:45)
Yeah. I can’t give you a precise number, sir, but one of the things we’re trying to emphasize to the American people …

Well I only have my five minutes. Can you tell us about how many people say get the flu every year, and how many new people are diagnosed?

Dr. Fauci: (01:18:58)
Get the flu. I didn’t hear you, I’m sorry.

Right.

Dr. Fauci: (01:19:01)
About five percent or so, to ten percent of the population. We have about 30,000 deaths. It ranges from 15,000 to about 69, 79,000 per year.

Okay. Based upon the current trajectory, how many people would you think will get this new virus, and how many people would you think will die?

Dr. Fauci: (01:19:20)
Cannot predict, and that’s-

I know you can’t predict, but we 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 give us some projections?

Dr. Fauci: (01:19:34)
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-

I’m not asking to be complacent. I’m asking for a realistic, I mean, that’s what the public is looking for-

Dr. Fauci: (01:19:47)
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 be involved in many, many millions. If we taught to contain, we could flatten it. So there’s no number answer to your question until we act upon it.

I’ll give you a question now. We mentioned earlier today that, I think one of the basketball tournaments, I think for the Ivy League, they’ve cut off their tournament all together. On the other, nobody talks about every night they play, I don’t know, eight to 10 NBA games and nobody talks about shutting them down. Is the NBA under-reacting or is the Ivy League overreacting?

Dr. Fauci: (01:20:36)
We would recommend that there not be large crowds. If that means not having any people in the audience [crosstalk 01:20:44] when 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.

I’ll 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 new flu?

Yes. So 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’ve seen are over the age of 70.

Okay. I’ll yield. Maybe give Dr. Green another chance to ask a question.

Mr. Green: (01:21:28)
Thank you. Very quickly, Dr. Fauci, you took the Hippocratic Oath, right? You took the Hippocratic Oath? Okay, are you offended by someone suggesting that you might intentionally not speak out when you’re confronted with something that could harm your patients and violate your Hippocratic Oath?

Dr. Fauci: (01:21:46)
Yeah, I just made that point a few moments ago. As I’ve 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 HW Bush, I 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.

Maloney: (01:22:15)
Okay. The gentleman from Illinois, Mr. [Krishnamoorthi 01:22:20] is recognized for five minutes.

Mr. Krishnamoorthi: (01:22:22)
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 tests. I want to understand why.” Director Redfield, Director Redfield over here. The first Coronavirus case in the US 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 4th, isn’t that right?

[inaudible 00:15:07].

Unfortunately, however, testing did not get underway because of problems with the test kits. Specifically, CDC’s Atlanta manufacturing facility had quality control problems. On February 24th, one month after Coronavirus was found in America, officials discovered that CDCs 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?

This is currently under an investigation at this point, and I think I’m going to leave it there.

Sir, 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 months, 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 had not shipped manufacturing, or we had still not shipped test kits to public labs. Now let’s currently discuss testing efforts underway in the US and other countries.

You have a copy of this chart before you. We talked about South Korea and the US, let me just drill down for a second, because this is very instructive. The US and South Korea both experienced their first confirmed Coronavirus cases roughly within a day of each other. The US on January 21st and South Korea on January 20th. Interestingly, both countries developed a test to diagnose coronavirus roughly around the same time, the US on February 4th and South Korea on February 7th, just three days later. But then, our testing at that point, the activities diverged dramatically.

Here we have a chart that shows the testing activities of four countries, the US, South Korea, Italy, and the UK on three separate dates and then in the past three weeks. You see, from zero ’til March 10th, 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?

I don’t see it on that graft.

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’s a response, a testing response that’s almost 300 times more aggressive than what’s 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 four million tests will be distributed.” But the real question I submit is not when the tests will be distributed, it’s 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’s 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?

Well first I’d 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. As for clinical medicine, we count on the private sector to work together with the FDA to bring those tests to bear, and I said finally-

So you’re blaming the private sector-

I’m not blaming, I’m just-

You’re passing the buck to the private [crosstalk 01:27:53] sector. Sir, because of this the virus is spreading, people are getting sick, people are dying. Thank you.

Maloney: (01:28:02)
The gentleman yields back. The gentleman from Kentucky, Mr. [Comer 01:28:05] is recognized for five minutes.

Mr. Comer: (01:28:07)
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’re having now. And I was very glad to see Congress come together last week, in a bipartisan way, after we’ve spent many months in a 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.

Mr. Comer: (01:28:45)
But I’ve 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’re 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’re just fooling around. It just reminds me so much of Katrina.”

Mr. Comer: (01:29:34)
Now 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 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 early decision to cut off the border, which has undoubtedly given the CDC and health officials time to prepare for this outbreak. I’m not confident the last administration would have made that decision, for fear of political incorrectness or whatever.

Mr. Comer: (01:30:25)
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’s a lot of concern, there’s a lot of misinformation. So my simple question would be, to anyone on the panel, which are the best websites for concerned Americans to get onto, that have factual information and important tips on how average, everyday Americans can prepare for this?

Dr. Fauci: (01:30:56)
So there are two. 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: (01:31:09)
Okay. So my next question to anyone on the panel, in the era of fake news and social media, how can Americans ensure that the information that they’re sharing on their social media, is accurate information? Do you have any advice on that?

Dr. Fauci: (01:31:34)
Yeah, 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 the one to go to the source of the data, CDC. And I’m not CDC, but I’m 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: (01:31:59)
We’ll make sure our office, I’m 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 in Kentucky and Tennessee. But, can you tell us what is being done to ensure that there’s not an outbreak, first of all, on our military bases to protect our troops? Secondly, 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: (01:32:35)
I’ll take that one.

Mr. Comer: (01:32:36)
Yes.

Dr. Rauch: (01:32:36)
Thank you for the question. So we have put out a series of force health protection guidance that is aligned to the CDC recommendations. And we have tailored that guidance for force health protection, for military commanders and particularly for installation commanders. And 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’re also doing is working with the inter agency efforts to develop vaccines, and also to develop antiviral treatments. And we are working with the inter-agency to develop what we call expeditionary field diagnostic kits, because we want kits that we can push far forward, because we have missions all over the world. We need to get our medical capability distributed.

Mr. Comer: (01:33:58)
Well thank you, and hopefully Congress can work with you all, in a bipartisan way, we can come together and help do everything we can to protect American lives. With that, Madam chair, I yield back.

Maloney: (01:34:10)
Thank … The gentleman from Maryland, Mr. [Raskin 01:34:15] is recognized for five minutes.

Mr. Raskin: (01:34:17)
Thank you. Dr. Fauci, we’ve got two enemies in this crisis. One is the virus and one is 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: (01:34:44)
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’ve got to assume that it’s going to get worse, and worse and worse.

Mr. Raskin: (01:35:28)
Okay. 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: (01:35:39)
No, I made myself clear in my statement.

Mr. Raskin: (01:35:42)
Okay. All right, Dr. Redfield, the first case of community spread of Coronavirus took place on February 26th. 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 26th to expand your testing criteria for anyone displaying Corona-like symptoms at that point, instead of waiting until March 4th to broaden the criteria?

Well, that’s a good question, Congressman. I mean, we always left the discretion to do testing to the local public health group. 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. That 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 suspected and the health department suspected, they should send that sample to the health department or out to CDC.

Mr. Raskin: (01:36:50)
Okay. We’ve been hearing stories about people who have had very compelling reasons to get tested but were not able to. I’ll 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 5th, the day after you brought in the testing criteria, she put out a statement about her situation and she said, 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 had the Coronavirus.” Are you familiar with this case?

No, and I would think that this is a misunderstanding if it did occur.

Mr. Raskin: (01:37:34)
Okay, so, what is the standing criteria, the existing criteria for testing now? So we have no confusion about it.

Again, it’s if a clinical physician, a physician, nurse practitioner or health care provider feels a test is indicated, then we-

Mr. Raskin: (01:37:53)
Based on what?

Based on their clinical assessment.

Mr. Raskin: (01:37:56)
And that’s based on the … Does it require that the person have to have had contact with someone who had been on a cruise or [crosstalk 01:38:04] who’d been to [crosstalk 01:38:04]-

This is their clinical assessment. We’re not going to judge the clinical assessment. We also say, if it’s the clinical assessment of the … Or if it’s the assessment of the public health department, that 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, but they have followed CDC guidance. Now, we’ve made it very clear, it’s up to the individual healthcare provider and the individual public health to make that decision.

Mr. Raskin: (01:38:33)
Okay. 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?

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’re concerned they may have Coronavirus infection, and then follow their instructions to where to get the test, right? And then proceed with getting the appropriate clinical evaluation.

Mr. Raskin: (01:39:09)
Okay, so they should call someone before they go in-

Well, we’d like to do that, because if you really think you’re infected, we’re trying to avoid someone to walk into a 200 person, 100 person emergency room first, to just to call in advance and then they’ll arrange exactly how they’re going to get the test, how they’re going to see the patient. They’re going to be prepared when that patient comes to the emergency room, that they’re going to be able to isolate them, get them tested, get them properly evaluated.

Mr. Raskin: (01:39:34)
Okay. Thank you for your work on behalf of the American people. I yield back, Madam chair.

Maloney: (01:39:37)
Well, thank you. The gentleman from Texas, Mr. Cloud is recognized for five minutes.

Mr. Cloud: (01:39:43)
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 in how to deal with this and how to address it. It’s been difficult, of course, to get information out to the public, especially in a hyper politicized environment. I’d 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 that 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: (01:40:38)
Okay. 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 nine to 10%. So that’s only 8,000 people. In about a year, in the two and a half months that we’ve had this Coronavirus, as you know, we now have multiple, multiples of that. So it clearly is not as lethal, and I’ll get to the lethality in a moment, but it certainly spreads better.

Dr. Fauci: (01:41:12)
Probably for the practical understanding of the American people, the seasonal flu that we deal with every year has a mortality of zero point one percent. The stated mortality overall 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’s something that people can get their arms around and understand.

Mr. Cloud: (01:41:57)
But less lethal than H1N1 or SARS?

Dr. Fauci: (01:42:02)
No, absolutely not. H …

Mr. Cloud: (01:42:03)
Than N1H1 or SARS?

Dr. Fauci: (01:42:03)
No, absolutely not. The 2009 pandemic of H1N1 was even less lethal than the regular seasonal flu.

Mr. Cloud: (01:42:12)
Yeah.

Dr. Fauci: (01:42:12)
It was a pandemic.

Mr. Cloud: (01:42:13)
I’m trying to help the American people know where to appropriately set their gauge.

Dr. Fauci: (01:42:17)
I think you set 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 flu does that.” The flu has a mortality of 0.1%.

Mr. Cloud: (01:42:30)
Sure.

Dr. Fauci: (01:42:30)
This has a mortality of 10 times that.

Mr. Cloud: (01:42:32)
Okay.

Dr. Fauci: (01:42:33)
And that’s the reason why I want to emphasize we have to stay ahead of the game in preventing this.

Mr. Cloud: (01:42:38)
Can we speak to the supply chain for a second, Dr. Kadlec, we’re 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: (01:42:58)
Sure. I know there’s been a run on Purell, but I think soap and 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, cover a sneeze, don’t touch your face, and again, ensure that you continue to wash your hands.

Mr. Cloud: (01:43:16)
In understanding in the legislation we just passed last week too, you know, face masks for health professionals. Of course, not for every citizen walking around, but for health professionals.

Mr. Cloud: (01:43:25)
Then, we have the U.S. supply that could provide them, but we … House leadership didn’t put the legal framework in it necessary. Is there anything the FDA is doing to to allow U.S. based companies to participate better?

Dr. Kadlec: (01:43:36)
Sir, 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. Basically making that available for increased use, so their numbers will be increased.

Dr. Kadlec: (01:43:56)
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’s a high number. That’s a model. All models are wrong, but some are useful. The number could be low as 600 million.

Dr. Kadlec: (01:44:12)
What we’re doing now is we’re 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’re issued a request for proposal for 500-

Mr. Cloud: (01:44:27)
I’ve got time for one more question if I [crosstalk 01:44:28]-

Dr. Kadlec: (01:44:28)
Yes, sir. Sorry.

Mr. Cloud: (01:44:29)
Regarding testing, Dr. Fauci, we’ve had people calling 911 showing no symptoms, asking for an ambulance to take him 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 kinds of questions. Who should be really concerned about this?

Dr. Fauci: (01:44:51)
Okay. So, very briefly, as Dr. Redfield has responded multiple times on this, there were really two two buckets, if you want to call it … If you have someone who has a reason to believe that they’re 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 or exposed. That’s something where you go to a physician, you get a test and you find that if an individual is infected … The other that was discussed a fair amount over the last several minutes is a surveillance type where you’re not looking to see if anybody’s been exposed, but you want to find what the penetrance of this particular infection is.

Dr. Fauci: (01:45:35)
That’s a different thing than the physician-patient relationship. That’s trying to get a feel for what’s out there. And that’s what the CDC is doing now in six sentinel cities and they will expand that throughout the country.

Dr. Fauci: (01:45:49)
So that we will be able to, hopefully very soon, to get an idea for getting the people who think they may be infected, who actually is infected.

Mr. Cloud: (01:46:01)
Thank you.

Maloney: (01:46:02)
Time has expired. The gentleman from California is recognized for five minutes.

Mr. Rouda: (01:46:07)
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’s exactly what we need.

Mr. Rouda: (01:46:23)
In times like this communication is so important and if you’re going to err on one side or the other, over-communication clearly is more important than under-communication.

Mr. Rouda: (01:46:34)
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 your peers.

Mr. Rouda: (01:46:45)
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 the 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.

Mr. Rouda: (01:47:05)
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: (01:47:19)
Yes sir.

Mr. Rouda: (01:47:22)
I think another way to say it too, it’s not a question of if, it’s 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: (01:47:35)
Yes, sir.

Mr. Rouda: (01:47:36)
Thank you. One of the issues too 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, that 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?

We have provided test kits to the health department. The University of Washington has developed their own tests that-

Mr. Rouda: (01:48:20)
Were those test kits available last Friday?

Yes, sir.

Mr. Rouda: (01:48:22)
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’s quite possible that they actually had COVID-19?

The standard practice is the first thing you do is test for influenza. If they had influenza, they would be positive for [crosstalk 01:48:48]-

Mr. Rouda: (01:48:47)
But only if they were tested. So, if they weren’t tested, we don’t know what they had.

Correct.

Mr. Rouda: (01:48:51)
Okay. And if somebody dies from influenza, are we doing post-mortem testing to see whether it was influenza or whether it was COVID-19?

There is a surveillance system of death from pneumonia that the CCC has. It’s not in every city, every state, every hospital.

Mr. Rouda: (01:49:06)
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?

Some cases have been actually diagnosed that way in the United States to date.

Mr. Rouda: (01:49:17)
Thank you. I want to turn a little bit to the CDC website, because I appreciate the information that you’re putting out and it’s so important to the American public. But I also want to make sure that they fully understand that on the CDC website is published a guide called quote, “Framework for Mitigation, Actions for Protecting Communities from COVID-19.”

Mr. Rouda: (01:49:41)
In that graph, it provides three levels of transmission. None, in other words you’re in a community where there is no reports of any cases whatsoever. The second area is minimal to moderate and the third is substantial.

Mr. Rouda: (01:49:59)
Dr. Redfield, how many cases of coronavirus are considered to be quote, “minimal to moderate?”

Right now when we see basically a transmission cases, particularly if they’re non-linked, we’re looking at cases in the 25 to 50 range to see that groups begin to move into the moderate range, sir.

Mr. Rouda: (01:50:23)
Okay, thank you. That’s 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.

Mr. Rouda: (01:50:33)
So, then substantial, I would assume that is when you have 50 cases or more in your community you can consider it substantial?

Yes, sir.

Mr. Rouda: (01:50:40)
Okay. 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 other places, major events being canceled or rescheduled. This would suggest this is a really serious issue. I share the thoughts of the member from Wisconsin that I think we’re concerned that we’re 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.

Mr. Rouda: (01:51:21)
Can you elaborate a little bit? I get that there’s no perfect model, but can you be helpful in helping us understand what we’re really looking at here?

Dr. Fauci: (01:51:31)
Yeah. If you look at the curves of outbreaks historically that are similar to this, the curve looks like this and then it goes up exponentially.

Dr. Fauci: (01:51:41)
That’s 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. I used the analogy at the press conference yesterday and I’ll use it today. It’s the old metaphor, the Wayne Gretzky approach. You skate not to where the puck is, but to where the puck is going to be.

Dr. Fauci: (01:52:07)
If we don’t do very serious mitigation now, what’s going to happen is that we’re going to be weeks behind and the horse is going to be out of the barn. That’s the reason why we’ve been saying even in areas of the country where there are no or few cases we’ve got to change our behavior. We have to essentially assume that we are going to get hit and that’s 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’s when you do it. Because we want this curve to be this. It’s not going to do that unless we act now.

Mr. Rouda: (01:52:52)
Thank you, doctor. Madam Chair, I yield back.

Maloney: (01:52:54)
Thank you. Thank you so much. The gentleman from Ohio, Mr. Gibbs is recognized for five minutes.

Mr. Gibbs: (01:53:01)
Thank you Madam Chair. And thank you all for the work you’re doing. It’s a huge challenge, and I know the stress you must be under, and can never thank you enough because I think the CDC and all our agencies are doing the best they can [inaudible 01:53:15] this unprecedented circumstance.

Mr. Gibbs: (01:53:18)
I also was glad to see Governor Newsom of California come out and say some good things, what the administration is doing that help, and I think the governor of Washington State did the same.

Mr. Gibbs: (01:53:28)
Also, I talk about a 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 being, kind of put, “Take the lead on this.” Head this up because he’s not a medical professional.

Mr. Gibbs: (01:53:48)
I would think when I look at this, that a person at that office, that level of that office, that helps bring the agencies together maybe help clean out some of the red tape and bureaucracy. Would you concur that that’s been helpful to have that level? To have the top level of our government involved at that level for your working relationship, especially if you’re working between agencies?

Dr. Fauci: (01:54:09)
Yes sir.

Absolutely.

Mr. Gibbs: (01:54:11)
I just wanted to make that point because I hear that criticism and I think that they’re either being political or they don’t know what the heck they’re talking about. Probably a little of both.

Mr. Gibbs: (01:54:21)
I also think it’s amazing. I want to praise the work CDC has done to develop a test in one week. Is that unprecedented? To develop a test [inaudible 01:54:33]?

I’m going to have my friend Dr. Fauci answer.

Dr. Fauci: (01:54:36)
I mean, obviously the technologies of today of 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 [crosstalk 01:54:47]-

Mr. Gibbs: (01:54:47)
And I fully understand the vaccine, because you’ve got all the testing to make it safe and the efficacy and all that. But we’re relatively close for an anti-viral.

Dr. Fauci: (01:54:58)
You know, you say relatively close. We don’t know if it works. So, I don’t want to promise anything. We’re 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: (01:55:11)
I do want to talk a little bit about the timeline. It broke in China. And then South Korea, Japan, Italy and the United States. Elsewhere, as you say, it’s really mushroomed. Seems to me, when I think about this, the next four weeks for us are really critical. Because can we kind of maybe think we’re getting information out of China?

Mr. Gibbs: (01:55:33)
I know sometimes it’s not reliable, but also we’re seeing it happening in South Korea, and Japan and maybe they’ve peaked a little bit, and maybe they’re on the better side of that curve now?

I think you’re right, Congressman, clearly China has got control of their outbreak. They had 20 cases in the last 24 hours. Where our real threat right now is Europe. That’s 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: (01:55:58)
Okay. But I praise you for, Dr. Fauci, talking about doing as much mitigation as we can. It’s critical. But, I think would you concur that my assessment, the rest of this month, the next four weeks is a real, real critical time for us?

Dr. Fauci: (01:56:16)
It’s critical. Yes. And it’s critical because we must be much more serious as a country about what we might expect. We cannot look at it and say, “Well, there are only a couple of cases here. That’s good.” Because a couple of cases today are going to be many, many cases tomorrow.

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 the time for everyone to get engaged. This is not just a response for the government and the public health system. It’s a response for all of America.

Mr. Gibbs: (01:56:57)
I understand that. Another thing that’s not really being reported, because it doesn’t, it’s not as … Raises the ratings [inaudible 01:57:03] when they talk about the number of cases and the number of fatalities. But also I see in the reports worldwide, we have a better than a 50% recovery rate. Is that true? Right?

Right now we’d say it’s probably about 85%, sir.

Mr. Gibbs: (01:57:19)
85% are people are affected-

Are recovering. 80 to 85. About 15 to 20%-

Mr. Gibbs: (01:57:26)
Okay, it’s even better than I thought. I was looking at the Johns Hopkins test, that real time chart. There’s like 120,000 confirmed cases and about 60,000 or something like that.

Dr. Fauci: (01:57:35)
Real time, when you look at the chart, it’s about half.

Mr. Gibbs: (01:57:38)
Okay.

Dr. Fauci: (01:57:38)
But at the end of the day, if you look at historically … For example, the experience we’ve had with China, about 80% of them have disease that makes people sick, but they ultimately recover without substantial medical intervention. It’s the 15 to 20% that have the serious disease and higher mortality.

Mr. Gibbs: (01:57:56)
And the bulk of them would have been people with underlying health conditions and over 70, right?

Dr. Fauci: (01:58:04)
The elderly as well as people with underlying conditions like heart disease, lung disease.

Mr. Gibbs: (01:58:08)
I’m out of time. I just want to say, I think we just 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’re going to go over this in due time with all the good work you’re doing. Thank you [inaudible 01:58:20] back.

Maloney: (01:58:20)
Thank you. The gentleman from California, Mr. Khanna is recognized for five minutes.

Mr. Khanna: (01:58:26)
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. Appreciate your service. And Dr. Redfield, I think it’s important to realize that you’ve served our country in the army. You’ve served this nation. We need to be focused not on personalizing this, but figuring out what we can do to solve the issue.

Mr. Khanna: (01:58:49)
Now, one of the things that I think this 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.

Mr. Khanna: (01:59:07)
The CDC budget is 11 billion dollars, 1.5% of our defense budget, 738 billion dollars. 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 it at 3% of our national defense budget in our capacity?

Thank you, Congressman. I think it’s important to realize that for decades we’ve under invested in the public health infrastructure of this nation. As many of you know, CDC is funding that we get from Congress. About 70% of it goes out to local and state, territorial and tribal health departments. They’re the backbone of our health system. 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 monitorization and predictive analysis, laboratory capacity at the local public health labs, making sure we have the human personnel in the public health communities. The rapid response fund that we’re very appreciative to Congress gave us. And build a global health security platform for the 2030 [crosstalk 02:00:17]-

Mr. Khanna: (02:00:17)
And Dr. Redfield, while you have the country’s attention, how much would that cost? Because right now we’re spending, I think most people realize this is a national security issue. And we’re putting 1.5% into the CDC of the defense budget. The NIH budget is 41 billion, which is less than 5% of national security? Why isn’t there a bipartisan call to double these budgets, triple these budgets? What would you ask the American people and congress to prepare?

I appreciate the opportunity, Congressman, and I’d have to get back to you with an exact estimate of all that for you.

Mr. Khanna: (02:00:52)
Dr. Fauci, do you have a view?

Dr. Fauci: (02:00:54)
Yeah, I mean, we’ve 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’s inconsistency at times. But luckily over the last four or five years congress has been quite generous with us.

Mr. Khanna: (02:01:10)
One question I do have is the WHO had tests. Some of the other countries use these tests. Why shouldn’t we be using these tests?

I think it’s important to understand about the key for proving tests 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 for public health. I would defer that question to the commissioner, what the exact hoops are for the foreign companies to get their test approved.

Mr. Khanna: (02:01:49)
Do you think we need to look at streamlining in these types of crises approval for things like WHO testing, which is, 60 other countries are using? Or, there are stories in the New York Times about how leading scientists had come up with tests in Seattle that weren’t approved? There’s got to be a better way of getting these tests out there.

I will say that … And 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 a laboratory developed test. The commissioner did though, I think it was on February 29th, issue regulatory discretion, so the University of Washington, or say, Columbia, could actually develop their own test 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: (02:02:45)
Let me ask one final question. I genuinely believe that we have the most brilliant scientist entrepreneurs in the world in the United States. The question is, if we want to come up with an anti-viral treatment, vaccine treatment, what is it … 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 that the scientists, and the technology and the entrepreneurs can solve this?

Dr. Fauci: (02:03:16)
From the NIH standpoint, it’s the consistency of funding, which thankfully you’ve been able to do. Back in 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 two years we’ve had a good, consistent increase. What you can do is continue to give the kind of investment in biomedical research that is consistent and predictable.

And I would say first and foremost, the most important thing that you already have done is the establishment of the Rapid Response Fund. 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 in enabling CDC to have a rapid infectious disease response fund, I think is really one of the most important tools we have right now. You all have started to do that already and we’re very thankful.

Maloney: (02:04:17)
Thank you for that important point. The gentleman’s time is expired. Let me intervene here. I’ve 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’s not what your staff just told us.

Maloney: (02:04:42)
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.

Speaker 3: (02:05:02)
Madam Chair?

Maloney: (02:05:03)
We have asked your staff if you can come back and resume this meeting at 2:00, after your meeting at the White House. They have not responded to our request.

Speaker 3: (02:05:14)
Madame Chair?

Maloney: (02:05:14)
I am not going to adjourn this hearing. I am going to recess it. We haven’t even gotten through half of our members-

Speaker 3: (02:05:23)
Madame Chair?

Maloney: (02:05:23)
On either side of … Excuse me, I am-

Speaker 3: (02:05:28)
When you have a moment.

Maloney: (02:05:29)
No, I am finishing my statement. We 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.

Maloney: (02:05:43)
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.

Maloney: (02:06:18)
So, I have one last question. Will you commit to producing the information we requested at least regarding testing? Dr. Fauci.

Dr. Fauci: (02:06:31)
Madam Chairperson, I’m not sure what information you’re referring to that we did not provide. We’re talking about the National Institute of Allergy and Infectious Diseases.

Maloney: (02:06:40)
We sent a letter with all the subcommittee chairs and myself requesting information to every department.

Dr. Fauci: (02:06:49)
Okay.

Maloney: (02:06:49)
Yours, the CDC, FDA.

Dr. Fauci: (02:06:52)
I will check this immediately after to find out what the issue is.

Maloney: (02:06:56)
Thank you. Thank you very much.

Mr. Roy: (02:07:00)
Madam Chair, may I interject here for one second? I’ve got a timely issue, I know you all need to go down to the White House [crosstalk 02:07:03]-

Speaker 3: (02:07:03)
Madam Chair, I do as well. I have a very specific district related question, there are people in danger [crosstalk 02:07:09]-

Mr. Roy: (02:07:09)
Madame Chair, I’ve got the floor here for [crosstalk 02:07:12]-

Maloney: (02:07:12)
Please, we will yield to the ranking member, then to the gentle lady from Florida for the last question.

Speaker 3: (02:07:18)
Thank you.

Mr. Rouda: (02:07:18)
I think the chair [crosstalk 02:07:19]-

Speaker 4: (02:07:19)
Madame Chair, with all due respect, I believe I was next in line. If we’re not going to follow committee procedures-

Maloney: (02:07:26)
Point well taken.

Speaker 4: (02:07:27)
Thank you very much, ma’am.

Maloney: (02:07:27)
Regular order, regular order. We are going to recess-

Mr. Roy: (02:07:31)
[crosstalk 02:07:31] But, as ranking member-

Maloney: (02:07:32)
After I recognize the ranking member for his closing statement.

Mr. Roy: (02:07:35)
Well, I appreciate the Chairwoman. We all recognize the importance of what’s going on here. I think it’s important to have level heads about what’s happening. We want to make sure that you guys can go do your work.

Mr. Roy: (02:07:45)
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 gentle lady from Florida has extreme concerns of urgency to the people that she represents. I can tell you that I do, representing San Antonio.

Mr. Roy: (02:07:59)
I sent a letter, Dr. Fauci, to the Department of Defense two and a half weeks ago and I’ve 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.

Mr. Roy: (02:08:16)
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 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.

Mr. Roy: (02:08:32)
I think that right now we’ve got 380 evacuees heading to a base in San Antonio. Yet, I’ve 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.

Mr. Roy: (02:08:49)
So, I expect you all to come back down here today in accordance with what the chair is asking for so that we can have those questions answered. Thank you.

Maloney: (02:08:55)
Well, responding to the ranking member, will you all be back at 2:00 today?

Dr. Fauci: (02:09:10)
We’re going to have to just … The reason I’m saying that, Madam Chairperson, is that we have a task force meeting at … What time is it?

Dr. Kadlec: (02:09:20)
3:30.

Dr. Fauci: (02:09:21)
We have a task force meeting at 3:30 in the White House. I will get myself down here at 2:00 if you would like me down here, but I would have to be at the task force meeting at 3:30 in the White House. I don’t know how we’re going to work that.

Maloney: (02:09:33)
We’ll continue discussion … We’ll stand at recess so that you can get to this meeting.

Dr. Fauci: (02:09:39)
All right.

Maloney: (02:09:39)
We are in recess.

Dr. Fauci: (02:09:40)
Thank you.

Maloney: (02:09:41)
Thank you. Thank you all for your service, your testimony. Tremendously helpful, thank you.

Dr. Fauci and Other CDC & NIH Officials Testify on Coronavirus – March 11

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