Dr. Fauci, CDC Director Redfield Testimony Transcript for Senate Committee on Health, Education, Labor, and Pensions

Chairman Alexander: (01:07) The Committee on Health, Education, Labor and Pensions will please come to order. First some administrative matters based on the advice of the attending physician and the Sergeant at Arms after consulting with the Department of Health and Human Services and the Centers for Disease Control, individuals in the hearing room are seated six feet apart. As a result there is no room for the public to attend in person. Representatives of the press are working as a pool. The hearing may be watched online. An unedited recording will be available on our website, www.health.senate.gov. All of our witnesses today are participating in-person. We thank you for that. Some senators are participating by videoconference. Before I make my opening statement I'd like to say a word about masks. The office of attending physician has advised us that we may remove our masks and talk into the microphone as long as we're six feet apart, so that's why my mask is off right now because I'm six feet away from everybody else, but like many other senators, when I'm walking the hallways or on the Senate floor, I am wearing a mask. People wear masks because CDC has said, "Simply cloth coverings slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others." Chairman Alexander: (02:28) Unfortunately this simple lifesaving practice has become part of the political debate that says this, if you're for Trump you don't wear a mask, if you're against Trump you do. That's why I've suggested that the president occasionally wear a mask, even though in most cases, it's not necessary for him to do so. The president has plenty of admirers. They would follow his lead. It would help end this political debate. The stakes are too high for this political debate about pro-Trump anti-Trump masks to continue. Around here, senators and staff wear masks because we don't want to make each other sick. For example, I was exposed to COVID-19 by a presymptomatic staff member on my way to Dulles Airport and as a result had to self-quarantine for two weeks. The Senate physician told me that one reason I didn't become infected was because the staff member was wearing a mask and that in the physician's word greatly reduced the chances of an exposure. Chairman Alexander: (03:35) It's also a pretty good way to make a statement. I like to wear my plaid mask. Dr. Fauci uses his mask to demonstrate his loyalty to the Washington Nationals. Senator Kaine is either a cowboy or a bandit, I'm never sure which. If you want college football to return this fall, here is what Coach Phillip Fulmer, our athletic director at the University of Tennessee says. "If you really, really want to see some football this fall, wear a mask." That might have more influence than anybody else in Tennessee. The United States is in the midst of a very concerning rise in COVID-19 cases and hospitalizations in many states. The experts in front of us have told us that washing our hands, staying apart and wearing a mask are three of the most important ways to contain the disease and slow the spread of the virus. Chairman Alexander: (04:29) I'm grateful to the Rules Committee, the Sergeant at Arms, the press gallery, the architect of the Capitol, the Capitol Police, our committee staff, both Democratic and Republican, Chung Shek and Evan Griffis and all for their hard work to keep us safe. Now Senator Murray and I will each have an opening statement, then we will turn to our witnesses who we thank for being with us today. Each will have five minutes. We would ask you to summarize your testimony in five minutes and then the senators will have a chance to ask a five minute round of questions. We have full participation today it looks like. It should be an interesting morning. Chairman Alexander: (05:06) Among the casualties of this dangerous and very sneaky COVID-19 virus are the 75 million students who were sent home from school and college in March. Add to the casualties the teachers who weren't prepared to teach remotely and the working parents who suddenly had children at home and who weren't prepared to homeschool. Add the lost sports seasons and the once in a lifetime graduation opportunities, then there were unprecedented dilemmas for administrators and inadequate school budgets. Being sent home from school doesn't rank with the sickness and the death that the virus has caused. The United States has over 2.5 million cases of the virus and over 125,000 deaths according to Johns Hopkins. While states and communities continue to take action to keep people safe, nothing though was more disruptive to American life and nothing was headed back toward normalcy more rapidly than for those 135,000 public and private schools and 6,000 colleges to reopen this fall. Chairman Alexander: (06:12) Earlier this month, this committee heard from college presidents and school leaders about their plans for safely reopening this fall. This hearing is an opportunity for an update and to hear from the nation's top health experts on how headmasters, principals, superintendents, chancellors and college presidents can open their schools safely just a few weeks from now. This committee last heard from today's four witnesses on May the 12th, when three of the four were quarantined and most of the senators were participating virtually. That was one of the first virtual Senate hearings in history, and surely the best watched. Every network carried the two and a half hours of statements and questions and answers from senators. The question before the country today is not whether to go back to school or college or childcare or work, but how to do it safely. Even though COVID-19 has not in general hurt young children and college age students nearly as much as older and more vulnerable Americans, there is some health risk, but in my view, the greater risk is not going back to school. Chairman Alexander: (07:21) Guidance for reopening schools from the American Academy of Pediatricians tells school administrators the following, " Our academy strongly believes that all policy considerations for the coming school year should start with the goal of having students physically present in school." The academy continues, "The importance of in-person learning is well-documented. There is already evidence of negative impacts on children because of school closures in the spring of 2020. Lengthy time away from school and associated interruption of supportive services often results in social isolation, making it difficult for schools to identify and address important learning deficits as well as child and adolescent physical or sexual abuse, substance use, depression, and suicidal ideation. This in turn places children and adolescents at considerable risk of morbidity and in some cases mortality. Beyond the educational impact and social impact of school closures, there has been substantial impact on food security and physical activity for children and families," that's the American Academy of Pediatricians. Chairman Alexander: (08:36) Dr. Lloyd Fisher, the incoming president of the Massachusetts chapter of that Academy of Pediatricians told reporters, "While for most children COVID-19 has not had the devastating and life-threatening physical health effects that have occurred in adults, the negative impact on their education, mental health and social development has been substantial. Nothing can take the place of the daily face to face interaction our children experience when attending school in person," Dr. Fisher said. Many American colleges overall considered the best in the world will be permanently damaged or even closed if they remain in Brown University President Christina Paxson's words, "ghost towns." Mitch Daniels, the president of Purdue wrote in a Washington Post op-ed, "Failure to take on the job of reopening would not only be anti-scientific but also an unacceptable breach of duty." Chairman Alexander: (09:37) So today, in addition to hearing more about the concerning rise in cases and hospitalizations in some states, I'd like to ask our witnesses in their statements and answers to questions to put yourselves in the place of one of America's approximately 14,000 superintendents of school districts or the principal or headmaster of 135,000 schools or as president or chancellor of one of 6,000 colleges and help them answer the question of how to reopen schools and colleges safely. So Dr. Fauci, I hope that in your opening statement or answers to questions, you'll suggest steps a superintendent might take to open schools safely and not only how to keep children safe, but to keep safe the adults, teachers, parents, grandparents, with whom they come in contact. Dr. Hahn, will there be treatments or medicines this fall that will help speed the recovery from COVID-19 or reduce the possibility of death? I believe the fear of going back to school or going anywhere these days is in large part because of the fear of severe illness or even death. If that risk can be lessened by new treatments, it should increase confidence in going back to school. Chairman Alexander: (10:58) I'd also like to commend Dr. Hahn and the work the FDA did to get tests on the market quickly as possible, to help understand the spread of the virus. Since then, the FDA has worked out which tests have not worked as well as they should and taken steps to remove them from the market. That's what's supposed to happen in the urgency of a pandemic. Admiral Giroir, at our last hearing, you said you expected there to be 40 to 50 million diagnostics available each month by September. Is that still true? And exactly how does a school district go about making sure it gets those tests and who pays for them? What are the prospects in the shark tank at the National Institutes of Health, that there will be new, reliable and inexpensive tests so we can have even more widespread testing, and Dr. Redfield, you are continuing to work on updated guidelines about going back to school and college safely and are CDC employees going to be available in our states to help work with school districts to develop their plans? What advice do you have about the arrival of the flu season this fall at the same time as COVID-19? Chairman Alexander: (12:13) This is a lot to discuss, but there will be time during the next two and a half hours to answer most of those questions. Let me quickly highlight three areas that have come up in our four earlier hearings this month that I think need clarification, first on contact tracing. No doubt contract tracing is crucially important. It identifies the people who might have been exposed so that they don't in turn expose someone else. According to an NPR report on June 18, states have already hired at least 37,000 contact tracers. State officials in Johns Hopkins Center for Health Security issued a report estimating the need for as many as 100,000 contact tracers. Several reports suggested Congress appropriate money to pay for those tracers. The reality is Congress already has. On April 24, Congress appropriated $11 billion which has been sent to states and tribes for the expenses of testing. That legislation explicitly said the money could be used for contact tracing. This is in addition to $755 million from the first emergency appropriations legislation on March 6 that could be used for contact tracing, and that's in addition to the March 27 legislation in which Congress appropriated $1.5 billion in the CARES Act for states, territories and tribes to use for COVID preparedness and response. Chairman Alexander: (13:54) The CARES Act also includes the $150 billion to states but a significant amount of that $150 billion has not been spent even though it is all designated for expenses related to COVID-19 which include contact tracing. For example, Tennessee's governor has told me he is reserving as much as a billion of that so that he could determine what flexibility he has in spending the money. Washington State has not spent as much as $1.2 billion. Missouri State Treasury says they've not spent about a billion. According to the report by state health officials in Johns Hopkins an average salary for a contact tracer would be a little more than $35,000.00. This adds up to about $3.5 billion for 100,000 contact tracers. So the point is Congress has already sent to states plenty of money to hire all the contact tracers that are needed. Chairman Alexander: (14:56) Second, who pays for the testing? In the CARES Act, Congress voted to make all COVID-19 tests available to patients at no cost. This meant insurers would cover diagnostic tests, which detect whether a person is currently infected with the virus, and also antibody tests, which indicate whether a person has had COVID-19 in the past and now may have some protection in the future. Guidance from the Labor Department, Treasury Department and Centers for Medicare and Medicaid Services said last week that insurers are only required to pay for tests without patient cost sharing if a doctor orders it. I agree with that, but given that the CDC specifically recommends doctors order tests in two situations, when a person has signs or symptoms of COVID-19, or recently had contact with someone known or suspected to have COVID-19 who pays for the testing at other times. Chairman Alexander: (15:59) I believe Congress will need to take action to further clarify who pays for the testing at other times. For example, the school may want to do random testing. Perhaps it should make an arrangement with the state to pay for that. Or perhaps Congress needs to provide more money to pay for that. If an automaker wants to test all of its employees at the plant every two weeks, perhaps the automaker should pay for that. Or perhaps the state would want to pay for that. That needs to be clarified. Chairman Alexander: (16:27) Finally, flu shots. CDC has said more people need to get flu shots this fall so healthcare workers can better distinguish between COVID-19 and the flu. CDC says a priority is for all children over the age of six months to be vaccinated for the flu so they don't become sick and pass it to more vulnerable populations who could have more severe consequences. On January 24, Senator Murray and I hosted our first bipartisan briefing on coronavirus at a time when there were only four cases in the United States. Since then, this committee has had four more briefings. Today is our eighth hearing on coronavirus and U.S. preparedness. Last week's hearing was about steps to take this year while our eye is on the ball to better prepare for the next pandemic. I have issued a whitepaper outlining five recommendations for Congress to prepare Americans for the next pandemic. That paper has received more than 350 substantive comments that are available to all members of the committee. After all senators have had a chance to ask their questions, I will conclude the hearing by asking our witnesses if they have two or three suggestions about steps Congress should take this year to deal with the next pandemic, most of which will also help with this one. Chairman Alexander: (17:54) This hearing is about what happens now, as administrators prepare to reopen schools and colleges. Experts underestimated this dangerous and sneaky virus and there is still much we don't know about it, but we do know the basic steps to take to reopen schools and colleges in 2020, before there is a vaccine, and those are these. Social distance, wear a mask, wash your hands, test, contact trace, and isolate those exposed or sick and hopefully by the fall there will be treatments to make the consequences of the disease less severe. I look forward to hearing from our distinguished witnesses, how school leaders and college presidents can safely reopen, 135,000 schools and 6,000 colleges, and also learning the latest developments on testing and treatments that we can expect during the year 2020 before vaccines arrive. Senator Murray. Senator Murray: (18:55) Well thank you very much Mr. Chairman. Thank you to all of our witnesses for joining us here today and of course thank you our staff for setting up the technology so we can hold this hearing safely. I want to get to the point quickly and I'm going to be blunt about it. The COVID-19 response in our country is still a disaster. 126,000 lives lost was once considered an estimate on the high end of the spectrum, but the year is just halfway over and it is now a grim reality. We have lost more Americans to COVID-19 than we lose to the flu each year, than we lost to the opioid crisis last year, and more lives than we've lost than in every American war except the Civil War and World War II. And despite what President Trump claims, this pandemic is not fading, far from it. Several states are seeing rapid record-setting increases and the country just saw its largest single day increase today. While this public health crisis rages across the country, we've seen a leadership crisis raging in the White House as the president proves time after time he cares less about how this pandemic is impacting families and communities and more about how it makes him look. Senator Murray: (20:20) Just consider his appalling continued failure on testing. President Trump said that anyone that wants a test can get a test. They still can't. He said testing was overrated. It is not. He said we prevailed on testing. We have not. Now he's saying we should be doing fewer tests and testing makes us look bad. Well it clearly does not and we clearly need to be doing more. The most honest thing he has said about testing is that he doesn't take responsibility at all and that is exactly the problem. It's why Congress actually took bipartisan action in the last COVID-19 response bill to require the Trump Administration to submit a comprehensive national testing plan, and it's why I'm still pushing for this administration to include more details in that plan and take more steps to ramp up testing. Because we are still nowhere close to the testing and tracing capacity we need to safely reopen our country and ending support for federal testing sites while sitting on billions in testing funds Congress provided is not going to get us there. The ongoing struggle to get President Trump to take testing seriously should be a stark warning to Congress that when it comes to vaccines, we can't just leave this administration to its own devices. We have to hold it accountable. Senator Murray: (21:53) We know this pandemic will not end until we have a vaccine that is safe and effective, that can be widely produced and equitably distributed and that is free and accessible to everyone, which is why we need a comprehensive national vaccine plan from the Trump Administration as soon as possible. Given the testing plan, which Congress only received after forcing the administration's hand, was too little, too late. We need to take the opportunity we have right now to get a vaccine plan much earlier and avoid the missteps we've seen with testing. So I hope Republicans will work with me in a bipartisan way once again to require this administration to put forward a plan. We need the Trump administration to show us how they will ensure a vaccine is safe and is effective. Senator Murray: (22:50) I'm as eager as anyone for a vaccine but this isn't just about doing something fast. It is about doing it right. That's why we need to know the process for developing a vaccine is rigorous, it's inclusive, it's transparent, and it is science-driven, but in light of the hydroxychloroquine debacle and the removal of Dr. Bright from BARDA for questioning the administration's efforts to promote that unproven treatment, we cannot take for granted this process will be free of political influence. We have to demand serious oversight. In order to give the public full confidence that a vaccine is safe and effective, the administration needs to commit now to being fully transparent about the stands a vaccine will be expected to meet and releasing the clinical trial data the FDA uses to evaluate safety and effectiveness. Senator Murray: (23:50) We also need a plan detailing how to produce and distribute vaccines nationwide and make sure everyone can actually get them. We saw with testing how avoidable bottlenecks create damaging delays when the federal government refuses to step in and lead like it needs to do in a time of crisis and unfortunately we saw how existing health disparities are exacerbated without a plan to overcome them as even the incomplete data we currently have shows black, Latino and tribal communities have significantly less accessing to testing than white communities. This is an injustice that we must not repeat when it comes to vaccines. We also need a plan to guarantee vaccines are free so that cost is not a barrier for patients and it's worth noting we still need to act to make COVID-19 treatment available at no cost too. The plan must address barriers like vaccine hesitancy and misinformation, especially when one of the most prominent sources of misinformation so far has been the President of the United States. Senator Murray: (25:03) While the discovery of an eventual vaccine may still be far off, these are issues we need the administration to answer now, so I hope Republicans will work with me to require the administration to submit a comprehensive vaccine plan and address many of the other urgent issues stemming from this pandemic. Our businesses, our workers, teachers, students and families do not have what they need to safely return to work or school, period. Our medical system, doctors, nurses, frontline workers continue to face unimaginable risk, stress and fatigue. They need Congress to step up, to help them continue to save lives and families need us to continue to ensure they have basic services and can keep food on their tables. The House passed the HEROES Act 46 days ago to get more relief to frontline workers, to families and businesses. It is well past time for Leader McConnell and Senate Republicans to sit down with fellow Democrats and get to work. There is no question our country is still in crisis and every day the Senate fails to take action is a day we allow it to get worse. Senator Murray: (26:19) I also hope Mr. Chairman that we will be able to have another hearing on this crisis soon with administration officials whose testimony is long overdue, Secretary Azar, Secretary DeVos, and Secretary Scalia. Thank you Mr. Chairman, I look forward to our witnesses today testimony and the questions that we have for them. Chairman Alexander: (26:41) Thank you Senator Murray. We would ask each witness now to summarize his testimony in five minutes. I'm pleased to welcome our witnesses. Each of you are making significant contributions to our government's response to COVID-19, helping us go safely back to school, back to work. We're grateful for your service to our country. Our first witness is Dr. Anthony Fauci. He is the director of the National Institute of Allergy & Infectious Diseases at the National Institute of Health. He has held this position since 1984. He has led the agency's research related to HIV/AIDS, influenza, malaria, Ebola, and other infectious diseases. He has advised six presidents on domestic and global health issues, he's one of the principal architects of the Emergency Plan for AIDS Relief. In 2014 he was involved in treating Ebola patients at NIH and worked on vaccine trials for Ebola. Next, Dr. Robert Redfield, director of the U.S. Center for Disease Control and Prevention, CDC. For more than 30 years, he has been involved with clinical research related to chronic human viral infections and infectious diseases, especially HIV. He was founding director of the Department of Retroviral Research within the U.S. military's HIV research program and retired after 20 years of service with the U.S. Army Medical Corps. Chairman Alexander: (28:15) Third, Admiral Brett Giroir. Admiral Giroir is the Assistant Secretary for Health at the U.S. Department of Health and Human Services. He oversees the development of the department's public health policy recommendations, specific to COVID-19 response, Admiral Giroir has taken on testing and focused on increasing the number of tests we can do with existing technology. His federal service includes directing the Defense Sciences Office of the Defense Advanced Research Projects Agency and a variety of other important responsibilities. Finally, we will hear from Dr. Stephen Hahn. Dr. Hahn is Commissioner of the U.S. Food and Drug Administration, the FDA. Before joining FDA, he held leadership positions as chief medical executive at the University of Texas MD Anderson Cancer Center and as chair of the Department of Radiation Oncology at the University of Pennsylvania. Early in his career, he was senior investigator at the National Cancer Institute, at the National Institutes of Health. He has been commander of the U.S. Public Health Service Commission Corps in 2005. We welcome our witnesses. Dr. Fauci, welcome, let's begin with you. Dr. Fauci: (29:39) Thank you very much Mr. Chairman, Ranking Member Murray, members of the committee, thank you for giving me the opportunity to discuss briefly with you today the role of the National Institutes of Health and research addressing COVID-19. As you indicated Mr. Chairman, I will during the question period and alluding to in the presentation, address some of the issues regarding schools. The NIAIDNIH strategic plan for COVID research involves four major components. The first is to improve the fundamental knowledge of understanding the biology of the virus and the immune response to the virus in order to better inform us in the development of diagnostics, therapeutics and vaccines. Some of the work that has come out of that program right now informs very greatly how we will address vaccine development, particularly understanding the confirmation of the components of the virus that induce an appropriate immune response. In addition, we will develop and are developing animal models, apropos of what you've mentioned about children in school. We have a program called HEROES which is Human Epidemiology and Response to SARS-Coronavirus which is determining the incidents and transmissibility among children, a very important issue when you talk about opening schools and the impact that might have. Dr. Fauci: (31:01) In addition, the development of diagnostics, point of care sensitive and specific diagnostics under the RADx program, including the RADx-UP for underserved populations. Third, to characterize and test therapeutics. You mentioned the importance of this as we open up schools. There are a number of programs very active that have already shown efficacy or not in some drugs as well as a number of clinical trials that are ongoing. One in particular was the first randomized placebo control trial showing that the drug Remdesivir diminishes by about 32% the time it takes to get to recovery in people with advanced disease, pulmonary involvement. In addition we have another study combining this with an anti-inflammatory agent. Dr. Fauci: (31:52) Next we have vaccines. As several have mentioned, it's extremely important to have safe and effective vaccines available for everyone in this country as well as globally. In that regard, we put together, myself and some of my colleagues and published in Science Magazine a few weeks ago what we call a strategic approach to Coronavirus-19 vaccine research and development. It's not a comprehensive plan about every aspect of vaccine, but it is a strong plan regarding the research and development pathway. What we have done in this is that we have what is called a harmonized effect because we know there are many vaccines that are in trial now at various stages and what we did and the federal government thanks to the generosity of the Congress, has put a considerable amount of money in order to harmonize the trials of multiple candidates from different companies so that we have common endpoints, common data and safety monitoring board, and common immunological parameters that are being funded and are being pursued. Dr. Fauci: (33:03) In addition there are a number of different platforms that are being pursued, so that we don’t have all our eggs in one basket. As you know one of those is right now getting ready as we approach next month of going into phase three trials and others will be staggered along the way in the middle of the summer, end of the summer, early on. There is no guarantee, and anyone who’s been involved in vaccinology will tell you, that we will have a safe and effective vaccine, but we are cautiously optimistic looking at animal data and the early preliminary data that we will at least know the extent of efficacy sometime in the winter and early part of next year. Again, working with the companies and the investment made by this Congress, hopefully there will be doses available by the beginning of next year. These are the things that we feel aspirationally hopeful about, and we will continue to pursue this. I'll stop there, Mr. Chairman, and be happy to answer questions later. Thank you. Chairman Alexander: (34:04) Thank you, Dr. Fauci. Dr. Redfield, Welcome. Dr. Redfield: (34:09) Good morning, Chairman Alexander, ranking member Murray and distinguished members of the committee. I want to thank you for the opportunity to testify before you today with my HHS colleagues. The COVID-19 pandemic is the most significant global public health challenge that we have faced as a nation in more than a century. In the United States, daily cases are increasing after an extended decline. We're seeing significant increases in the Southeast and Southwest regions of this nation. The number of jurisdictions in upward trajectory has continued to increase. Now 29 of 55 jurisdictions fall into this category. Dr. Redfield: (34:50) The evidence tells us that these cases are driven by many factors to include increased testing, community transmission, and outbreaks in the settings such as nursing homes and occupational settings. Hospitalizations now are going up in 12 States, and as of this weekend, daily death now has increased in the State of Arizona. CDC is closely monitoring these increase and have 48 teams, with more than 140 staff currently deployed in 20 States and two territories. Dr. Redfield: (35:23) CDC is providing technical expertise to the health departments in epidemiology, contact tracing, infection prevention and control and communication. Beyond providing this critical boots on the ground, CDC is working with your states and community in other ways. CDC is speaking with the state's tribal, local and territorial health departments on a daily basis to develop strategies to stop COVID while reopening businesses in schools. The initial guidance for institutes of higher learning, which shared in March, in the K through 12 setting was shared in February. Both these guidance's have been since and over the past several months. As more information becomes available, we'll continue to disseminate that more broadly. Dr. Redfield: (36:08) CDC released consolidated recommendations for COVID testing, including interim testing guidelines for nursing homes, as well as testing options for high density, critical infrastructure workplaces after a COVID case is identified. Testing guidance for higher education in K through 12, the higher education should be posted today and K through 12 later this week. These recommendations are consistent with previously published testing guidelines, and are meant to supplement, not replace the guidance of local jurisdictions. Dr. Redfield: (36:41) CDC continues to advance science around the COVID-19 impact in certain populations, and those who are at heightened risk for severe outcomes. Our most recent analysis of the United States case data from the pandemic hospitalizations were six times higher, and death 12 times higher among those with reportedly underlying conditions compared to those who did not have these conditions. We've expanded the list of underlying conditions where the evidence is clear that they put people at higher risk of severe illness. These conditions include chronic kidney disease, COPD, having a weakened immune system from a solid organ transplant, obesity, serious heart disease, sickle cell disease, and type two diabetes. Dr. Redfield: (37:25) Our Analysis also provides further evidence that racial and ethnic populations are disproportionately affected by this epidemic. While data is the backbone of this response, containing the outbreak depends on four core interventions. Readily available testing, comprehensive contact tracing, timely isolation of known cases, and quarantine to break the transmission. We are not defenseless against this disease. We have powerful tools at our disposal. Social distancing, wear face cover in public, and be disciplined about the frequent hand washing. Dr. Redfield: (37:59) It is critical that we all take the personal responsibility to slow the transmission of COVID-19, and embrace the universal use of face coverings. Specifically, I'm addressing the younger members of our society, the millennials and the generation Z's. I ask those that are listening to spread the word. Before I close, I'd like to speak briefly about how CDC is assisting the front lines of our health departments to fight COVID. With your support, CDC has awarded $ 12 billion to 64 jurisdictions. Data monitorization is underway. Public health laboratories are building resilience. Number of contact tracers have grown 345%. The disease impacts us all, and it's going to take all of us working together to stop it. Together, I believe we can achieve the possible. Thank you, and I look forward to your questions. Chairman Alexander: (38:58) Thank you, Dr. Redfield. Admiral Giroir, welcome. Admiral Giroir: (39:03) Chairman Alexander, ranking member Murray, distinguished members of the committee. It's good to see all of you again. First, I want to clarify my current role. On March 12th Secretary Azar requested that I lead the coordination of COVID-19 testing efforts within the department. To be clear, although I am assuming some of my traditional duties as the assistant secretary, I am maintaining my role coordinating testing, including now the NIH RADx Diagnostics Program, along with Dr. Collins, to assure that innovations are immediately translated into practice. Admiral Giroir: (39:38) In order to get back safely to work and school, the overarching, most critical and essential action we must first accomplish is to control the virus. Meaning rapidly extinguishing any outbreaks, and minimizing community transmission. All of us are concerned about recent data from several states, indicating rising infections and now, an uptick in hospitalizations and deaths, even as other states and the majority of counties are maintaining a low infection burden. Knowing what we know now about asymptomatic transmission, and the fact that we are in a much better position today, in terms of our mitigation strategies, PPE, and testing, we can reverse these concerning trends, if we work together. Admiral Giroir: (40:25) First, we must take personal responsibility and be disciplined about our own behavior. Maintain physical distancing. Wear a face covering whenever you can't physically distance. Wash your hands. Stay at home if you feel sick. If you have been in close contact with someone infected, or in a gathering without appropriate precautions, get tested. Shield the elderly and the vulnerable of any age, and follow the guidelines for opening up America again. The criteria are very specific, and are as relevant today as when we released them. In addition, this week, we are initiating surge testing in multiple communities of highest concern, in coordination with state and local officials. Admiral Giroir: (41:14) Now back to schools and businesses. As Dr. Redfield stated, the CDC will release recommendations on K through 12, institutions of higher education, and general business reopening. These will include considerations for integrating testing, especially surveillance testing, into a comprehensive strategy. As you asked me, Mr. Chairman, if you are a superintendent of a school system or a president of a university, number one, apply the CDC guidelines in consultation with your state and local public health officials, so that testing is a part of your comprehensive plan, which should also include prevention and clear mechanisms to isolate positive students. Admiral Giroir: (41:57) Number two, assure your testing needs are incorporated into your state testing plans. As we outlined in the National Testing Strategy, each state has developed and will continue to build upon a customized to state testing plan developed in full coordination with the federal government. The next iteration covering July to December is due on July 10th. These state plans drive the allocation of certain scarce resources. For example, in May and June the federal government has distributed nearly 26 million collection swabs, and over 19 million tubes of transport media. HHS also prioritizes allocation of certain key laboratory tests, like point of care tests, according to state specific needs. Admiral Giroir: (42:45) There are also strategies particularly relevant to surveillance testing, especially in universities and businesses. For example, pooling of samples, meaning combining two or more samples, and possibly up to 10, into a single test makes sense where the prevalence of infection is low, and such pooled surveillance testing can be conducted in a university research lab outside of a CLIA environment. But, if a pooled sample is positive for COVID, every individual in that pool would need to be tested through a health system. Admiral Giroir: (43:18) I would like to close by recognizing my fellow officers in the United States Public Health Service Commission Corps, the uniformed service that I lead. 4,536 officers have deployed to support the pandemic response, exemplifying the care and compassion that all of us feel for those who have suffered during this pandemic. I thank each and every one of these officers and their families, and on their behalf, sincerely thank all of you in Congress for supporting our training needs in establishment of a Ready Reserve Corps, to supplement our ranks during inevitable future national emergencies. Thank you for the opportunity to provide these remarks. Chairman Alexander: (44:03) Thank you. Thank you, Admiral Giroir. Welcome, Dr. Hahn. Dr. Hahn: (44:08) Thank you, Chairman Alexander, ranking member Murray and members of the HELP Committee. I appreciate very much the support that you all have provided for our efforts during this time of COVID-19. FDA has a vital role in the federal government's response to the pandemic. One of our core missions is to advance the public health, by helping to speed medical products that are safe and effective. We have provided appropriate regulatory flexibilities to assure that the American public has access to critical medical products, and safe food, and confidence that our decisions are based on medicine and science. Dr. Hahn: (44:45) Since the public health emergency was declared, FDA has issued more than 100 emergency use authorizations for diagnostic tests, personal protective equipment, ventilators, other devices and drug products. And we have issued more than 50 guidance documents to ensure the continuity of healthcare in the food supply. I am pleased to announce that today FDA is taking action to aid the timely development of a safe and effective vaccine to prevent COVID-19, by providing guidance for developers, with recommendations on the data needed to facilitate manufacturing, clinical development and approval. Dr. Hahn: (45:24) We recognize the urgent need to develop a safe and effective vaccine to prevent COVID-19, and we want to work collaboratively with industry, researchers, and other partners to accelerate these efforts. While the FDA is committed to help expedite this work, we will not cut corners in our decision making, and we are making clear in our guidance, what are the data that we need that should be submitted to meet our regulatory standards of approval. This is particularly as important, as we know that some people are skeptical of vaccine development efforts. Dr. Hahn: (45:58) The FDA strongly encourages the inclusion of diverse populations in all phases of clinical development, including populations most effected by COVID-19, and specifically racial and ethnic minorities, as well as adequate representation in late phase trials of elderly individuals and those with medical comorbidities. We also have information in this guidance about including women who are pregnant, as well as for pediatric assessments of safety and effectiveness. Dr. Hahn: (46:29) The American people should know that we have not lost sight of our responsibility to maintain our regulatory independence, and ensure that our decisions related to all medical products, including COVID-19 vaccines, are based on sound science in the available data. This is a commitment that the American public can have confidence in, and that I will continue to uphold personally. While vaccine research is ongoing, rapid testing and therapeutic development can aid in the safe return to school, college, and the workplace. Dr. Hahn: (46:59) FDA is constantly evaluating new data we receive on testing, so that we can promote the development of new and better tests, and remove tests that are not reliable from the market. And we have put into place an initiative to accelerate the development of treatments, called the coronavirus treatment acceleration program, or CTAP. We've seen some of the consequences of that program, such as the authorization of Remdesivir, and the recent information regarding other therapeutics that might be of benefit to patients with COVID-19. We are working day and night to provide guidance to, and review proposals from companies, scientists, and researchers who are developing therapies for COVID-19. Dr. Hahn: (47:42) We are now preparing for the next phase of addressing this evolving crisis. It is mission critical that the agency constantly evaluate whether our processes are maximal to promote and protect the public health. And therefore, we are beginning a comprehensive, real time review and assessment of our actions to date, to address the COVID-19 pandemic, and I'm glad to answer questions about that review. Dr. Hahn: (48:04) I want to thank the more than 17,000 FDA employees who have been working night and day to help expedite medical products, but also to provide the necessary oversight with the appropriate science and data. We know that the virus remains with us. FDA is committed to doing the critical work that will get the country to the point at which Americans judge it safe to return to work and school, as quickly as possible. I am incredibly proud of the dedicated women and men of the FDA, whose commitment to defeating this pandemic has been unwavering. I can assure you the FDA will continue to provide leadership, expertise, guidance, and information as we continue to address this unprecedented challenge, and fulfill our mission to protect and promote public health. Thank you and appreciate, and look forward to your questions. Chairman Alexander: (48:50) Thank you, Dr. Hahn, and thanks to each of our witnesses. We'll now begin a round of five minute questions. All of the senators are participating today, almost all. And so, I would ask the senators and the witnesses to try to keep each segment within five minutes. Dr. Fauci, assume I'm superintendent of one of 14,000 school districts, and in our community we understand that there are health risks for children going back to school, but we've concluded that the risks to their education, mental health and social development is a greater risk if they don't go back to school. So, what would your advice be to a school superintendent about what he or she should be thinking about his children go back to school in a few weeks, to keep them safe? Dr. Fauci: (49:43) Thank you for that question, Mr. Chairman. It is an important question, but I think we need to point out that it really will depend on the dynamics of the outbreak, and the particular location where the school is. And one of the things we want to emphasize and have been emphasizing, is to take a look at where you are in the particular area of the so-called opening America again. Are you at the gateway, phase one, phase two, phase three? The CDC has guidelines about the opening of schools at various stages of those checkpoints. The basic fundamental goal would be, as you possibly can, to get the children back to school and to use the public health efforts as a tool to help get children back to school. Dr. Fauci: (50:39) Let me explain what I mean. In other words, if we adhere to guidelines of what we've heard in many of these presentations you just heard, about the physical distance in the community, the use of masks, things like that. That will help to keep the level of infection in the community down, which will then make it easier to get the children back to school. If you are in an area where you have a certain amount of infection dynamics, there are things that can creatively be done about modifying things like the school's schedule, alternate days, morning versus evening, allowing under certain circumstances, online virtual lessons. Those are the kind of things that we need to consider, but also importantly always make the goal that it is very important to get the children back to school, for the unintended negative consequences that occur when we keep them out of school. Chairman Alexander: (51:40) Thank you, doctor. Dr. Redfield, one of the concerns would be that children who, generally speaking, haven't been damaged nearly as much as adults, particularly elderly adults by this virus, might carry the virus to their teachers, administrators, or parents, or grandparents at home. It seems to me that the availability of treatments this fall, medicine for the environments that reduce the risk of sickness and death could be very important in increasing confidence in going back to school. You mentioned some of those in your testimony. Are there others? What will the availability of treatments be this fall? And specifically, what about so-called antibody cocktails of the kind that were developed for Ebola and approved by the FDA? Dr. Redfield: (52:39) Well, I think that'd be a great question also for Dr. Fauci. I'm going to make a small statement. He may want to add to it. Clearly we do have Remdesivir, as you mentioned, we have now evidence that steroids can improve therapy, and as you mentioned, we have convalescent plasma that Steve Hahn could comment on, that's using the antibodies from individuals that have gotten better from COVID that are currently under evaluation, and potentially be available [crosstalk 00:20:09]- Chairman Alexander: (53:09) Have just a minute, Dr. Redfield, let me go to Dr. Hahn and let him answer that question too. Thank you. Dr. Hahn: (53:15) Yes, sir. As I mentioned, Remdesivir has been authorized based on its reduction in hospitalization days. The steroids were mentioned. Convalescent plasma we have evaluated the safety through a large expanded access program at the Mayo Clinic, and it's been found to be safe in over 20,000 patients who administered it. We are waiting for the safety data, and we will be passing those data along to BARDA, who's the sponsor of that program. I think that antibody data will help us in terms of the development of monoclonal antibodies. We have a number of sponsors who've come in from monoclonal antibody studies, and we are already well into that treatment. Monoclonal antibodies are synthetic antibodies that will provide, that the theory is, will provide protection against the infection of the virus. And we're hopeful that those studies by the late summer, early fall, will provide us information about their effectiveness and safety [crosstalk 00:54:10]- Chairman Alexander: (54:10) So you're optimistic that there will be more than one treatment available this fall for teachers, administrators, older adults? Dr. Hahn: (54:17) Yes, sir. I'm optimistic. Chairman Alexander: (54:19) Thank you very much. Senator Murray. Senator Murray: (54:22) Thank you very much to all of our witnesses. We all very much appreciate your service and your work. Dr. Fauci, last time you testified before this committee, you warned us of needless suffering and death if states begin reopening too early. And just over a month later now we are seeing a record number of cases. We do not have enough tests, and we did not have enough contact tracers. And just yesterday, CDC's Dr. Schuchat said we have too much virus to control in the US arguing, and I quote, "This is really the beginning. Our strategy hasn't worked." I wanted to ask you, what do the federal government and the more than 30 states with rising case numbers need to do to reverse this trend? Dr. Fauci: (55:12) Thank you very much for that question, Senator Murray. I am also quite concerned about what we are seeing evolve right now in several of the states. As you know, in four of the states, in Florida, Texas, California, and Arizona, more than 50% of the new infections are in those areas where we're seeing surges. The things we need to do, I think you alluded to in your question to me. We've got to make sure that when states start to try and open again, they need to follow the guidelines that have been very carefully laid out, with regard to checkpoints. What we've seen in several states are different iterations of that, perhaps maybe in some, going too quickly and skipping over some of the checkpoints. But even in states in which the leadership, in the form of the governors and the mayors, did it right with the right recommendations, what we saw visually in clips and in photographs of individuals in the community, doing an all or none phenomenon, which is dangerous. And by all or none I mean, either be locked down or open up in a way where you see people at bars, not wearing masks, not avoiding crowds, not paying attention to physical distancing. Dr. Fauci: (56:33) I think we need to emphasize the responsibility that we have, both as individuals and as part of a societal effort to end the epidemic, that we all have to play a part in that. And I think if you look at the visuals, what we saw were a lot of people who maybe felt that because they think they are invulnerable, and we know many young people are not, because they're getting serious disease. That therefore, their getting infected has nothing at all to do with anyone else, when in fact, it does. Because if a person gets infected, they may not be symptomatic, but they could pass it to someone else, who passes it to someone else, who then makes someone's grandmother, grandfather, sick uncle, or a leukemic child on chemotherapy, get sick and die. We've got to get that message out, that we are all in this together, and if we are going to contain this, we've got to contain it together. Senator Murray: (57:35) Well I assume that would mean that elected and community leaders need to model good public health behavior and wear a mask. Dr. Fauci: (57:45) We recommend masks for everyone on the outside, anyone who comes into contact in a crowded area. You should avoid crowds where possible, and when you're outside and not have the capability of maintaining distance, you should wear a mask at all times. Senator Murray: (58:02) Thank you. Dr. Redfield, last week Dr. Julie Gerberding, who served as the CDC director under President George W. Bush, testified to our committee that if she were in charge, one of her top priorities would be the creation of a national vaccine plan that addresses the science, development, allocation, uptake and monitoring of a vaccine saying, "We know this is in our future and we are not ready for it." I couldn't agree more, and that plan has to detail how the federal government will scale up manufacturing, coordinate the supply chain so we avoid the missteps we saw with testing, needs to combat misinformation and vaccine hesitancy, and make sure that vaccine distribution addresses health disparities, and a lot more. Dr. Redfield, do you agree a plan like that is needed? Dr. Redfield: (58:57) Senator, I think it's very important that we have a integrated plan for this vaccine. Senator Murray: (59:02) When can we ... One? Dr. Redfield: (59:06) Well, I'm going to ask Dr. Hahn if he'd like to comment. I know recently they had a vaccine plan for, at least for the FDA's perspective. CDC is working on the issues that you said, that I think are so important in building vaccines confidence [crosstalk 00:26:20]- Senator Murray: (59:21) The CDC will be giving us their plans, since CDC would be writing the comprehensive plan? Dr. Redfield: (59:27) We're developing a plan as we speak. And again, to keep building on the efforts that we have to rebuild what I call vaccine confidence in this country, which is really critical. And then on top of that, there'll be a very defined plan for distribution of this vaccine, prioritization of this vaccine [crosstalk 00:59:45] monitoring for safety of this [crosstalk 00:59:46] vaccine. Senator Murray: (59:46) Couple weeks, a couple months, the end of the year. Do you have any estimate on when we'll see that plan? Dr. Redfield: (59:52) Well, it's currently in development within the group, and I'd anticipate that we'll see that plan in the near weeks ahead, senator. Senator Murray: (01:00:00) Weeks not days, months [crosstalk 00:27:07]- Dr. Redfield: (01:00:06) In the weeks ahead, it's a collective effort that we're doing together, within the concept of Operation Warp Speed. But CDC has been working on this plan, literally for probably the last 10 to 12 weeks. Senator Murray: (01:00:19) Well, Mr. Chairman, I would just say, we need to see that plan. We need to know what it is. The American public needs to know what that is. Communities need to know what that is. So I hope that we urge that plan to be public as soon as possible, so we all know what to expect. Chairman Alexander: (01:00:34) [crosstalk 01:00:34] Thank you, Senator Murray. Senator Burr. Senator Burr: (01:00:39) Thank you, Mr. Chairman. After working on pandemic policy now for 17 years, I'm reminded this morning, Tony Fauci has been doing it twice as long as I have, and most of you at the dais have been doing that as well. I urge my colleagues, pay attention to what each of these individuals say, because some things are predictable up here. Congress is a full fledged partner and funds things when there is an urgent need, a threat that's out there. And I know, Tony, you've seen over the years when there's not that threat out there, things get shelved like platforms, that we could have developed and had better countermeasures today, platforms that then could address vaccines in a much faster pace than maybe what we're doing. But we spend more time with the blame game than we do with focuses on how the future should look. Senator Burr: (01:01:36) While all of us, members of Congress and people within government, wish that we could get back to normalcy, your agencies and members of Congress are also charged with making sure that we map the future so the future generations have better protections than what we have. And that's why I applaud the Chairman for his white paper, and I would encourage every member of that dais to be brutally honest with us, about where changes need to be made and where they don't need to be made. Dr. Redfield, I think you would agree with me that testing and surveillance on this has not been the best performance by CDC. I don't want to dwell on where we've come up short. Share with these members and myself, what can we expect over the next several months from CDC that will be different than what the past has looked like? Dr. Redfield: (01:02:32) Well, thank you, senator, for your question. I think CDC will continue to work with the state, local, tribal, territory health departments to build their capacity. I think we all know that for decades, there's been consistent under investment in public health in this nation, and the core capabilities to do that job, data monitorization, predictive data analysis, laboratory resilience, workforce. Very appreciative for the emergency response fund that Congress provided. Dr. Redfield: (01:03:03) These are critical infrastructure issues that the reality are, have been under-invested. CDC is right now probably providing 50 to 70% of all public health funding to each state. We need to have a much more robust investment in these core capabilities. What you are going to see, because of the Congress acting, CDC has provided now $12 billion to the local state, territorial, tribal health departments to begin to build that core capability that we would have liked to built over the last several decades, so that there is enhanced testing. Dr. Redfield: (01:03:41) As it's been mentioned, it's complicated here because this virus is so asymptomatic for so many. So the traditional methods of diagnosis, contact tracing, isolation, are going to be inhibited for many individuals, and that's going to require broader community based surveillance strategies. Those plans, as was mentioned by the admiral, are we've received them for June and July. We're working with the local jurisdictions. They're going to have them in middle July for the plans for the rest of the year, and we're going to be working side by side with them to continue to augment the public health capacity respond to this COVID virus, with basically enhanced surveillance, and enhanced early diagnosis, contact tracing, isolation to begin to bring this outbreak under control. Senator Burr: (01:04:24) I hope some of that money will be used to upgrade the systems at CDC that are antiquated. Dr. Redfield: (01:04:31) Sir, I agree with you there. I mean, I think as those of you know, when I was given the opportunity to do this job, very early on, within a month I recognized that the core capabilities of our public health infrastructure is not there. Particularly the one that I know you've been very supportive of data, data monitorization, predictive data analysis. And that is in progress. It can't happen too soon, and we're appreciative of the support that Congress has given, and I do think it's fundamentally critical to bring our data system, and as you know, the data personnel that we have. And we thank you for your efforts there. And as we need to hire those individuals strategically, we will continue to do that, to make sure that the premier public health agency in this country has the personnel and data systems that it does need. But I will say the other big issue we have to correct, is to make sure our public health, state, local territorial and tribal have that integrated health system of data. Senator Burr: (01:05:27) Dr. Hahn, I think you have used your authorities under PAPA at FDA in a very effective way. And, the FDA has risen to the challenge during the public health emergency, cutting red tape and maintaining the agency's gold standard for review of lifesaving medical products. You've specifically mentioned innovative trial, clinical trial designs and the use of real world data, as areas where the FDA has gained ground during the response to COVID. How do you plan to ensure that this progress is maintained long after the coronavirus response is over? Senator Burr: (01:06:03) ... long after the coronavirus response is over. Dr. Hahn: (01:06:04) Thank you, Senator Burr. Critical issues that you bring up. In addition, some of the things that we're doing on the review side to actually expedite review and work with innovators and developers, we will continue. Part of our review of our actions to date, so a mid action review, will inform how we move forward. No question the fact that real world evidence and modernization of our data systems are needed, particularly around supply chain and demand for medical products, but also on the review cycle and the innovative clinical design trials, as you mentioned, Senator Burr: (01:06:37) Thank you for that. Mr. Chairman, I do hope that you or another member will allow Dr. Fauci at some point today to make any comments on the reports that there is a new swine flu that the Chinese have apparently identified and how that might affect us in the future in this country. Chairman: (01:06:57) Well, Dr. Fauci, why don't you do that now, if you have anything to say about a swine flu? Dr. Fauci: (01:07:05) The Chinese over the last week or two have identified a virus in the environment. It has not yet shown to be infecting humans, but it is exhibiting what we call reassortment capabilities. In other words, when you get a brand new virus that turns out to be a pandemic virus, it's either due to mutations and/or the reassortment or exchanges of genes. And they're seeing virus in swine, in pigs now that have characteristics of the 2009 H1N1, of the original 1918, which many of our flu viruses have remnants of that in it, as well as segments from other hosts like swine. When they all mix up together and they contain some of the elements that might make them susceptible to being transmitted to humans, you'll always have the possibility that you might have another swine flu type outbreak as we had in 2009. Dr. Fauci: (01:08:10) It's something that still is in the stage of examination. It's not so called an immediate threat where you're seeing infections, but it's something we need to keep our eye on, just the way we did in 2009 with the emergence of the swine flu. It's called G4, is the name of it. Chairman: (01:08:29) Thank you. Senator Sanders. Senator Sanders: (01:08:34) Thank you very much, Mr. Chairman, and let me thank all of our panelists for being here and for the great work that they are doing on this pandemic. Let me ask a question that has just bothered me lately. Are all of you ... and I think most Americans understand how important social distancing is. We're told over and over again, the chairman told us at the beginning of this meeting, stay apart, at least six feet apart, if you can. And just the other day, however, American Airlines announced that they were going to fill up all of their planes and other airlines have done the same. So you're going to have people going from New York to California, five, six hours sitting inches apart from each other. And then you've got buses all over America where people are packed in like sardines. But my question is why hasn't the government, whether it's the CDC or the Department of Transportation, issued guidelines prohibiting those violations of what we all know to be common sense. Who wants to ... Dr. Fauci, you want to start on that one? Dr. Fauci: (01:09:44) Thank you, Senator. Well, I'm not the CDC, but I'd be happy to make a comment on that, and maybe Bob would also. I mean, obviously that is something that is of concern. I'm not sure exactly what went into that decision making. I would hope there would be something to mitigate against that because I know as we've said and I continue to repeat it, that avoiding crowds, staying distance and when in a situation like that wear a mask. I think in the confines of an airplane that becomes even more problematic. Senator Sanders: (01:10:16) But generally, I understand the mask thing, but doesn't it sound a little bit silly and a little bit in violation of everything you guys have been talking about to have people sitting next to each other for five or six hours in an airplane or crowded into a bus? And my question is why hasn't ... The president issues a lot of executive orders. Why haven't we stopped that type of activity and told the airlines and bus companies that is unhealthy? Dr. Redfield: (01:10:43) Senator, I appreciate your question, and I think it's a critical area. I can tell you that when they announced that the other day, obviously there was substantial disappointment with American Airlines. A number of the airlines had decided to keep the middle seat thing. I can say this is under critical review right now by us at CDC. We don't think it's the right message, as you pointed out. Again, we think it's really important in individuals that are in whether it's a bus or a train or a plane or social distancing to the degree that's feasible and at least have a reliable face covering, so- Senator Sanders: (01:11:27) Well, I thank you. And I just hope very much that the CDC or the appropriate agency basically tells these companies that that is unacceptable behavior. They're endangering the lives of the American people. Let me go to another question. I just have a few more questions and not a lot of time. So I'd appreciate brief answers. At the University of Washington, the Institute of Health there indicated that if 95% of the American people were to wear masks, we could some 30,000 lives. A number of countries, including South Korea, France, Turkey, and Austria have provided low cost or free masks to all of their people, something that I believe in. Would you support an effort to greatly increase the production of high quality masks in this country and distribute them free of charge to every household in America? Dr. Fauci or anybody else who wants to jump in on that. Dr. Fauci: (01:12:26) Yes, of course, I think masks are extremely important and we keep hammering home, and I think what you just mentioned is as important. There's no doubt that wearing masks protects you and gets you to be protected. So it's people protecting each other. Anything that furthers the use of mask, whether it's giving out free masks or any other mechanism, I am thoroughly in favor of. Dr. Redfield: (01:12:51) And I just want to echo that. Senator, in my opening statement, again, I called on an environment that we have universal masks. Senator Sanders: (01:12:59) Good. Dr. Redfield: (01:12:59) I think it's fundamentally the most important thing we can do. Senator Sanders: (01:13:02) That's great. But when you refer to "universal masks", which I agree with you on, would you be supporting the increased production of high quality masks and basically distributing free of charge to every household in America? Because I think that's going to save tens of thousands of lives. Would you agree? Admiral Giroir: (01:13:21) So Senator Sanders, this is Brett Giroir. Yes, sir, I agree that that is very important because we need to support mask wearing. I would also point out that Dr. Kadlec, the ASPR has contracted for hundreds of millions of cloth face coverings that could be distributed around the country, and those kinds of processes are being thought of. When I'm not in uniform, I wear them. They're white. They work very effective and I think they're a great investment for the American people. Senator Sanders: (01:13:50) Good. Thank you. My very last question, it's an issue I've raised now for the last couple of months. All of us hope to God that a good safe vaccine will be developed as soon as possible, but that vaccine may not mean anything to a low income person who might not be able to afford it. I happen to believe that we should make these vaccines. And by the way, as you all know, the federal government, our tax dollars are going to the tune of billions of dollars into drug companies to help develop this vaccine. That's okay. But would you agree with me that after that kind of investment, we should make sure that every American, every person in this country can get a vaccine regardless of their income? Dr. Fauci: (01:14:37) Yes. Senator Sanders: (01:14:41) Anybody else want to comment on that? Dr. Hahn: (01:14:43) Yes, Senator. Agreed. Dr. Redfield: (01:14:44) Yes, Senator. Admiral Giroir: (01:14:45) Yes, Senator. Senator Sanders: (01:14:47) Well, good. Thank you all very much. Chairman: (01:14:51) Thank you, Senator Sanders. Senator Paul. Senator Paul: (01:14:57) Thank you. Fatal conceit is the concept that central planning with decision making concentrated in a few hands can never fully grasp the millions of complex individual interactions occurring simultaneously in the marketplace. It is a fatal conceit to believe any one person or small group of people has the knowledge necessary to direct an economy or dictate public health behavior. I think government health experts during this pandemic need to show caution in their prognostications. It's important to realize that if society meekly submits to an expert and that expert is wrong, a great deal of harm may occur when we allow one man's policy or one group of small men and women to be foisted on an entire nation. Take for example government experts who continue to call for schools and daycare to stay closed, or that recommend restrictions that make it impossible for a school to function. For a time there may not have been enough information about coronavirus and children, but now there is. There are examples from all across the United States and the world that show that young children rarely spread the virus. Senator Paul: (01:16:11) Let's start in Europe. 22 countries have reopened their schools and have seen no discernible increases in cases. These graphs behind me show no surge when schools open. The red line is where the schools opened. There is data from Austria, Belgium, Denmark, France, Germany, Netherlands, no spike when schools are opened. Contact tracing studies in China, Iceland, Britain, and the Netherlands failed to find a single case of child to adult infection. Here at home childcare for essential workers continued to be available in some states throughout the pandemic. Brown University researchers collected data on daycares that remained open during the pandemic, over 25,000 kids in their study. Found that only 0.16% got COVID. And when you looked at the confirmed cases for staff, there was about 1% of more than 9,000 staff. Senator Paul: (01:17:14) The YMCA also has put forward statistics. 40,000 kids at 1100 sites, there were no reports of coronavirus outbreaks or clusters. Dr. Joshua Sharfstein of Johns Hopkins writes, "There is converging evidence that the coronavirus doesn't transmit among children like the flu, that it is a lower risk." Just yesterday, the American Academy of Pediatrics says, "We've got to get kids back in school. We want them physically present in school." They even cite mounting evidence that children are less likely to contract the virus. Ultimately, this all comes down to the fatal conceit that central planners have enough knowledge somehow to tell a nation of 330 million people what they can and can't do. Senator Paul: (01:18:03) Perhaps our planners might think twice before they weigh in on every subject. Perhaps our government experts might hold their tongue before expressing the opinion whether we can play NFL football or major league baseball, not in October. Perhaps our experts might think twice before telling the whole world that a COVID vaccine likely won't provide herd immunity. We don't know. Why weigh in with these opinions that we have no knowledge of? These are forecasts that may well be wrong. Perhaps our experts might consider the undue fear they are instilling in teachers who are now afraid to go back to work. No one knows the answers to these questions. We shouldn't presume that a group of experts somehow knows what's best for everyone. Senator Paul: (01:18:52) Hayek had it right, only decentralized power and decision making based on millions of individualized situations can arrive at what risks and behaviors each individual should choose. That's what America was founded on. Not a herd with a couple of people in Washington, all telling us what to do and we like sheep blindly follow. This all begs the question, when are we going to tell the people the truth that it's okay to take their kids back to school? Senator Paul: (01:19:21) Dr. Fauci, every day, virtually every day we seem to hear from you things we can't do. But when you're asked, can we go back to school, I don't hear much certitude at all. I hear, well maybe it depends. All of this body of evidence about schools around the world shows there's no surge. All of the evidence shows it's rare. I mean, we've so politicized this and made it politically correct that the WHO releases that it's rare and you have a scientist up there honestly giving her opinion. What happens to her? She's blackballed and her report that she refers to is taken off the website. When you go to that scientist's speech and you try to click on the link, the WHO has now screened it from us because it said something that's not politically correct, that, guess what? It's rare for kids to transmit this. But I hear nothing of that coming from you. Senator Paul: (01:20:12) All I hear, Dr. Fauci, is we can't do this, we can't do that. We can't play baseball. Even that's not based on the science. I mean, flu season peaks in February. We don't know that COVID is going to be like the flu season. It might, but we don't know that. But we wouldn't ban school in October. You might close some schools when they get the flu. We need to not be so presumptuous that we know everything. But my question to you is can't you give us a little bit more on schools that we can get back to school, that there's a great deal of evidence, and that it's actually good evidence that kids aren't transmitting this. It's rare. And that kids are staying healthy and that yes, we can open our schools. Dr. Fauci: (01:20:50) Mr. Chairman, do I have a little bit of time to ... Chairman: (01:20:54) Well, I'll give you a ... That was well over five minutes, but go ahead and please answer the question. Dr. Fauci: (01:20:57) Thank you, Senator Paul. So very quickly, Senator Paul, I agree with a lot of what you say about this idea about people having to put their opinions out without data. And sometimes you have to make extrapolations because you're in a position where you need to at least give some sort of recommendation. But if you were listening, and I think you were, to my opening statement and my response to one of the questions, I feel very strongly we need to do whatever we can to get the children back to school. So I think we are in lock agreement with that. The other thing that I'd like to clarify very briefly is that when things get in the press of what I supposedly said, I didn't say. I never said we can't play a certain sport. Dr. Fauci: (01:21:45) What happens is that people in the sport industry, they could either be people from players association, owners, people involved in the health of the players ask me opinions regarding certain facts about the spread of the virus, what the dynamics are. I give it and then it gets interpreted that I'm saying you can't play this sport or you can't play that sport. I agree with you. I am completely unqualified to tell you whether you can play a sport or not. The only thing that I can do is, to the best of my ability, give you the facts and the evidence associating what I know about this outbreak. Thank you. Senator Paul: (01:22:25) Thank you. We just need more optimism. There is good things out there- Chairman: (01:22:29) Thank you, Senator Paul. Senator Paul: (01:22:29) ... I'm not [inaudible 01:22:29]. Chairman: (01:22:29) We'll now go to Senator Casey. Senator Casey: (01:22:34) Mr. Chairman, thank you very much for the hearing, and I want to thank our witnesses for their public service. Mr. Chairman, let me start with Dr. Hahn, then I'll move to Admiral Giroir. Dr. Hahn, I wanted to ask you about vaccines. And as your testimony indicates, and as we've been discussing over time, as researchers work to develop vaccines to protect against COVID-19, it's important that the final FDA approved products have the full confidence of the American people. A vaccine doesn't help if people don't choose to in fact be vaccinated. So my first question is given that we've seen very high rates of both vaccine refusal, as well as skepticism, what role can the FDA play in the coming months to earn the public's trust that the COVID-19 vaccines are safe and effective? That's question number one, what role the FDA can play. And then the second question is what steps can you take as FDA commissioner to bolster public confidence? Dr. Hahn: (01:23:44) Thank you Senator, for that question. I couldn't agree more that public confidence in vaccines is so important. So to your first question, we have an obligation to use all of our scientific knowledge, our regulatory framework, to ensure that any vaccine that comes before us, whether for authorization or approval, meets our stringent standards for safety and effectiveness. One of the reasons that we issued that guidance that I mentioned in my opening statement was to provide regulatory clarity around what FDA expects with respect to those data. We want to see certain parts of those data so that we can demonstrate to the world, to the nation, to the American people, that we are following our rigorous standards with respect to safety and efficacy. The other thing that we've done is draw a very bright line between FDA and our regulatory independence, and all the sponsors who are putting forth vaccine applications to us. And that includes operation warp speed. So we are providing technical assistance to those sponsors, but we are not part of the decision making process, and we will maintain our regulatory independence. Dr. Hahn: (01:24:53) I will not prejudge, the agency will not prejudge any decision with respect to this, but we will use the science and the data. With respect to what I can do personally, Senator, I commit to you that I will continue to be a voice emphasizing the regulatory independence. We have a number of communications in progress to communicate to the American people that the standards we're going to uphold are firm, they are rooted in science and data, and that they will ensure that we meet the usual high standards of FDA with respect to safety and efficacy. Senator Casey: (01:25:29) Thanks very much, doctor. I might submit a question for the record to Dr. Redfield as well, but just so I can get my second question in to the Admiral. Admiral, I want to ask you about testing and insurance coverage. Testing, as you know, and as we we've emphasized in these hearings, is so fundamental in order to prevent the spread of COVID-19. Congress, I think, acted upon that knowledge by mandating full coverage of COVID-19 diagnostic and antibody testing, both in the Families First bill, as well as the CARES Act. We made it clear that Americans shouldn't have to pay a dime for COVID-19 testing, but we're hearing alarming reports of people not being tested often for one of two reasons, because they're under the impression they will have to pay for testing and patients who have been tested are receiving surprise medical bills. Senator Casey: (01:26:26) The administration has issued guidance that appears to be in conflict with congressional intent and public health guidance. And so we have some confusion here. I'd ask you Admiral, can you assure the American people that the Department of Health and Human Services will fulfill the intent of both the Families First bill and the CARES Act, and ensure the American people will be provided wide access to COVID-19 tests without cost or limitation. Admiral Giroir: (01:26:59) So, thank you Senator. And I want to thank all of you for emphasizing the importance of testing and eliminating any barriers that there could be. I can't speak for the department. I certainly speak as the Assistant Secretary and as the testing person that we firmly believe and support the concept of no cost testing. There should not be a disincentive in any single way to get the diagnostic test that you need to get tested during a screening, or the serology test as Congress intended. So thank you for that. We do need to keep getting that message out. It's a very important one to have. Senator Casey: (01:27:38) Thank you, Admiral. Thank you, Mr. Chairman. Chairman: (01:27:42) Thank you, Senator Casey. Senator Collins. Senator Collins: (01:27:48) Thank you very much, Mr. Chairman, and I want to thank all of our witnesses today for your dedication and hard work. It's really been important. The chairman raised a very important question about who pays for the testing when a person has no symptoms and no known exposure to the virus. And I would add another key question, and that is how are such tests even accessed? These are critical questions for the reopening of schools and for the thousands of jobs in the tourism industry upon which Maine's economy depends. In Maine for tourists to come and visit, that out of state visitor, one option is to show a recent negative COVID test. The problem is that when hotel owners in Maine surveyed testing sites in 10 states, they found that 90% of requests for a test for travel purposes were denied. Senator Collins: (01:29:11) Now, this lack of access to tests is devastating for reopening Maine's tourism businesses. One innkeeper told me that last year in the month of June, she had an occupancy rate of 94%. This year it was 6%. So you can imagine the impact on employment at that inn. Given the impact on reopening schools and on jobs in the tourism and other industries, how is the federal government working with states to better match demand for testing with supply and to overcome these geographic variations? Admiral, I would direct that question to you. Admiral Giroir: (01:30:06) So, thank you, ma'am. I will try to be brief and not to take much of your time, but we were very careful in our prioritization that we do prioritize persons without symptoms who are prioritized by health departments or clinicians for any reason, including public health monitoring surveillance or screening of other asymptomatic individuals, according to state and local plans. So that is a priority, that if it is important for the state, those asymptomatic individuals can be screened. The second issue, just again to be brief, is we have worked individually with every single state to determine what their state testing needs are. How are they organizing in the context of the CDC? And we are supplying them with the supplies they need to meet that. Admiral Giroir: (01:30:56) So every week, shipments of the basic supplies go to every single state, according to their state testing plans. And we keep a little bit in reserve because when there's an outbreak somewhere that we need to surge, we do have that. So for example, the state testing goals for July are somewhere across the country, about 13.9 million tests is our first line goals. And we will match those state by state. Senator Collins: (01:31:22) I hope that you will help us get that word out to testing sites in states from which a lot of tourists usually come to Maine. That would be very helpful to us. Dr. Fauci, let me turn to you. Earlier this month, higher education leaders in Maine issued a framework for safely returning to campuses this fall that recognizes the importance of testing and the need to include financially struggling institutions in partnerships in order to make sufficient testing protocols possible. You last week spoke about the possibility of the development of pool testing strategies. And as I understand this, this would allow more people to be tested using fewer resources and the medical director of Stanford's clinical virology lab suggests that this makes particular sense in areas with low rates of COVID-19 where you would expect the large majority of tests to be negative. Could you expand on the possibility of expanding pool testing and tell us more about that? Dr. Fauci: (01:32:50) Yes. Thank you for the question, Senator. What that really is, if you want to get a feel for the penetrance of infection in the community, rather than testing multiple each individual person, which takes resources and time, what you do, and you can do a statistical analysis of not losing sensitivity by pooling, let's say 10 or 15 or five together. So you put all the tests together and you do one test. If that test is negative, then you know those 10 people are all negative. So instead of utilizing 10 tests, you've utilized one test. Then you get another batch of we'll say 10 or so. And if you then find one is positive, then you go backtrack and figure out who that person is. And if you do the mathematical calculation, you can save a lot of time, a lot of resources and use the testing for a variety of other things that you would need. Dr. Fauci: (01:33:50) So it's a really good tool. It can be used in any of a number of circumstances at the community level or even in school, if you wanted to do that. So apropos of what you started your comment off with it, it clearly can be extrapolated to that. Senator Collins: (01:34:05) Thank you so much. That sounds like an excellent technique for our schools to use. Chairman: (01:34:12) Thank you, Senator Collins. Senator Baldwin. Senator Baldwin: (01:34:17) Thank you, Mr. Chairman. I want to thank all of our witnesses today for joining us. Like so many members of this committee, I'm concerned about new outbreaks and increasing cases. Certainly I've seen them in my home state of Wisconsin and I know we're seeing that nationally. Now CDC and OSHA have issued recommended safety guidance for businesses, but this guidance is not enforceable. Many businesses are truly trying to do the right thing in protecting workers and customers, and the public then interacts with those businesses. And so, we also had a previous discussion. I think Senator Sanders raised the issue of American Airlines filling up their planes versus others that are still not trying to push to do so because of safety concerns. We also had, I think it was Admiral Giroir, hold up the what he called critical guidance. Please follow this critical guidance. So Dr. Redfield, should we be supporting businesses that have taken the steps to protect their workers and customers by fully implementing CDC's and OSHA's recommended safety guidance? Yes or no? Dr. Redfield: (01:35:36) Yes. Yes. We should be supporting those businesses. Senator Baldwin: (01:35:40) Now can you confirm, yes or no, that all businesses have adopted and implemented this guidance as they've opened up? Dr. Redfield: (01:35:49) I think Senator, you know that unfortunately that's not been the case. Senator Baldwin: (01:35:54) So it's an uneven playing field and it hurts businesses that are trying to do the right thing by voluntarily adopting CDC and OSHA safety guidelines because their competitors don't have to incur the same safety and health costs. And if you believe that we should be supporting the good actors, then shouldn't we create a level playing field by issuing an emergency temporary standard to require all businesses to adopt and comply with enforceable safety standards? Dr. Redfield: (01:36:28) I made two comments, Senator. The first one is so important, that we've tried to say is that this is a time that everyone in our nation accept the responsibility that Dr. Fauci and I spoke about to recognize they have the fundamental responsibility not just to protect themselves, to protect others by the social distancing, face mask and hand washing. Secondly, again, is we look at the local jurisdictions, again, to see where in fact that enforceability would be, whether it's in the local health department, the state health department, or the federal health department. I think again, we see that the community can get behind that responsibility. Those businesses that support that responsibility may find in fact their business is better than those businesses that don't. I can tell you that if you- Senator Baldwin: (01:37:25) Well, if I could interrupt you, I apologize Dr. Redfield, but my time is limited. The panel right now is composed of people representing public health and public health institutions. OSHA is our lead federal agency for protecting worker safety and health. Have you had communication with the Department of Labor and OSHA about issuing mandatory enforceable standards rather than this voluntary guidance? Dr. Redfield: (01:38:04) Secretary Scalia is a member of the taskforce and he's in the discussions with us that the Vice President chairs. Senator Baldwin: (01:38:13) So, that's a yes? Dr. Redfield: (01:38:13) That specific topics we have not had a discussion directly, but we have had discussions and review of the guidance that we've put to businesses, both critical infrastructure and noncritical infrastructure businesses, with OSHA. Senator Baldwin: (01:38:30) So I have limited time left, but I do want to say that the University of Wisconsin announced that they will be reopening for classes in the fall. They've released a plan called Smart Restart. It calls for about 2000 tests per week on campus. They'll need supplies to do this, including PPE, reagents, and swabs. At every hearing on COVID-19, we've heard about shortages of these supplies, and it's why I introduced the medical supply- Senator Baldwin: (01:39:03) ... Of these supplies. And it's why I introduced the Medical Supply Transparency and Delivery Act to unlock the full authority of the Defense Production Act to increase production of critical supplies. The things that are needed to conduct widespread testing. Admiral Giroir, can you describe how you're working to make sure that universities and others will have access to these supplies needed to conduct this testing in the fall? Admiral Giroir: (01:39:28) Thank you so much, senator. And I want to communicate this and I'm happy to work with any university. We coordinate what we give to the states through the state plan. So it's very important that universities coordinate through the states and we supply those materials directly to a single point of contact in the state who distributes them. We've been through a lot, but we have a lot of swabs now. Partially because of increased domestic production using the DPA, we're distributing about 20 million swabs per month. We're going to do a lot more than that. Senator Baldwin: (01:40:05) What about reagents? Admiral Giroir: (01:40:07) So reagents, we do not purchase centrally because the market is a little bit more mature. So we can trust with an allocation strategy that we support the allocation to different states depending on their needs. So we've mapped to every single machine and every single state, every single county, every single city. And unfortunately, there's not enough of one thing that everybody, if they want that, can get it. So we really do a matching game to understand specific state needs. For example, in Alaska, it is very rural and there's varied limitations to what they have. So we need to make sure they get what they absolutely need versus other states that can be a little bit more flexible. So we do have this control-[crosstalk 01:40:52] Chairman Alexander: (01:40:53) Thank you very much. Senator [crosstalk 01:40:54], I'm afraid we're- Admiral Giroir: (01:40:55) I'm so sorry. Chairman Alexander: (01:40:56) Well over time. We have a large number of senators who want to ask questions. So I would renew my request that senators and witnesses try to keep the questions and answers within five minutes. Senator Cassidy. Senator Cassidy: (01:41:13) Thank you gentlemen for all that you're doing. I have a couple of slides. Can I ask the staff to show the first two slides? So here it shows that we're doing poorly relative to the countries that are doing it best, and you can argue that Taiwan is much smaller than we, but Taipei is a very congested city. So we consider our city's just a collection of Taipei's, for example. Then are Seoul, South Koreas. That would suggest that what we are currently doing is less robust and less, whatever adjective you want to use, then the countries that are doing it best. Could I have the next slide please? Senator Cassidy: (01:41:57) And so this is developed out of a group by a Harvard and just so I can put a plug in it, they will be speaking in a round table we have Thursday morning and you can get details from my office if you wish. But kind of that interplay between doing the testing, tracing those, compiling your data, knowing where your hotspots are and then tracing. And everyone on this panel knows that this is how it's done. And you mentioned that you're going to have a strategy that's coming out later on. And it does beg the question, why has it been so long? And I'm not accusing, I'm just curious, but this has been developed. Senator Cassidy: (01:42:34) You can take the slide down, please. So knowing that you're going to develop this strategy and to kind of build upon Senator Byrd mentioned, what is the goal of the strategy? Is the goal of the strategy to achieve suppression? That's number one, and number two, what metrics will you use? And knowing that CDC is the one who really gives guidance to state and local governments. I'm hoping Dr. Redfield, since I'll direct this to you, that it won't be up to the states and locals to put this plan together, but it'll be the considerable intellectual firepower of the CDC. That gives a pretty detailed. If you have this kind of community, this is what you do. If you have that kind of community, that is what you do because that's the kind of role the CDC is expected to play. Dr. Redfield, any thoughts on this? Dr. Redfield: (01:43:27) Thank you very much, senator. A very important question. First, on your first slide, just as a quick comment and I'll try to be quick. I think it's really important because it does illustrate back to the comment that we tried to make of the importance of personal responsibility. To really practice the social distancing and- Senator Cassidy: (01:43:45) That is a given Dr. Redfield. I'm going to ask you just to go quickly because I have limited time. That's a given, but there has to be a testing aspect of this because you awaken people to the responsibility, if they know they'd been exposed, if they don't know they've been exposed, they tend to be more complacent. So please focus upon the testing data and tracking aspect of it. Dr. Redfield: (01:44:07) Yes, Senator, I initially obviously, it was early case identification, contact tracing, isolation. Obviously testing and contact tracing without isolation has little value. The challenge has been when we learned in March that this virus is significantly asymptomatically transmissible, then therefore requiring alternative strategies. The strategy that we're evaluating now is more of a community led testing strategy, where you go into a broader community and you actually test a wide number of individuals as opposed to- Senator Cassidy: (01:44:42) What metrics are you following? And is there a specific strategy that's going to be given to state and locals as how to implement this? That's very high level. What we need is granularity. That's my question. Dr. Redfield: (01:44:54) Yeah, we did the initial strategy. As I said, we're currently evaluating this community test led strategy in a number of communities, now. The metrics are simple. It's the percent cases that are positive. We were doing well there for awhile. Senator Cassidy: (01:45:09) [crosstalk 01:45:09]. Sorry to interrupt, but of course, if you take the entire city of New Orleans or Shreveport, you're going to have some that are hotspots and some that are really fairly safe. And so I guess, I'm pulling into the granularity, should it be a census track? Should it be a hotspot, a building with multifamily housing, et cetera. I guess I'm just frustrated because when I speak to my state and locals, they're not getting that granularity from CDC. That seems to be where we get to where Seoul South Korea is. And I've not yet heard that as kind of what were doing. Dr. Redfield: (01:45:42) We're sharing right now at the county level, the exact kinetics. We have about 130 counties in this country out of the more than 5,000, of more than 3,000 are having trouble, And continuing to get that granularity, I think you've said it senator, it's critical. It's got to be a very local focal response at the ground level. Senator Cassidy: (01:46:01) But Dr. Redfield, do we have that granularity? We've been at this for three months. We've got all these data systems. We know where the people live, who are tested. We have a federated system, which you alluded to earlier, is the plan coming out tonight, this afternoon, going to implement that granularity? I'm over time, but if you would allow Mr. Chairman for an answer, then I'll cease. I apologize for going over. Dr. Redfield: (01:46:26) Yeah. My comment would be that's where we're going with that granularity. We appreciate some of the changes in reporting to CDC in terms of testing that Congress recently did. We are now looking at the granular level. We don't disagree with the premise behind you. It's that granular response to control those mini outbreaks, which is going to be fundamental to get this under control. Chairman Alexander: (01:46:47) Thank you, Senator Cassidy. Senator Murphy. Senator Murphy: (01:46:50) Thank you very much, Mr. Chairman. Mr. Chairman, if this were the policy of the United States of America, the recommendations and guidelines being given by our panelists today. We would likely not be in the situation we are with a virus back on the march, spreading at rapid rates throughout big parts of the country. The problem is our four panelists do not set the policy of the United States of America. The president of the United States does. And so while our panelists tell us about the importance of wearing masks, the president of the United States is retweeting articles. For example, entitled, mandatory masks aren't about safety. They're about social control. Senator Murphy: (01:47:35) He retweets people that are criticizing how folks look when they wear masks. Though, our panelists today are telling us about the effectiveness of social distancing. The present United States is holding rallies all across the country in which he deliberately prevents people from distancing. His staff ripped signs off of chairs, encouraging people to separate from each other. The president's allies are out there on TV every day saying that wearing masks are dehumanizing. Somebody said the other day, a member of the House. That viruses do what viruses do, the only way you're going to get immunity is to get exposed. These are the president's allies trying to curry favor with him. Senator Murphy: (01:48:23) And so we have these two parallel messaging operations, and I just think it's worth stipulating that. Everything we're hearing today is responsible, is based on evidence, but the agencies represented here today have social media followings of about five million people. The president United States has a social media following of 82 million. And so you can understand why folks are confused out there. They hear the recommendations from Dr. Fauci and Dr. Redfield, but then they hear the president of United States criticizing a reporter for wearing a mask because that reporter is being politically correct. Senator Murphy: (01:49:04) That's why we're in the position we're in today where you see large numbers of people not complying with recommendations because they're hearing something very different from the chief executive. And they're watching him behave in a manner and encourage behavior that is directly contrary to what we're being told today. And it just probably requires saying that out loud at this hearing. Let me ask a few questions, Mr. Chairman, if I can about global public health. Because we haven't covered that here today. Dr. Fauci, this virus got here really quickly. And what we learned is that well, travel restrictions can help or give you time. They can't fully prevent a disease from arriving here. And so even if we do turn the corner in the United States in a meaningful way. So long as this virus exists in large quantities outside of the United States, we are still vulnerable. Is that right? Dr. Fauci: (01:50:05) That's correct, sir. Senator Murphy: (01:50:06) And so Dr. Redfield, what is your understanding of why the United States has not joined the global vaccine effort? Why are we not in something like CEPI? An organization that is working with other nations to try to coordinate not only the development of the vaccine, but also the distribution of the vaccine? Dr. Redfield: (01:50:31) Well, I think the US has obviously developed an aggressive comprehensive program, but senator it wouldn't preclude being part of these international organizations also, from my perspective. Senator Murphy: (01:50:43) We have legislation pending right now before the Foreign Relations Committee that would put the United States into these global vaccine efforts. It just doesn't make a lot of sense to many of us on both of the aisle as to why the Trump administration has not joined. And finally Admiral, just maybe help us understand what our relationship with the WHO is today. Right around the time that the president declared that we were pulling out of the WHO, not just that we were not going to fund it, but his announcement was actually, we were going to sever our relationship with the WHO. You are confirmed to a seat on the executive board. And so have you been recalled from the WHO? Are you attending meetings? Are you participating? What are the details surrounding our withdrawal from the WHO, which by the way is maybe one of the most dangerous things in my opinion, that the administration has done in the middle of a global pandemic. What's our status and what's your status as a confirmed member of that board? Admiral Giroir: (01:51:42) So thank you senator. And I really do appreciate the confirmation. I was confirmed on May 7th and I did attend the executive board on May 22nd. The executive board, it was virtual. I did participate and support our multilateral commitments. I have not been recalled. I have not been given any direction to recall myself in any way. There would be another executive board meeting probably in October. And I believe all of us on our public health standards still work with the WHO as a WHO partner. For example, we participated with the WHO on a global sickle cell meeting just two days ago. So we certainly work from the public health aspects direction on the official, whether we're going to be a member or whether I'm not going to go to the executive board. I have not gotten that direction yet. Senator Murphy: (01:52:33) Okay. Thank you. The announcement was, that we're terminating our relationship with the WHO. So probably some additional clarification would be helpful. Thank you, Mr. Chairman. Chairman Alexander: (01:52:41) Thank you, Senator Murphy, Senator Murkowski. Senator Murkowski: (01:52:44) Thank you, Mr. Chairman. And gentlemen, thank you for not only your testimony today, but all that you have been doing. I think I've had conversations with each one of you about the Alaska specific issues. Most notably with regards to our seafood processing. This is the time of year where we typically welcome a million plus tourists, as well as many thousands that come up from the lower 48 and other places to help with our seafood processing. And it has been a very anxious time, I think for all of us in Alaska, as we see outsiders coming in. We have seen obviously elevated cases of confirmed COVID. Our numbers, I think are enviable. When other states look at us to know that we're working about 500 active cases right now about double that in terms of what we have seen throughout this whole pandemic. Senator Murkowski: (01:53:49) But again, we know, and you have stated that we don't have resources that we can look to, to neighboring states. We're kind of on our own island there in terms of resourcing. So what you have done to help facilitate whether it's the plans with the seafood processors, the guidance, the ability to come in on an as needed, if the situation so demands, we appreciate that. We have seen the benefit of how these very rigorous plans have worked. An individual who comes up to work in a seafood processing facility is tested before they come to the state. They're tested when they get to the state, they're put in a 14 day quarantine. We have seen positive cases once people have arrived, but we've been able to do what the plan calls for, which is that contact tracing and then isolation and keeping things to a minimum. Senator Murkowski: (01:54:53) So I think it does demonstrate that these tough plans really can work. They are expensive, though. If you are bringing in several hundred or perhaps a thousand workers, and you have to put them up in a hotel for 14 days with pay. When you have to provide for the health protocols, this is costly. I would ask for your input and probably a question for the record, just in terms of which agencies can best help facilitate these seafood processors with not only implementation of the specific guidance, but how we can be dealing with the costs? We do receive some benefit from the discretionary funds provided to the states. But I think we would all recognize, like the meat packing facilities, our seafood processors are an important and a critical industry, not only to Alaska, but to the country. So we want to work to address that. Senator Murkowski: (01:55:53) I do want to speak very quickly though, to the public health infrastructure. I'm told that in Alaska, as we are doing our contract tracing, it is still a paper copy, Excel spreadsheet faxed to the epidemiology labs. This is how we're doing our tracing. I thought, well, maybe that's just Alaska. And I'm told by Dr. Zinke, who you have all had conversations with. Well, this is actually going on in California as well. That to me is not a contact tracing system that works and is sufficient. So I want to ask about not only your view of the sufficiency of contact tracing, and this is probably to you Dr. Redfield. But then Dr. Fauci, I want to ask you about the concern that we have with certain parts of the country, where you have public mistrust of vaccines in general. My fear is that we may get to the place where ... We will get to that place where we have that successful vaccine, but we still have the concern from many and a mistrust. And whether it's vaccine hesitation or vaccine confidence, I don't know what the buzz word is, but I'm worried that we don't have a plan for how to deal with that. So first contact tracing and then the vaccine. Dr. Redfield: (01:57:25) Thank you very much, senator. I think it's really important just to highlight what you said about the current state of data systems for public health in the United States. That they really are in need of aggressive monitorization. And again, thank Congress for the funding there, but it is a substantial investment that needs to take place. There are a number of counties that are still doing this pen and pencil, as you commented. And we need to have a comprehensive, integrated public health data system. That's not only able to do something that's in real time, but actually can be predictive. And it would be one of the great, I think, investments of our time to make that happen once and for all. Senator Murkowski: (01:58:08) I agree. Dr. Redfield: (01:58:09) And that's really fundamental to be able to operationalize contact tracing et cetera, and in contact tracing in this case, and I'll be very quick. Really doesn't have any value unless you can do it in real time. It doesn't help. Like I just did with the airlines where we had people that were flying infected from Afghanistan and we didn't get the information until day 14, day 15 day 16. It's irrelevant. So again, we love the partnership to get an integrated public health data system, not just for CDC, but for all of our jurisdictions across the nation into one timely integrated system. Senator Murkowski: (01:58:43) Appreciate it. Dr. Fauci: (01:58:45) Senator, thank you for the question about the- Chairman Alexander: (01:58:47) If you could be succinct, we're well over time. Dr. Fauci: (01:58:49) Yeah, we'll be quick. We have a community engagement program that is embedded within the sites where the vaccine trials will be done because we're thoroughly aware of what you're concerned about. And it is a reality. A lack of trust of authority, a lack of trust in government and a concern about vaccines in general. We need to engage the community by boots on the ground and getting community, particularly those populations that have not always been treated fairly by the government. Minority populations, African-Americans, Latinx and Native Americans. And we have a program that's already operable right now to do that. Thank you. Senator Murkowski: (01:59:29) Thank you. Chairman Alexander: (01:59:30) Thank you, Senator Murkowski, Senator Warren. Senator Warren: (01:59:34) Thank you very Mr. Chairman. Dr. Fauci you came before the Health Committee seven weeks ago to discuss the country's response to the COVID-19. And at the time you told me that the US did not quote, "By any means have total control over this outbreak." But you also told me that we were quote, "Going in the right direction." Now on the day you testified before the committee, that was May 12th, 2020, there were about 21,000 new cases of coronavirus. Yesterday, there were about 40,000 new cases of coronavirus. Dr. Fauci, do these numbers show that the country is still moving quote, "In the right direction." And that the coronavirus pandemic is under control? Dr. Fauci: (02:00:27) Well, I think the numbers speak for themselves. Although, we do have a number of parts of the country that are doing well. I'm very concerned about what's going on right now, particularly in the four states that are accounting for about 50% of the new infections, but the other vulnerable states. So I'd have to say the numbers speak for themselves. I'm very concerned, and I'm not satisfied with what's going on because we're going in the wrong direction. If you look at the curves of the new cases. So we've really got to do something about that and we need to do it quickly. Short answer to your question is that clearly we are not in total control right now. Senator Warren: (02:01:06) Thank you. Thank you very much. No, our case numbers are getting worse and our death rates are going to get worse soon. During this same period of time, some other countries around the world have controlled the virus. They're reporting fewer cases each day, and they are able to provide targeted testing and to keep it up, so that they can tell what's happening. And follow up, if there is an outbreak. In other words, controlling the coronavirus can be done, but because of bad federal leadership, we have not been able to do this here in the United States. So Dr. Fauci the last time you were before this committee, you told me that if the US did not have quote, "An adequate response, that the country would," quote, "have the deleterious consequences of more infections and more deaths." Senator Warren: (02:02:06) Now I know that we've made some progress, but half measures won't save lives. Dr. Fauci, I'm asking you to be very direct with all of us on this. If we don't fully implement the widespread testing, contact tracing programs and social distancing practices, that everyone seems to agree that we need. Can we expect these spikes and infection to keep happening in different places around the country? Dr. Fauci: (02:02:35) Thank you, senator. I'm always direct with you, and I'll tell you in direct answer to your question, that if you look at what's going on and just look at some of the film clips that you've seen of people congregating often without masks, of being in crowds and jumping over and avoiding and not paying attention to the guidelines that we very carefully put out. We're going to continue to be in a lot of trouble, and there's going to be a lot of hurt if that does not stop. And that-[crosstalk 02:03:08] Senator Warren: (02:03:07) Okay, so if we don't get our act together more and more communities around the country are going to see these dangerous surges of COVID-19. Dr. Fauci, back in March, you also said, quote, "Looking at what we're seeing now, you expected there to be between a 100,000 and 200,000 coronavirus, deaths, and millions of infections in the US." So let's flash forward to late June. Here we are. At the end of June, we've already seen 126,000 deaths with infection rates rising rapidly. Dr. Fauci, based on what you're seeing now, how many COVID-19 deaths and infections should America expect before this is all over? Dr. Fauci: (02:03:58) I can't make an accurate prediction, but it is going to be very disturbing, I will guarantee you that. Because when you have an outbreak in one part of the country, even though in other parts of the country, they're doing well, they are vulnerable. I made that point very clearly last week at a press conference. We can't just focus on those areas that are having the surge. It puts the entire country at risk. We are now having 40 plus thousand new cases a day. I would not be surprised if we go up to 100,000 a day, if this does not turn around. And so I am very concerned. Senator Warren: (02:04:36) Can you make any kind of estimate on what we're looking at overall on the number of deaths before this is over? You made an estimate back in March between a 100,000 and 200,000, but we have a lot more information, now. And we're already at 126,000 deaths. Dr. Fauci: (02:04:53) Right. I can't make an estimation because that would have to be modeled out because when models are done and that's where those original numbers came from, senator. As I've said, very often models are as good as the assumptions that you put into the model. And those assumptions often change depending upon what your response is. So I would really be hesitant to give a number that will come back and either be contradicted or overblown or under blown. But I think it's important to tell you and the American public, that I'm very concerned because it could get very bad. Senator Warren: (02:05:29) Yeah. All right. I appreciate that. Dr. Fauci. Look we all are- Chairman Alexander: (02:05:34) We're well over time, Senator Warren. Senator Warren: (02:05:36) I'd just like the same time that my Republican colleagues got, because I'm want to say- Chairman Alexander: (02:05:40) All right, then your time is up. Senator Warren, Senator Warren, I'm being just as fair to you as I was to Senator Sanders and the others. Senator Warren: (02:05:51) My Republican colleagues got a lot more time. Chairman Alexander: (02:05:52) Senator Warren, I always treat you fairly and I would appreciate you respecting the chairman's rules. If you'd like to make a closing statement, go ahead and do it, but I don't appreciate your questioning my fairness and presiding over the hearing. I've been scrupulously fair. Senator Warren: (02:06:10) [crosstalk 02:06:10] Based on what others had done, that you were allowing more time, since we had such important witnesses. Chairman Alexander: (02:06:15) Well, when your chairman, you can make those decisions. Senator Warren: (02:06:19) Thank you. I just want to make the point that we can't keep pretending this virus is getting better when it isn't. That's how we end up with messes, like the situation in Texas. Racing to reopen too soon, then scrambling to close down before the hospitals get completely overwhelmed. If we don't get our act together, this is our future, seesawing back and forth between too few restrictions and then exploding cases and repeated shut downs. In this future, thousands more Americans will die and our economy will be brought to its knees. We've got to have a national strategy that makes testing available to every school, every business, every hospital, every church, anywhere that Americans come together. We need to expand contact tracing. And we need leaders starting with President Trump who have enough backbone to face reality, distribute our resources, set our standards and stick to them because if we don't, the result is going to be more economic wreckage and more death. Thank you, Mr. Chairman. Chairman Alexander: (02:07:20) Thank you, Senator Warren, what I've tried to do in this hearing is to ask senators to stay within five minutes and the answers within five minutes and if the answers go beyond that. I've tried to be respectful of that, but I would ask senators not to ask their questions into well past five minutes and then expect to make a speech at the end. Senator Scott. Senator Scott: (02:07:48) I thank you, Mr. Chairman, and I will certainly respect your time limits. I think we all should do that. And frankly, as we're asking Dr. Fauci for an estimate of how many lives may be lost, I recall the first estimates were between 1 and 2.4 million lives. So I'm certainly glad that we are not there. And perhaps one of the reasons why we should be thankful for where we are now and force ourselves to have a serious conversation about continuing to flatten the curve is because the all hands on deck approach is effective. We just need as much cooperation from as many people as conceivably possible in every state around the country, in order for us to see these numbers continue to make a dive in the right direction, as opposed to a spike in the wrong direction. Senator Scott: (02:08:34) And I think about the Operations Warp Speed, along with the crucial support from BARDA and other federal agencies. Public private partnerships in accelerating groundbreaking technologies that could eradicate COVID-19 and revolutionize frankly, the vaccine development landscape. Because of these efforts by industry, academia and government working in concert, we could see a viable candidate or candidates in a matter of months for a vaccine. And because of the growing number of large scale manufacturing agreements with companies like Moderna Pfizer and J&J producing hundreds of millions of doses at risk, which means in advance, we are already working to address issues of access. And this is critical, especially for our most distressed communities. Senator Scott: (02:09:24) That said, effective development and widespread access, while essential, are only part of the equation. If, and when, and I feel optimistic that it's when, and not if, we get a viable vaccine, we need to encourage folks to choose to get vaccinated. I was really concerned when I saw a recent AP survey that showed that only 49% of American adults plan to get vaccinated once the COVID-19 vaccine came to market. A full 20% said that they did not plan to get vaccinated. And one third of Americans were not sure. Given the public's recent and vital focus on health disparities, it's worth noting that among certain groups, these figures are even more alarming, just 25% of black Americans, 37% of Hispanic Americans plan to get vaccinated against the coronavirus. Senator Scott: (02:10:20) My question to the full panel, what steps can we take at every level of government and in the private sector with healthcare providers to ensure a proactive education campaign and outreach strategy on the importance of getting vaccinated, both for COVID-19 and frankly, even more broadly? Dr. Fauci: (02:10:42) I'll take a shot at it first senator. As I mentioned in response to another question that we have a community engagement program that actually operates out of Operation Warp Speed, the vaccine development program component of that. Also, there needs to be engagement of people who the community trusts, particularly individuals who are noted sports figures or whomever. When we were involved and continue to be involved in community engagement with HIV. We used people in the community, boots on the ground to go out who looked and lived and are like the people they're trying to engage. It's very critical because I share with you the concern that we get to the hoop and we get through it of getting a safe and effective vaccine only to find that a substantial proportion of the population do not want to get vaccinated. Dr. Fauci: (02:11:39) Of particular concern, is it's that proportion of the population that generally are the most vulnerable in the sense of the minority communities. African-Americans Latinx, Native Americans, who in fact, because of underlying conditions, make it more likely that if they do get infected, they would have a poor outcome. So it's extremely important to engage them at the local ... Dr. Fauci: (02:12:03) ... outcome, so it's extremely important to engage them at the local level. Thank you. Senator Scott: (02:12:08) Well, thank you very much for your answers, Dr. Fauci. Let me just close with my 40 seconds that I have left, respecting the time, and I hope that we continue to do so. The pandemic has triggered a drop of 60-80% of immunization rates among children, and even now that states are reopening or not seeing the rebound and these rates that are necessary. This creates a real risk of secondary infections and disease outbreaks that are not on the general public's radar, as they reckon with the chief crisis at hand. So I think it's incredibly important that we follow your strategy, Dr. Fauci, as it relates to engaging community leaders and perhaps people with notoriety to challenge us to get involved and taking the vaccines. Thank you, Mr. Chairman. I apologize for being four seconds over my time. Senator Alexander: (02:12:59) Thank you, Senator Scott, for respecting the time. We have eight senators remaining who have questions, and we should have time for all of them to have a chance to ask their questions. Senator Kaine. Senator Kaine: (02:13:11) Thank you, Mr. Chair, and thank you to the witnesses. Dr. Fauci, I saw an interview with you last week, where you talked about a concern that there's too sizable a percentage of our population that doesn't like science and scientists and advice from scientists. I hear real emotion in your voice as you express concern about people gathering in large groups and without masks. I gather that's the kind of anti-science concern that you were worrying about when you had that interview last week. Dr. Fauci: (02:13:43) Yeah, that is part of, Senator. Yes, because the disregard of recommendations that come from authorities, only because it's a recommendation. I think the attitude of pushing back from authority and pushing back on scientific data is very concerning. We're in the middle of a catastrophic outbreak, and we really do need to be guided by scientific principles. Senator Kaine: (02:14:07) This could cause problems down the road if we get to a vaccine, but people don't want to get the vaccine, so we all have to message this pretty strongly. Dr. Redfield, I want to thank you. I was going to ask you a question today that I've been asking over and over again. Why does the CDC guidance for institutions of higher education not even mention the word "testing?" But as soon as your testimony was done this morning, the CDC website changed, and there are now guidelines for the institutes of higher education with fairly extensive recommendations and guidance, not mandates about testing. I didn't have a chance to read them, but I saw them popped up on the CDC website, and I wanted to thank you for that. Senator Kaine: (02:14:49) Your testimony, Dr. Redfield, today, and some of the written testimony talks about the fact that the public health system relies on timely and accurate data systems, but that we've under-invested in them, and the crisis has "highlighted the need to continue efforts to modernize the public health systems." Last year, I introduced a bill called the Saving Lives Through Better Data Act. It was with Senator Isaacs and then Senator King, and colleagues were helpful in this. We were able to get $50 million in December in the appropriations deal and then another $500 million in the CARES Act, but I would urge my colleagues to do even more because the request from our public health communities is significantly more sizable. I hope we might be able to get that into the next COVID package. Senator Kaine: (02:15:39) Dr. Fauci, this is a challenging question, challenging how to figure it out. The CDC last week said that a new group that we have to consider at risk is pregnant women and lactating women. The NIAID'S remdesivir and vaccine testing and vaccine testing often doesn't include pregnant women, I think for some safety reasons, but we would want to make sure that pregnant and lactating women have access to treatments and access to the vaccine. So how will we be trying to do research and testing so that the women can safely access these treatments or vaccines? Dr. Fauci: (02:16:20) Yeah. That is a great question. It applies also to children. So what we're doing with the vaccine is you do a phase one trial in normal, healthy adults, not pregnant, not children, and you show initial safety. Then when you move into this phase two and three studies, if you get even the slightest glimpse of efficacy and safety in that population, you go back and do a phase one in pregnant and lactating women as well as in children, and if that is safe there, you bridge the data so that you could use the efficacy data that you already started to apply back to pregnant women. Senator Kaine: (02:17:01) I see. Dr. Fauci: (02:17:02) That's how you do it. Senator Kaine: (02:17:03) Let me ask you this. At this point, is the nation's goal with respect to coronavirus to mitigate it or suppress it? Dr. Fauci: (02:17:12) Vaccines right now ... Are you talking about vaccines, sir? Senator Kaine: (02:17:15) No, I'm just talking about what is our goal? Are we trying to mitigate or are we trying to suppress? Dr. Fauci: (02:17:21) It depends on where you are. There's containment and mitigation. So if you have a level of virus that's low enough that you can adequately contain by the standard way of identification, isolation, contact tracing, particularly if you make sure you link the identification with isolation, because if you just do contact tracing without isolation, it's not going to work. When you get into a situation- Senator Kaine: (02:17:47) If I could, Dr. Fauci, because I don't want to go over time. I want to say just one thing about testing real quick. Admiral Giroir, when you were here last, you said we would capacity to do 40 to 50 million tests a month in September. That's about 1.3 to 1.7 million a day. On May 12th, we had done about 310,000. Yesterday, we did 560,000. Are we going to get to 1.3 to 1.7 million tests a day by September? Admiral Giroir: (02:18:18) So thank you for asking that. We will absolutely have the capacity to do that. It's depending on the need. And again, as you might expect, a few weeks ago, the need for testing was much less than it is now. We had a good system that it was actually very good that we were able to identify an increase in positivity very early, but obviously with the outbreaks we're having now, we need to massively surge testing in those areas. We will have that capability across the board. Yeah, we'll have that. That's assuming no pooling. When we start pooling these together, three, four tests, then you do the math. So I'm never going to be happy until we have more tests that we never have to say the word test again, but we're going to be in reasonably good shape, given those parameters. Senator Kaine: (02:19:04) Thanks, Mr. Chair. Senator Alexander: (02:19:05) Thank you, Senator Kaine. Senator Romney. Senator Romney: (02:19:09) Thank you Mr. Chairman, and thank you to each of the panelists for the sacrifice and the effort that you've been making over these past several years or past several months as well as years. As you know, because we didn't know a great deal about this virus as it first sprung on the scene in America, we asked the American people to do basically shut down their lives, cut back on flying, family reunions, funerals, church services, restaurants, bars, theaters. Everything got shut down. Well, now it's end of June, and hopefully we've learned something about how this disease actually spreads, and the American people need to go back out. They're going to go back out and they are going back out. We saw, for instance, at the Lake of the Ozarks, all these people that we said, "Oh my goodness, this is going to be a major problem," but my impression was because people were outside or who knows what other reason, it wasn't a major problem. Senator Romney: (02:20:02) So my question is this: where is the risk greatest? How is it that it's spreading? Is it spreading indoors? Is it spreading more at restaurants and bars? Is it okay to be outdoors and perhaps not socially distanced? Our family reunions okay? Can you give us some guidance based on what hopefully we know as to where the risks are greatest? I know you keep saying social distance and masks, but people are getting an airplanes. They're going to restaurants. Where is the risk greatest and where are we relatively safe? Can you help us do that? Family reunions? Can we get together with family reunions outdoors? Is it safe for outdoors and indoors? Give us some guidance. Can you do that to Dr. Fauci and Dr. Redfield? Dr. Redfield: (02:20:50) Thank you, Senator. I think first and foremost, the most important thing in that assessment is knowing at the granular level what the kinetics of transmission are in that community. As I mentioned, we have 130 counties right now in the United States where we consider them "hot spots." We have many other areas where there's very limited transmission, so first and foremost, it's knowing if you're in that area of active transmission. Then secondly, it's knowing what you do when you're in that area of active transmission and what precautions one takes. Senator Romney: (02:21:28) Got to be brief, doctor. I've only got five minutes. Dr. Redfield: (02:21:30) All right. Well, I think those are the two things. I will say that there's just more and more data showing that the use of face coverings and mask are an effective way to prevent transmission in these gatherings, and I think we're just going to come back and tell you the most important thing. If you're within a community with limited transmission and you're wearing face mask or there's significant transmission, you're wearing face mask and you practice those social distancing and hand washing, that's the best thing, best recommendations I can tell you. Dr. Fauci: (02:22:01) Yeah. In addition, Senator, outdoor better than indoor. Bars, really not good. Really not good. Congregation at a bar inside is bad news. We've really got to stop that right now when you have areas that are surging like we see right now. But an answer to your question a little bit more granular, outdoor is always better than indoor. If you're outdoor distanced, as Bob said, wear a mask if you can, but you can have some social interaction. The one point I want to make very briefly is that we should not look at the public health endeavors as being an obstruction to opening up. We should look at it as a vehicle to opening up so that you don't want to just restrict everything, because people are not going to tolerate that. So you can get outdoors, you can interact. Wear a mask, try to avoid the close congregation of people, wash your hands often, but don't just make it all or none. We've got to be able to get people to get out and enjoy themselves within the safe guidelines that we have, so make public health work for you as opposed to against you. Senator Romney: (02:23:13) I very much appreciate those responses. I think it would be extraordinarily helpful for all of us as we're going about our lives if there was data that indicated where people are getting infected. Were they in a bar, were they in a restaurant, were they outdoors at a pool? I've heard reports that virtually nobody has been infected if they're outdoors. Is that true or not true? Given how long we've been at this, we've got to have more granular data so people know where there's greater risk. How many people, for instance, have been infected as a result of flying on airplanes? We have to know that. If we could publish that information for the American people, they will know where can be safe and go back, of course, continuing social distancing and wearing masks, but we need that data. Finally, I'll just ask one answer. Who is responsible for distributing the vaccine? What person or what agency determines how the vaccine, when it's available, will be distributed? Dr. Redfield: (02:24:11) Well, thank you, Senator. This is a central function of CDC where we really help with vaccine distribution throughout the nation, childhood vaccines. Senator Romney: (02:24:23) So that's so that's the CDC. That's on your shoulders. Thank you. Mr. Chairman, back to you. Senator Alexander: (02:24:28) Thank you very much, Senator Romney. Senator Hassan. Senator Hassan: (02:24:32) Well, thank you, Mr. Chair, and thank you to all the witnesses for being here and for the teams you lead. I know how hard everybody is working. Dr. Redfield, I wanted to start with a question to you. 43% of the deaths in this country have been in nursing homes or longterm care facilities. In my state of New Hampshire, 80% of our deaths are attributed to residents of nursing homes and longterm care facilities. In mid May, the White House urged states to complete COVID-19 testing on every nursing home worker and resident within 14 days. A month and a half later, that still has not happened. CDC has since put out different guidance on nursing home testing, calling for a baseline test for residents and weekly testing from nursing home workers. Given the widespread outbreaks within nursing homes and unique risks posed to residents, what is CDC doing to ensure that states carry out the recommendations for nursing home testing issued by CDC on June 13th, and how many states have met these guidelines so far? Dr. Redfield: (02:25:37) Thank you, Senator. We are working in close contact with CMS on that issue. As you say, we're not an enforcement agency. We make recommendations. Senator Hassan: (02:25:49) But I'm asking, and my time is short. I'm asking what you are doing to keep track of compliance with guidelines. 43% death rate nationwide is huge, and people are looking to you all for granular guidance here, so what are you doing to find out who's in compliance and who's not? Dr. Redfield: (02:26:10) I was trying to emphasize that we're working in partnership with CMS, which has that regulatory oversight, and we're there to continue to reinforce the guidance as you mentioned, which we think is critical. We think we do have to get everyone screened in these nursing homes and the employees every week. Unfortunately, we still think that we need to keep visitors isolated from the homes right now, particularly in areas with high jurisdictions, but the regulatory function of this is CMS, but we are really meeting with them daily to see what more we can do to try to ensure that there's greater compliance. Senator Hassan: (02:26:43) I thank you for that. People are looking to the CDC for not only very clear and granular guidelines, and you've heard that all throughout the questioning, but particularly with nursing homes and longterm care facilities, there's a lot more work to be done, and we are still hearing that they're not getting usable personal protective equipment all the time either. Let me go to another question, and Dr. Fauci, I'll start with you. We've heard discussion already today about the difference in the effectiveness of measures taken, for instance, in Europe and the United States. This is a graph that shows the disparity between new confirmed cases per million residents over the previous seven days to the United States, Europe, Canada, and Japan. The disparity is eye-popping. Surveys suggest that mask wearing in the United States occurs less frequently than in Europe. You and our witnesses have been very clear on the importance of mask wearing in public places. Do you attribute the improvements in Europe to more widespread use of masks, or are there also other specific government policies or individual behavioral differences that you believe should be incorporated into our national strategy? Dr. Fauci: (02:28:02) Certainly masks play a role, but there are a number of other multifaceted things in each of those very disturbing graphs that you show. One of the things that became clear, when we shut down as a nation, in reality, only about 50% of the nation shut down with regard to other things that were allowed. In many of the European countries, 90-95% of all activities were shut down, so that is one of the reasons why you saw, particularly in Italy, which shut down to a much greater extent than we did, the cases came way down in a sharp curve downward and then stayed. So it's not only masks, it's the fact that the countries in Europe and the other countries you have there had a much more uniform response. We're a very heterogeneous country, and we had a heterogeneous response depending whether you are in the Northeast, Southern, West or what have you. So there's a number of other factors, probably some that we still don't even understand. Senator Hassan: (02:29:07) Well, thank you. I'm going to move on to just one other issue, and it's really just to urge Dr. Redfield and the CDC to issue additional guidance for schools in particular on reopening. I understand that you are continuing to do that. I appreciate that the CDC has released FAQ, frequently asked questions documents on things like youth sports, which provide more concrete, useful information for families, and I'm hoping that you'll do the same kind of FAQ documents for parents and teachers that directly address practical questions and concerns about school reopening plans, simply like what happens? What should a school do specifically if one or two positive cases come up in a classroom or in a teacher? What should parents and teachers expect school administrations to do? So we can follow up with that. I appreciate the chair's indulgence. Senator Alexander: (02:30:05) Thank you, Senator Hassan. Senator Braun. Senator Burr: (02:30:09) Thank you, Mr. Chairman. I've got two sets of questions and I'd like for Dr. Fauci and Redfield give about a minute each to the first. I want to get the broad numbers. I think, Dr. Redfield, you might've been on a record that you think there's 10 times as many cases out there is. I know that's a guess. I'd like to know, because if that's the case, all of a sudden the fatality rate goes from 5% down to five tenths a percent. 20 times as many cases, of course, a two and a half down the 0.25. What is your, start with you, Dr. Redfield, How many cases you think we actually have out there, and then how many vaccinations and/or herd immunity combinations as a percentage of our total population do we need to get to for this thing to be in the rear view mirror? So we've got a few big numbers to kind of relate the journey ahead. Dr. Redfield: (02:31:04) Thank you very much, Senator. Quickly, we now know that this virus began to really spread in the United States in March. In between March and the end of May, we've been able to do antibody testing and that's what allowed us to understand how many people were really infected. So during that period, it was our best estimate, about 10 to one, so we're probably talking over 20 million, 22 million Americans have been infected. I don't want people to assume that's the same ratio now in June and July going forward, because- Senator Burr: (02:31:40) You think it's more than that? Dr. Redfield: (02:31:41) No, I think it would be less because we're doing more and more testing, okay? But clearly it gives us a good idea the extent of infection was more in March, April and May, not 2 million individuals, but more closer to 20 million. Senator Burr: (02:31:57) What is your opinion of how many individuals we need vaccinated and/or having heard immunity before this thing goes into the rear view mirror. Dr. Redfield: (02:32:06) Yeah. Tony may comment on that too. It's really got to be over 70% of the population's got to be immune before we even see any impact on herd immunity. Senator Burr: (02:32:15) Dr. Fauci? Dr. Fauci: (02:32:16) Yeah, I totally agree. Given the transmissibility, which is highly efficient, you're going to need somewhere between 70% and 85%. I would say 70% at the lowest. Senator Burr: (02:32:26) Okay. Second set of questions would be on the issue of herd immunity, because of course we don't know how long it's going to take to have an effective vaccine. I'm guessing when you're talking about herd immunity, it's got to actually confer immunity if you get it, and there might be some uncertain. Let's assume you do get the immunity. How do we go about the approaches that we've used at this point? Is herd immunity going to be something that you think will march through if we take the strategy of having a different approach for younger people that seem to have lower hospitalization rates and less significant consequences? Because I think that's another thing we need to know, because I think that's already going to be done by each individual in a way as a size up their own personal risk. So how much can we count on herd immunity? Dr. Redfield: (02:33:28) I can answer quickly and then turn it to Tony. I think it's important to realize even now, we're probably looking at somewhere between 5% and 8% of the American public has experienced this virus. So for me, herd immunity as a basic strategy, you're talking about a multi-year strategy. This is why it's so important that the alternative strategy has a biological countermeasure in the development of a vaccine. Dr. Fauci: (02:33:53) One of issues that might be complicating, I don't think it's going to be something that is going to be any kind of a showstopper, but we've got to realize, and as Senator Paul said, we have to be humble and know there's a lot we don't know. What we don't know is what the durability is in other words, so if you wind up getting hurt immunity to 75-80%, what we need to learn and only time will teach us this, is how long this immunity lasts. Is it a year, two, three, four, or is it even less? Is it months? We don't know. When we find out, then that will inform us as to whether or not if you get a vaccine, how often you need to boost it. So we have to realize, we don't really know the answer to your question in any definitive way. Senator Burr: (02:34:38) At least that gives us some clarity, some parameters to live within. Senator Hassan stressed the point of protecting the most vulnerable. Because to me, the one thing it looks like we can certainly do is to take that highest risk group from the data we've already got and build, in essence, an iron dome around them as the one thing that would seem to be the most important thing to do where you get certain results. I think that has to be in place as the uncertainty of herd immunity and when we get an effective vaccine actually converge. Dr. Fauci: (02:35:18) I might add, just we always think about herd immunity with regard to natural infection and/or vaccination, but when you want to talk about protecting the vulnerable, we want to see if some of the other programs that are more prophylactic treatment programs like passive transfer of plasma or monoclonal antibodies or hyper immune globulin. Those are some of the things that you can do to protect the vulnerable until do get an effective vaccine. Senator Burr: (02:35:46) Thank you. Senator Alexander: (02:35:47) Thank you, Senator Braun. Senator Smith. Senator Smith: (02:35:50) Thank you, Chairman Alexander, ranking member Murray. It's good to see all of you today and thank you again to our panelists. So we need robust surveillance and occupational testing if we are going to safely reopen our economy and our schools, our nursing homes and our group homes to make sure that they're not a conduit for infection, and we're seeing this. A good example of this is in New York state, where employees in nursing homes are required to get a COVID-19 test twice a week. So here's the problem; if you're a worker. Who pays for that test? Is it my employer? Is it my private insurance if I have insurance, or do I have to pay for it out of my pocket? So I'm thinking about that low wage worker working in childcare or food processing, or maybe as a security worker or a janitor. Senator Smith: (02:36:37) The average cost of a test is somewhere in the neighborhood of $75 to $150, though there are reports of people being charged over $6,000 to be tested, assuming you can find a test. So this is my first question. Last week, federal agencies posted guidance on this question, and the guidance said that health plans are not required to cover the full cost of tests for surveillance for occupational reasons, and the federal testing plan, which talks about the value of surveillance testing and occupational testing is silent on this. So let me ask you, Dr. Fauci, do you agree that we are going to be better able to contain the spread of COVID-19 and save lives if we have surveillance testing? Dr. Fauci: (02:37:29) No doubt surveillance testing is going to be a very important part of the program to understand not only the current penetrance of the virus in society, but where it's going. A short answer to your question is it's going to be very important in our public health measure. Senator Smith: (02:37:46) And would not also the price of these tests or the ability to pay for these tests be a pretty significant barrier to having that surveillance happen? Dr. Fauci: (02:37:56) I think common sense tells you that if people cannot pay for it, they're not going to do it, and that's one of the reasons why we've got to figure out how we can do it without having the stress of people who can't afford it to be part of that process. Senator Smith: (02:38:11) And the worry, of course, is that this ability to pay for these surveillance tests, for this kind of surveillance testing that could really tend to exacerbate underlying inequities since a lot of frontline workers and essential workers who don't have the privilege of working for home are much more likely to be Black and Brown and indigenous people, people of color. Isn't that right? Dr. Fauci: (02:38:35) As in old cases, that people who are economically not able to engage in some of the things that benefit others, they always in general get a short end of the stick on that, and that's what we have to be concerned about. Senator Smith: (02:38:47) Right. Right. Well, colleagues, I think this is a really important place where we have the potential to work together and make sure that as we expand surveillance testing and occupational testing, as we look at our schools, our higher institutions of higher education coming back, that we have the ability to do this and that the ability to pay for that test isn't a barrier. So I appreciate, Chair Alexander, you mentioned this at the beginning. Others of my colleagues have mentioned this, and I think this is a place where we could work together in constructive way. I want to ask a question specifically related to vaccines, because there's been a lot of discussion about this, a lot of discussion about how we can make sure that people trust these vaccines, that they are safe, that they work, and that the longterm consequences, potential negative side effects, we understand those. So let me just ask, maybe I'll ask you again, Dr. Fauci, how do we trust a vaccine that has only had a short number of months potentially being tested in the human body? Dr. Fauci: (02:39:57) There are a couple of ways to overcome that. First is that you have a large number of people in the trial. The trials that we're talking about now are going to have 30,000 people in the trial and maybe even more in some of them. You can get a considerable amount of safety data, but then there's a process after a vaccine maybe would show efficacy to do further studies following licensure availability. I'll let Dr. Hahn maybe comment on that more, because that becomes something very much involved with the FDA's authority and making sure we do have safe vaccines. So Steve? Senator Smith: (02:40:37) Let me just add, if I could maybe put a finer point in this question for you, Dr. Hahn. I mean, what if a manufacturer were to say that they could get a vaccine to market in January, but only if they were released from liability? What's the FDA policy on that? How would you resolve that question? Dr. Hahn: (02:40:56) Thank you, Senator. So we would not get into the issue of liability for an individual sponsor, and what we would do, and that's why we released the guidance this morning, is we would ensure that our normal regulatory approach and our standards for safety and efficacy are met. So while we're all really anxious- Senator Smith: (02:41:17) So you would not release said manufacturer from liability? Dr. Hahn: (02:41:20) That's not an FDA authority that we would use. Senator Smith: (02:41:22) Okay. And how do you guard against the possibility- Senator Alexander: (02:41:27) Senator Smith, we're running a little late, but go ahead with your question, but let's [crosstalk 02:41:32]. Senator Smith: (02:41:32) This should be ... Hopefully this will be an easy one. I mean, what I'm worried about is that there's some sort of October surprise and that there is a pressure put on the decision makers here to announce the vaccine in October of 2020. Dr. Hahn, can you just tell us how we can have transparency so that people can trust that that isn't happening? Dr. Hahn: (02:41:48) Senator Smith, a very good question and really important and leads to the issue of public confidence. It's why we released our guidance today. We want to be clear about what the standards and the data that we'll need to make a decision and what factors go into those decisions. I want the American people to hear me when I say we will use the science and data from those trials, and we will ensure that our high levels of standards for safety and efficacy are met. Senator Alexander: (02:42:14) Thank you, Senator Smith. Senator Smith: (02:42:15) Thank you, Chairman. Senator Alexander: (02:42:16) Senator Loeffler. Senator Loeffler: (02:42:23) Good morning. Thank you all for being here. Sorry. I can't be there in person. I wanted to ask, Dr. Redfield, can you outline what steps the CDC is taking to look at, as we prepare for handling both the flu and COVID-19 season simultaneously this fall. I know the CDC recently developed a test that diagnoses both COVID-19 and the flu, but what other activities is the agency engaged in, and are there any novel approaches that you see in terms of implementing this? Would love to hear about the agency's process for approaching the season this fall and your thoughts there. Dr. Redfield: (02:43:08) Thank you very much, Senator. I think it's really important to recognize that it is going to be difficult with the flu and COVID this fall. First and foremost is to try to increase the American public's acceptance of flu vaccine. As you know, less than 50% accept it. We're working hard to begin to reach out, particularly to groups that have been underrepresented, to try to build that confidence in vaccination. We've worked with the manufacturers to see if they could boost the amount of vaccine that would be available. They've now increased their commitment to almost 189 million doses. CDC bought another 7.1 million doses. Normally, we buy about 500,000 to be able to be available to the states and local health departments for uninsured adults. We've done that, and we increased that to 7.1 million doses. We've augmented our commitment to the children vaccine program, anticipating that there's going to be more children that will qualify in light of the unemployment. So those are some of the areas that we've begun to prepare for. Senator Loeffler: (02:44:16) Thank you. And this question is for Dr. Hahn. The pandemic has exposed our vulnerabilities in the medical supply chain, and obviously we have a reliance on imports from country like China that can quickly pose a national security risk in the face of an outbreak of infectious disease. We need to come up with a strategy to boost our production here, both pharmaceuticals and supplies. I've introduced some legislation titled the Beat China Act to offer incentives to companies that bring manufacturing back to the United States but would like to hear from you, what additional steps can policymakers take to boost our capability to produce these supplies and pharmaceuticals domestically. Senator Loeffler: (02:45:00) ... The pharmaceuticals domestically. Dr. Hahn: (02:45:04) Thank you, Senator Loeffler and thank you for your leadership on this. I think one issue that we can all agree upon is the lack of redundancy in the supply chain and the dependency that we've seen during the COVID-19 pandemic has been a problem. Dr. Hahn: (02:45:19) The agency's primary focus has been on instilling redundancy in the supply chain, particularly of pharmaceuticals by diversifying that supply chain and really looking for opportunities to encourage domestic manufacturing. Dr. Hahn: (02:45:35) We, of course, on the regulatory side, provide guidance as well as regulations, around the manufacturing specifications to ensure quality of pharmaceuticals and other medical products. We will continue to do that, particularly in the advanced manufacturing space, in order to encourage domestic manufacturing. Dr. Hahn: (02:45:54) We look forward very much to working with you and other members of Congress to see how we can create the proper incentives to have that redundancy and particularly to have as much domestic manufacturing as possible. Senator Loeffler: (02:46:08) Thank you Doctor Hahn. No further questions. I'll yield my time. Chairman Alexander: (02:46:12) Thank you, Senator Loeffler. Senator Jones. Senator Jones: (02:46:16) Thank you, Mr. Chairman and thank you all for being here today. I really appreciate your testimony, your consistency over the last few months. It has got to be somewhat discouraging to all of you as it is to us to see these numbers. I want to kind of focus a little bit on schools, as we will start opening schools up in Alabama in August. Let me give you a little chronology here. Senator Jones: (02:46:37) The state of Alabama kind of began to open up its economy more in May. A little bit more toward the end of May and then for Memorial Day, we saw the photographs and videos that Doctor Fauci referred to with everybody just having a big time for a Memorial day holiday. Senator Jones: (02:46:54) Now, at the end of June, we are at our highest levels. The last 14 days have shown over 10,000 cases, which is 28% of the cases that we have seen, have occurred just in the last 14 days. At the end of this week, we have the July 4th holiday coming up and we're going to see a delay in hospitalizations from right now. If we do the same thing on July 4th, we're going to have a huge problem at the end of July and early August when we start opening schools up. Senator Jones: (02:47:26) Our state school superintendent this week said that it would cost about $1.8 million for the average school system to do those things necessary, to try to protect kids and the faculty. But I heard Senator Paul in his comments and discussing a number of things, to where you would get the impression that we could just open schools back up without spending any of that money. Senator Jones: (02:47:51) So my question primarily to Doctor Fauci and Doctor Redfield. Could you comment on some of the statistics and some things that you heard children transmitting this disease and whether or not we need to spend some additional monies for our schools to do things like have extra PPE, to do things like hiring, potentially hiring additional health officers, temperature screenings, those kinds of things. Are those going to be necessary based on what I've heard from Senator Paul and what happened on his charts and other countries. Doctor Fauci and Doctor Redfield. Dr. Fauci: (02:48:26) But I'll quickly give it a shot and then hand it over to Doctor Redfield. We don't know precisely. I think the data that was very interesting that Senator Paul showed about school openings and not seeing any real obvious surge in cases is important but we don't really know exactly what the efficiency of spread is. Dr. Fauci: (02:48:48) First of all, how many children get infected? That was the reason why in my opening statement, I mentioned the study that we're doing at the NIH of 6,000 families, looking at children, what is the rate of their infection and how often do they infect their families? Because if it's true that the rate is down, we know that they don't get seriously ill with hospitalizations when they get infected, but if the rate of infection is down and they don't readily transmit to their parents and family members, that's going to be very important in the decision making process of opening schools. Dr. Fauci: (02:49:22) Hopefully we're going to find that out reasonably soon by this study that we're doing. Bob. Dr. Redfield: (02:49:30) I'd echo what Doctor Fauci said. CDC has a number of what we call household studies going on to try to get a better understanding of how does the virus get into a household? Who brings it in? What happens when it's in the household? How does transmission vary depending on how the household responds in terms of social distancing, et cetera. So there is information that we are gathering. I think we don't know the impact that children have yet on the transmission cycle. So I think we should just acknowledge that. Dr. Redfield: (02:50:04) The greater threat obviously is again, the children to the vulnerable but I think one can actually have social behavior that can prevent that and so I think that would be just to emphasize. I think it's a really important. It's been said already that we move forward and work to reopening schools in a safe way. I think it's of note that CDC never really recommended closing schools. It's sort of just happened as you know. We can do targeted school closings if we have to, in a particular region, like we've done for other viral diseases, but I think we really need to move forward now and work to how to reopen these schools safely. Senator Jones: (02:50:43) Thank you. Admiral Giroir, I want to make sure we're tuned in and we've talked about it a little bit. Are we going to be able to make sure that we get vaccines distributed in the most vulnerable of communities because seems to be where so much is happening right now, in the rural South, and are you making specific plans to make sure that we get that into the rural areas? Admiral Giroir: (02:51:07) So, so thank you very much. So we, we all work on parts of this problem, right? So the CDC actually controls the distribution but what my office does running the National Vaccine Program, does things like the Morehouse Grant, a cooperative agreement that we announced last week, that really reaches into the rural, into the Hispanic, into African-American, to really have the community, the people who are in that community, not only linked the services like testing but to lay the groundwork for vaccine acceptance because we know that the burden of disease is fundamentally burdened on these individuals. So these are the people, assuming the science works out, that we want to get vaccinated first. Senator Jones: (02:51:53) All right, great. Thank you. Thank you. Mr. Chairman. Chairman Alexander: (02:51:55) Thank you, Senator Jones. We know the witnesses need to leave about one. We're going to try to respect that. Senator Rosen. Senator Rosen: (02:52:09) Hold on. Can you hear me? Chairman Alexander: (02:52:11) Yes, we can. Senator Rosen: (02:52:16) Well good morning. I will try to be as quick as I can talking about antibodies this morning. Thank you, Chairman Alexander, Ranking Member Murray, all of our witnesses, for being here today. Senator Rosen: (02:52:26) As our community is focused on to how safely get back to work and school just like we're all talking about, we know we have to follow the science and adapt to new information, to be sure that we're making timely, targeted and thoughtful decisions to protect both lives and livelihoods. Senator Rosen: (02:52:43) So Doctor Fauci, the last time you were here, we talked about the monoclonal antibody treatments and I'd like to follow up on that conversation if we could. As we've learned more about the virus, how it functions, how it's different from other respiratory illnesses, what updates can you tell us about the development of preventative treatments that block the virus from attaching to the cells that it's targeting? Dr. Fauci: (02:53:10) Well, thank you for the question, Senator. You mentioned monoclonal antibodies. Monoclonal antibodies are going into trials right now and a number of trials sponsored by a number of groups. Hopefully within a reasonable period of time, we'll get information as to whether or not that's effective, both in the prevention, as well as in the treatment. Dr. Fauci: (02:53:32) Those antibodies are directed against a component of the virus that is what's called a spike protein and that protein is the one that binds to the now well established receptor in your body for the virus. That's a receptacle ACE2. Dr. Fauci: (02:53:51) There are a number of other studies that are not necessarily antibody studies but studies that have a effect on the virus itself and its initial replication. In answer to a question that the chairman mentioned just a bit ago, is that there will be therapies that we will be giving some for treatment early on and others for prophylaxis. And as we hope, as we get into the fall and winter, we'll have everything from small molecule treatments and prophylaxis, to the kinds of antibodies that you're talking about. Dr. Fauci: (02:54:27) So there's a lot of activity going on to do that early in disease, both for prevention and for the treatment of early disease. Senator Rosen: (02:54:36) I know that you've been doing a lot of serology testing and then individuals are presenting with antibodies. Senator Rosen: (02:54:43) So out of the five type of antibodies that people are most likely to have, which ones do most recovers patients, which ones do they show? And if one of these specific antibodies are present, does that make a difference and if the patient could be reinfected and not or not? Are they effectively immune at least for some period of time? What kind of answers does this give us if you do have the presence of certain antibiotics? Dr. Fauci: (02:55:13) I'd love to give you a really precise, scientifically based answer but the fact is we don't know. Standard wise, when you get an acute infection, you get an IgM antibody. As you go off in time and develop a more mature immune response, it becomes an IgG. There are subclasses of IgG, some more protective than others. Dr. Fauci: (02:55:34) The thing we don't know, Senator, that we will know in time but it's going to take time to know it, is what the relationship between the neutralizing antibody and binding antibodies that don't neutralize, what is the relationship between the titer and the degree of protection and what is the durability of protection? Dr. Fauci: (02:55:54) We've seen some puzzling things. We've seen people recover from COVID infection and find out they don't have very high of numbers of antibody. Could it be a cell mediated response that got them through the illness and some other individuals have very high levels and we don't know how long those levels last. Dr. Fauci: (02:56:13) So we're getting there with regards to our knowledge but it's going to take several more months to a year to really be able to definitively answer your question about the role of antibodies in protection, following natural infection. Senator Rosen: (02:56:28) Building upon that I'd like to ask this question. We know that this virus affects, is multi-organ. It can affect your kidneys, your lungs, your heart, producing strokes, all kinds of things. Your digestive system, your sense of smell. Senator Rosen: (02:56:42) So on the science that you're talking about in the antibodies, is the science of stopping the virus from causing harm the same regardless of which organ it attacks and how do we help direct funding for the kind of research that you're going to need to look at this multi-organ attack of this virus, if you will? Dr. Fauci: (02:57:04) This is a very perplexing virus because it's a respiratory virus and it gets in through the respiratory tract. If the virus stays in the respiratory tract and doesn't go systemic to involve other organs, that's good news because you don't get very sick. Dr. Fauci: (02:57:21) The other side of the coin is your antibody response is not as potent because when you get systemic involvement invariably, you will have a more potent and robust immune response. So many people and probably the people who are the asymptomatic carriers, they have a reasonable titer of virus in their nasal pharynx but the virus doesn't go any other place in their body. Dr. Fauci: (02:57:46) People who get multisystem disease, that get triggered by the virus, those are the ones that unfortunately get more sick but also the ones that make a more potent immune response. Senator Rosen: (02:57:58) Thank you so much. I appreciate you all being here today. Chairman Alexander: (02:58:02) Thank you, Senator Rosen. Very interesting question. Senator Murray, do you have closing remarks? Senator Murray: (02:58:08) I have one additional question if I might and then some closing remarks. I wanted to ask Admiral Giroir one question. Admiral Giroir: (02:58:16) Yes ma'am. Senator Murray: (02:58:18) Thank you. Despite some of the limited data, we do know that COVID-19 is infecting and killing black, Latino, and native American people at a much higher rate than white people. I want to ask you how HHS is going to adjust its response to reduce cases and deaths in communities of color and specifically, can you commit to redirect some of the $14 billion that is in unspent funds Congress provided to address those disparities? Admiral Giroir: (02:58:47) Let me answer the two parts of the question. Admiral Giroir: (02:58:50) First, as you know, and really appreciate your support, we've tried to focus our testing into high social vulnerability community. So 70% of our over 600 pharmacy sites are in high SVI communities. That means racial and ethnic minorities, language disparities, socioeconomic, FQHC. So we've made a major push that the federally qualified health centers that take care of one out of three of those in poverty, over 1,300 of those are now offering testing and of course we're super excited about the award to Morehouse School of Medicine last week that has a large coalition to create a national infrastructure, to reach minorities and underserved. So that's what we're really doing and you know my office, this is what we do on a daily basis, even without a pandemic. Admiral Giroir: (02:59:41) Your second question is I don't commit the money. So I certainly think we need continued investment in this area, continued significant investment in this area, that the $40 million is a down payment on how we can best reach the underserved community. But you're going to have to talk to OMB about how the money is spent. Senator Murray: (03:00:02) Well actually HHS oversees that so we will ask them but I think that's an important question. I'll keep following up and tracking that. Admiral Giroir: (03:00:10) Yes, Ma'am. Senator Murray: (03:00:10) Thank you, Mr. Chairman. I appreciate all of our witnesses taking the time to join us today, to update our committee on the course of this pandemic and all of our efforts to respond to it. Senator Murray: (03:00:20) I hope we will continue to have an opportunity to hear from all of you as well as other key administration officials about this because the absolute worst thing we could do right now is to pretend this crisis is over when it is painfully obvious that that is not true. Senator Murray: (03:00:36) The reality is that the losses in this pandemic so far are nearly unthinkable and any further delays in our response is really unacceptable. We need to take this president, to take this crisis seriously and lead, and we need Congress to act. Senator Murray: (03:00:52) So I hope we can all get back to work as soon as possible. We need to support our families, our frontline workers, our businesses, our schools, our communities. We need to get testing where it needs to be. We need to make sure we are making progress towards a safe, effective, widely available vaccine and we need to strengthen our ties with the global community rather than cut them. So there's a lot left to do Mr. Chairman. I look forward to working with you on this. Chairman Alexander: (03:01:17) Thank you, Senator Murray. I know our witnesses have a meeting they need to go to, so I'll abbreviate my remarks, but one thing I want to ask you, perhaps you can each do it in a minute or less. I put out a white paper in recognition of what some of you have said, which is that in between pandemics, we have found it difficult to do some of the things we need to do to prepare for the next pandemic. Chairman Alexander: (03:01:44) So if there were one or two things that you thought we should try to do now in order to be prepared for the next pandemic, what were those one or two things be? Doctor Fauci? Dr. Fauci: (03:02:02) One of the things that I would like to see is an appreciation on the part of our entire nation, of the importance of responding, as a nation as a whole, and not have a situation where when you have a challenge such as we have right now, we have very disparate responses. We've got to do it in a coordinated way because we are all in this together. Dr. Fauci: (03:02:28) The other thing I'd like to do now is to cement in our minds, as we bridge to the future, the fact that we cannot forget that what was thought to be unimaginable, turned out to be the reality that we're facing right now. So it relates to the kind of appreciation that outbreaks happen and you have to deal with them in a very aggressive, proactive way. Chairman Alexander: (03:02:55) Dr. Redfield? Dr. Redfield: (03:03:00) Thank you, Mr. Chairman. I think the most important thing that I could say is that when it comes to public health threats, our nation needs to be over-prepared not under-prepared. As I mentioned before, decades of under investment in the core capabilities of public health, data monitorization, laboratory resilience workforce, mergers response, I think is fundamental. Dr. Redfield: (03:03:28) We've really been hit with this simple virus and I think at the end of the day, it's going to cost our nation trillions of dollars and I think that we have a moment in time where I think people are attuned and I would say now's the time to make the necessary investment in our public health, at the local, territorial, tribal state and federal level, so that this nation finally has the public health system, not only that it needs, but that it deserves. Chairman Alexander: (03:04:08) [inaudible 03:04:08] Giroir. Admiral Giroir: (03:04:09) Of course, I agree completely with my colleagues and we're all singing from the same hymnal here. I'll say three things. Admiral Giroir: (03:04:16) Number one. Data infrastructure is really important. When we came into this, we didn't know how many ventilators were in use, how many tests were out there, were the tests positive or negative, who was being tested. I mean, the complete soup to nuts infrastructure that we need to make decisions, you need those data to make decisions and to allocate resources and now that we built this on the fly but we absolutely have to invest in that. Admiral Giroir: (03:04:41) Secondly, I would say resiliency of the healthcare system. Yes, we need to attack COVID, but what happens to everything else? We've seen cancer screenings go down by 80%. Childhood immunizations plummet. Just about every other thing in the healthcare system was sacrificed for our COVID response. So it's not just the pandemic response but it's everything else we need to do. Admiral Giroir: (03:05:03) And the third thing I would say is, we continue, have to focus on health disparities. If everyone was healthier in this country, if we invested into those hypertension, diabetes, obesity, all the things that could bring the general health up, you would not see as horrible of outcomes as we have in any pandemic. Admiral Giroir: (03:05:23) So working on health disparities that have been here for decades is I think critical to raise our general health and prepare us for whatever's going to hit us. Chairman Alexander: (03:05:31) Doctor Hahn, you can have the last word. Dr. Hahn: (03:05:34) Thank you, Mr. Chairman. Dr. Hahn: (03:05:35) First of all, thank you for your leadership on your white paper. I think that's really important to put this conversation forward. There are two things I want to emphasize. Dr. Hahn: (03:05:42) One is the data modernization, but from an FDA perspective. It's a very manual process to number one, collect data on demand and also set the supply chain. We need a very robust system to understand that. We also need a robust, real world, evidence approach so that when we make decisions in real time during an emergency, doctors do that all the time, agencies do that particularly during public health emergencies, we have the appropriate data infrastructure to collect real world evidence and feedback into our decisions and then revise those decisions as needed, critically important for the agency. Dr. Hahn: (03:06:17) The second thing is linked and that is to my previous comments that Senator Loeffler asked about. We absolutely need redundancy in the supply chain. We need redundancy in manufacturing and we need to emphasize the importance of domestic manufacturing. Thank you. Chairman Alexander: (03:06:31) Thank you, Doctor Hahn. Chairman Alexander: (03:06:32) Well, the one thing this sneaky, dangerous virus has reminded us is that there will be another sneaky, dangerous virus one day and we know from experience that it may be easier to take the steps you've just described while our eye is on the ball, rather than between pandemics, because we get interested in other issues. Chairman Alexander: (03:06:57) I'm grateful to the witnesses for your time. I thank the senators on both sides of the aisle for really careful, insightful, and courteous questioning. Chairman Alexander: (03:07:07) The hearing record will remain open for 10 days. Members may submit additional information within that time, if they would like. Chairman Alexander: (03:07:15) Thank you for being here, the committee will... Speaker 1: (03:10:37) Does joint discomfort have you feeling like something is holding you back? Does joint discomfort, have you feeling like something is holding you back? Then it's time to look for real results from a trusted leader in joint health. Taking Cosamin DS as recommended, is a simple way to help support your joint health. Cosamin DS's revolutionary formula works at the cellular level to block certain enzymes that break down cartilage, cutting the strings of discomfort and helping provide you with the confidence to get back to the things you love. Speaker 1: (03:11:29) Cosamin. This is what joint comfort looks like. Leader McCarthy: (03:11:34) One thing about America, we will overcome this. We will find a vaccine. We're finding therapies for it. One thing about America, we will overcome this. One thing about America, we will overcome this. We will find a vaccine. We're finding therapies for it and we will, actually not only save America, but save the rest of the world from what China lied to us and put havoc and death throughout this world. Speaker 2: (03:12:00) Leader McCarthy, you've said that everybody should wear a mask. What about the president? You know, he's made it clear he doesn't want to wear a mask but his federal government says everybody should wear a mask. Speaker 2: (03:12:12) Don't you think it would be a powerful symbol if the president of the United States would put on a mask and understand what so many people around the country are doing to try to slow down the spread of this thing? Leader McCarthy: (03:12:24) Remember, I say wear a mask but when you see me speak on the floor, when nobody else is around me, I'm not wearing a mask at that time. Speaker 2: (03:12:31) Sure. Leader McCarthy: (03:12:31) When you see the president speak, I think the social distancing. I've known the president to have worn masks at times as he goes forward. I do think the health of the nation to make sure [inaudible 03:12:42] this economy down. That is not the approach to take. Leader McCarthy: (03:12:45) With the more information we have, knowledge today, wearing the mask is the best opportunities for us to keep this economy open, keep us working, keep us safe and help us as we build towards that vaccine where we're in a much stronger position than any other country before. Speaker 2: (03:13:00) Sure and Leader McCarthy, we actually all have to wear a masks to get into this building. When we go into the green room, we have to as well. So we take it off when we're on TV, just as you do when you speak as well. Speaker 2: (03:13:11) I just don't see any downside in the president being seen more often wearing it. It's symbolic. Obviously it's patriotic because you're not only protecting yourself, you're protecting other people. Speaker 2: (03:13:22) I've heard that there are people around the president who say, "[inaudible 00:18:22] you shouldn't wear it," but nonetheless, it would be a powerful symbol. Leader McCarthy: (03:13:29) It would. I mean for the Fourth of July, we could all show our patriotism with a red, white and blue mask going out there. Speaker 2: (03:13:35) Great idea.