Circumstances that your state desires guidance from soon isn't terribly helpful. Thank you Mister Chairman. Thank you. Senator Murphy Senator Cassidy, a gentleman. Thank you very much for your service and I will have a a set of questions so if your questions can be brief, I appreciate your answers could be brief Doctor Hanh in your testimony, you mentioned that the testing for the populations and the vaccine trials now includes all Americans. guess my question, though is what about children does it include children as. Also include the obese the diabetic Fein compromise those who are at risk of having a less a non response or mitigated response vaccination. can you comment on that? Please Yes sir. Thank you, Senator Cassidy when the phase two phase three trials are in place they will include our most vulnerable populations, including the individuals that you describe. We're working very closely. If I if I get interrupt phase two is only. For safety, you would not have to do a separate phase two in the patient who was younger. if I can, you just assume the safety data from the adults supplies to that of the children. so you know we would also want to assess safety as well in children so the current phase two trials do they include children. They're in phase one studies right now, Sir-I. I thought that you said we had a phase two going on well. I think it's about to start from the majority of perhaps doctor Fal. You can answer that. Yeah, I know the Senator Cassidy No-I. I did not say a phase two is I think we. In the second dose of the phase one and we will proceed when we finish the phase one to go to phase two. So that's so I'm hearing the children will be included in phase two trials. No that's that's so that's under discussion between the FDA and NIH this time because we do realize that it's important for us to understand what this is in children but that's Doctor Redfield the bill back upon what Senator Murphys. the published guidelines for schools school opening obviously you're about to modify, but I noticed as I read through them. There's nothing about testing. so we speak about testing targeted testing how we use testing, but the guidelines for the school systems has nothing about how to integrate testing will this be in those guidelines that are being released. Senator thanks for the question, clearly there's gonna need to be already been stated and integration of a testing strategy that is gonna be different. It's a different school settings as well as different jurisdictions, whether it's setting and that is gonna have to be integrated into each of those. there's a general overarching guidelines and then as I say I do think the strategy, which is important. Including the surveillance it needs to be a individualized. Let me let me let me know that doctors doctor Redfield all due respect. I think children whether you're a rule, frontier, suburban or urban is the one setting in which there is a remarkable commonality and I will echo what Senator Murphy said the resources that the federal government has greatly exceeds all but the most sophisticated. The populous wealthy state and even then it exceeded by some extent, so I do think it would be good to have okay in a primary school setting. This is the best practices are these are three options and choose between one of these three to say to each school district or each private or parochial or independent school work with your state Board of health figured it out seems a wasted effort. I say that because children play such a role in both protection of disease, the spread of disease. So your thoughts on that because it really seems that's the one setting where you can have. you know not cookie cutter but certainly a pattern which can be followed the senator. I must have been misunderstood when I was talking about differences. I was thinking of the difference between an elementary school, a high school or College in terms of how we trade school, there may be differences on how you integrated testing strategy, but I do think having a test and strategy with different options for people to evaluate based on different principles will be important in terms of guidance Doctor Fal Persuasively argue that the risk of reopening prematurely is great, but I think the frustration If I think of children in particular the risk benefit ratio of a child being at home, potentially away from enhanced nutrition without the parent able to work because to school provides day care without the monitoring and sometimes occurs for incidents such as a child abuse, but perhaps most importantly for all children, the opportunity cost of a brain, which is forming not having access. The information that will help that brain form optimally now as there been any sort of kind of risk benefit ratio for the child. Yes, they are at risk for Kawasaki, but they are particular risk for missing out on a year of education, particularly for those from less than rich backgrounds. I guess I'm very concerned about that tension. What are your thoughts on that? No? you mean you make a very good point and Cassidy that obvious I'm very difficult of the unintended consequences of trying to do something that broadly is important. Of the public health and the risk of having a return or resurgence of an outbreak and the unintended consequences of having children out of school, we fully appreciate that I don't have an easy answer to that. I just don't you just have to see on a step-by-step basis as we get into the the period of time with the fall about reopening the schools exactly where we'll be at the dynamics of the outbreak. I might point out something that I think has been alluded to throughout some of the question. That we have a very large country and the dynamics of the outbreak of different in different regions of the country, so I would imagine that situations regarding school will be very different in one region versus another so that it's not gonna be universally or Homo genius, but I don't have a good explanation or solution to the problem of what happens when you close schools and it triggers a cascade of events that could have some circumstances. I I've Mister chairman I. By asking permission of the of the chair to submit for the record, the article that just came out in the Journal of Pediatric Nursing children are at risk Covid- 19, so it'll be included. Thank Senator Senator Warren thank you mister. Thank you Mister chairman and thank you to our witnesses for being here today. I hope everybody's staying safe and healthy in the past 16 weeks over one point, Three million Americans have been infected with Corona virus. We now know that about 80000 people have died and 33 million people are out of work. Doctor Fal You have advised six presidents you have battled deadly viruses for your entire career, so I just like to hear your honest opinion. Do we have the Corona virus contained? Senator Thank you for the question. right now. It depends on what you mean by containment. If you think that we have it completely under control, we don't I mean if you look at the the dynamics of the outbreak and we are seeing a diminution of hospitalizations and infections in some places such as in New York City, which has plateaued and starting to come down New Orleans But in other parts of the country, we are seeing spikes. so when you look at the dynamics of new cases, even though some are coming down, the curve looks flat with some slight coming down. So I think we're going in the right direction, but the right direction does not mean we have by any means total control of this outbreak so right direction as I understand that we have about 20 - 5000 new infections a day and over 2000 deaths a day. I think those are the right numbers and some estimating we could be at 200000 cases. A day by June, is that right doctor Frye. I don't. I don't foresee that as 200000 new cases by June and I am hoping and looking. At the dynamics of things, starting to flatten off and come down that we will be much better than that. Senator. I think it's really it's just so I understand we are right now at 2000 new infections a day and 220 - 5000 new infections a day and 2000 deaths a day right and that's where we are right now. So yeah. So so let me just ask if we know that it is possible to get this virus under better control other country. Have done it like South Korea, but we are now three months into this pandemic and basically we've continue to set records for the number of people who are diagnosed and the number of people who die Doctor Fulcher. You recently said that the second wave of the virus in the fall was quote inevitable, but that if America it's in place, all of the counter measures that you need to address this, We should do reasonably well and the counter measures you are. Or things like continued social dist significantly more testing widespread contact Tracy. You also said that America doesn't do what it takes and this is your quote. We be in for a bad fall and a bad winter. so right now we're about 16 weeks away from Labor Day. That's about the same length of time since the virus was first detected here in the US don't have enough robust. Measures in place that we don't have to worry about a bad fall and winter right now the projection as you've heard from ad with regard the testing and other elements that would be needed to respond. The projection is that by the time we get to the end of the summer and early fall, and we will have that in place. That's the projection that I get from. We don't have an place now that we are projecting that we'll have in place. And let me just ask the other side of this if we don't do better on testing on contact racing and on social distancing will deaths from Corona virus necessarily increase of course, if you do not do an adequate response, we will have the deleterious consequences of more infections and more deaths, and that's the reason why you quoted me, Senator quite correctly and everything you said. and I will stand by that if we do not. In an adequate way, when the fall comes given that it is without a doubt that they will be infections that will be in the community and we run the risk of having a resurgence. I would hope by that point in time in the fall that we have more than enough to respond adequately. but if we don't there will be problems, I appreciate your help and I wish we could tell the American people that the federal government has this pandemic under control, but we can. Fact, you have said that the virus is not under control in the US. We haven't yet taken the measures necessary to prevent a second wave of death, and we all know that the people who are gonna be most affected are going to be seniors essential workers the people who are out on the front lines The President needs to stop pretending that if he just ignores news, it will go away. It won't the time for. Thinking is over here. President Trump must acknowledge that the federal response has been insufficient and that more people are dying. As a result, we are running out of time to save lives and we need to act now. so thank you Doctor Frye for all you're doing. We appreciate it but the urgency of the moment could not be clear. Thank you. Thank you. Senator Warren. Senator Roberts. thank you very much Mister chairman and thanks to all the witnesses are you all are like the the Tabb for I guess it was a Fab five back in the day, but we're shining the light of truth in the darkness at the individual flashlights for sure that take you Mister chairman for emphasizing that we have to be bipartisan approach. We're not gonna get anywhere and that obviously is in the eyes of the behold. I'm happy to say. We have a very good relationship Governor Kelly, who happens to be a Democrat or a Republican and her her emergency management team is spot on Doctor Lee Normans doing a job. That's the wraps up this morning. I talked to Lee Situate in Kansas is a very good. I'm reading here. Candace receives 7000 new hovis for cats with food processing facilities. you see this behind me. That's a stagecoach coming in to do opposed to get out of Dodge Dodge City is my hometown. We are the hot spot in regards to mainly because of two packing plants. We have five. That's a 26 percent of the cattle in any way. Candace is going through a tough time and it it. We shouldn't be worrying about the safety of the food the food supply chain I think nationwide is under a great deal of stress. We see that we see that in poultry, we see that in part there, euthanizing pigs and and See the livestock Sony Perdue with the Department of Agriculture has stepped up so as the President of the declaring that he's packing plants are in National asset, we progress Dodge City when we first started out, we had five tests five. That's between four and 65. It's not 50 million as we hope to receive that has been said by one of the witnesses the reason I'm really happy. On all of the problems, we're having an agriculture on the fact that the relationship with China as I said even first breakthrough with regards to trade to China seems to be on hold now and that's another depress and this is going on five or six years for our prices have been below the production end result. Our consumers are really figuring out that food doesn't come from the grocery store and I'm very worried that the harmed the good value chain is. It is very real, not to mention the financial situation. There are farmers, ranchers and growers are now having said all that I wanna ask Admiral drawer you spoken about the importance of having diversity and kinds of tests that are available now the five packing plants we have Ints if we could get a rapid test and we can get it as we hopefully ask for because of the hotspots developing not only in Kansas but also doing great harvest for the food value chain that would be absolutely wonderful. Would you speak to that? Sir? Yes, Thank you Senator both doctor Redfield and I have been very actively involved in getting strategies or the industry, particularly in Kansas. we are supplying very heavily the public health lab with rapid diagnostics as well as surging them to areas like that. The one trade off, however, is that the rapid the rapid point of care. Agnostics are very slow, so each machine can only do four per hour and that's very slow. So it's a mix of testing that you need at these kinds of situations sort of the the high throughput tests that are available at a major lab. A quest lab right there in Kansas as well as a mix of the rapid testing, and that's what we're supplying in order to provide a comprehensive holistic solution and I believe CD. Sees on the ground as well in Kansas supporting that I appreciate that if you only do it for an hour, that's not a rapid test. Maybe it's a rapid slow test. I'm not quite sure how you define that. but I for one think that as we reopen and by the way Governor Kelly started the opening process first of this month and there's and then we go to June and then the hope is we hope not but we do have contingency plans that if that doesn't work as a. Described by doctor voucher. I I think we'll be right but this is gonna be a tough go. I I have to tell you that in terms of agriculture, we're not in good shape. I appreciate everybody and the job that you were doing We stand beside you when you're taking the booze and behind you when you're taking BS. Thank you. Senator Roberts Senator Kain Thank you Mister chair to the Committee leadership and witnesses for calling this important hearing. The last time Doctor Fuchs and Hanh were before us was March three. I have a slide that I wanna put up that shows what's happened in America since then the chart which is here, compares the experience of the United States and South Korea on three dates on January 21. Both Nations experience their first case of Cove in 19 at that time, the unemployment rate in both countries were essentially identical on March three when the witness. Were last year, South Korea had experienced 20 - eight Cove in 19 deaths in the US experience. Nine again. The economies of both Nations is measured by the unemployment rates were nearly identical, but now the story changes as of yesterday more than 81000 Americans have died and the US economy has experienced job loss is not seen since the Great Depression. Meanwhile, the economy of South Korea has not changed dramatically at all and the death toll is now at 256. In the United States, one sixth of our population, but even if you bulk up the death toll to reflect the difference, the per capita death toll in the US is more than 45 times the rate in South Korea and the health care carnage Here is causing a near depression while South Korea has protected its economy by managing correctly, I could have done this chart with other Nations. The US has the seventh highest per capita death rate in the world are death rate is off the charts higher than that, India, Australia, New Zealand, Japan and Mexico. It's nearly three times the death rate in Germany twice as high as Canada's rate. The question is why if we wanna open up our economy in schools, we have to learn the lessons of Nations that have managed this well. Here's some things that don't explain the difference. Our hospitals are as good or better than those in South Korea. Our health care providers heroes are as good or better than those in South Korea. Our research capacity is as good or better than that in South Korea and we have more resources than South Our GDP is 12 times, South Korea's and our per cap. Income is 50 percent higher so to Doctor Fuch the death row in the United States, the death rate in the United States, especially when compared with other Nations, is unacceptable, isn't it. Excuse me. Sorry, sir. yes. Of course, I mean a death rate at that high is something that in any manner or form in my mind is unacceptable and Doctor Fal. The experience of other Nations shows that the US death rate is not only unacceptable, but it's unnecessary isn't that correct. I don't I don't know if we can say that Senator, but would you say that the US has to do better? Of course, you always have to do better. I mean as a and the. Experience of South Korea shows that how a nation manages the health care crisis has a huge impact. Also, it's on it's economic condition isn't that the case that is the case Sir-I understand where you're going with this, but I have to tell you there is a big difference between South Korea and the United States and the outbreak and and let me and let me get to that. I wanna get to factors that do explain the difference since we know it's not resources or health providers first is tests. South Korea began began aggressive testing in the US now in the fifth month of the pandemic, we surpassed South Korea in per capita testing, but in the critical month of March, South Korea was testing its population at a rate of 40 times the testing in the US Admiral Gerard Doctor Gerard has set out the standard for us when we get to September, He says the United States needs to do 40 to 50 million tests a month to be safe. That equates to about one point three million to one point Seven million deaths a day yesterday, we did 390 - 5000 tests. We've got a long way to go. a second factor is contract trace contact tracing South Korea embraced a rigorous contact tracing program right from the beginning. The United States still has not engaged in a National contract tracing program isn't that right. Would that be doctor Boucher Redfield, so I think that question would be directed to the CDC and then when the outbreak started so we had an aggressive contact Tracy program, but unfortunately as the cases grow, it went beyond the capacity and we went to mitigation. So we lost the containment. It's clearly that and that was the key to the economy as well because South Korea did testing contact tracing protect serve isolate the sick and then they didn't have to do the shutdowns, which help their economy. Social distancing is the third factor that we've talked about it, but finally the last one how. Care systems Would you agree with me that it helps keep people safer either from serious conditions or death from covid- 19 if they have access to health care. Yes, of course, of course, of course, that's the case in South Korea, 97 percent of the population have health insurance in the United States for Covid- 19. Millions didn't have it and lack access to health care the massive job losses in the last months threatened to take health insurance away from millions more and President Trump is doing all he can to dismantle the Affordable Care Act, which would take health insurance away from tens of millions more. Let's learn the less. From those who are doing this right, Thank you Mister chair I yield back. Thank you make a clarification, Please Mister chairman. this is Brett. I just wanted to clarify that I did project that we will have the ability to perform 40 to 50 million tests per month in in in that time frame. But I said if needed that at that time, I am not making a proclamation. we have to really understand what were the epidemic is what the community spread is before we can estimate the number of tests that are needed. I was simply stating the fact that our combination of testing capabilities will be at the. Even boring new input from the NIH. Thank you very much. Senator Kane Senator Musky Thank you, Mister chairman and gentlemen. Thank you for being here this morning Ritu but also for all of you who have been doing for these many months Alaska's doing okay right now from a numbers perspective and quite honestly, we want to keep it that way because we know we have exceptionally vulnerable populations. We know we have a geography that is challenging. We know that we have facilities that are very limited last year. We had an opportunity to hear from Doctor Collins and he shared where they are with the Redd, Xs and and also spoke to Redd exx up which was very interesting about what we can be doing in rural areas but focusing on hot spots and as I reminded him, we don't want to be a hot spot in Alaska, so every effort that we make to keep the virus out of is our lives that are saved. I educated. On the community of Cordova, that is just getting ready to open, it's it's Copper River salmon fishery in two days and was able to share that they had had one worker tested positive as he was coming in from the lower 48 to come to work The good news on that is that all the protocols that we have put in place seem to be working the quarantine the isolation and not only for that individual, but for others that he had. In contact we're secure so I want I wanna recognize the assistance that we have received from the administration doctor Eastman is in the state at this moment, the chief medical officer for the Department of Homeland Security, going out to rural communities to really better understand our vulnerabilities go to some of our fishing communities to again understand how we can successfully prosecute a fisheries when you have to bring. In from the outside, we thank you for the assistance with regards to additional testing capacity. I've been in in contact with our chief Medical officer of the state this morning and the mayor of Cordova just better understanding again. Do we have the test that we need what do we need on the ground and one of the things that I would like to have clarified and that this is probably to you. Doctor Shira could be because you have been so helpful in. Kinda shining the light on what we need to be doing in these rural areas, but so much of the focus has been on hot spots and responding to the hot spots. But how do you keep those rural remote small communities from becoming the hot spots in the first place? Are we doing enough and right now? The strategy has been We just lock it off the travel restrictions that are in place are apparently we're. but they're also they're also devastating our economy, whether it's tourism or whether it's our resource industries or whether it's the potential for our fisheries. so Admiral if you might speak to that aspect of it and then I have a very important question as it relates to contract a contact tracing that I'd like to direct to either Admiral Guerra or doctor Redfield. So. Thank you senator and as you know, you have an outstanding state health officer and doctor and Zain we do I've had the privilege of working with her and you have a very good protocol in trying to keep a Alaska safe by isolation over a period of time when you come in as you know, we also work with the state to meet your very challenging testing requirements because you can't really. Then lays out a thousand miles away, so we put a real customized mix of point of care and also the machines. I think we set nine or 10 new to Alaska and about 50000 tests, which is about four times, then you've done to date collectively in order to provide that support. So again, I do think there's a comprehensive strategy that you do have but again the mitigation it is the degree that you can given the circumstances that face masks the hand washing the hygiene we understand fully the challenges. In the fishing, reva environment and the remote, but all these have to come together The testing the tracing the mitigation the hygiene factors to try to keep your community safe and we really understand culturally that many of your communities we're almost annihilated in the 1918 influenza pandemic so in that memory is still very sharp and very hurtful to many of the citizens. so we wanna do our best to assure them that we're giving them all the protection we can so Amira let me let me turn to doctor Redfield because this relates to contact Trey. I think that this is a very key part of how we move forward into getting people back to work getting people back to school right now, we have about a hundred people that are involved in in contact tracing in Alaska. that's clearly not sufficient. there's been talk about a National strategy, but I think we recognize that we have teams in place whether it's a miracle or whether it's peace or whether it's our our public health core. What more do we need to be doing to make sure that once you've been tested positive? You know, then what happens after that who else needs to be brought into into this and I'm not convinced that we're focusing enough on that aspect of how we move to reopening If we haven't done the contact tracing. Thank you very much Senator and I wanted to just reemphasize what you said, and I think contact tracing capabilities is critical. it's gonna be the difference from succeeding in containing this outbreak. Once again using wide scales community transmission or not we're positioned as you know to deploy and redeploy the number of CDC over 500 CDC individuals, we have another about 650 that you're trying to put in to our foundation, but most importantly, we're trying to work with your health Department with the resources that we've been able to give because of the Congress's also as you mentioned. With these other agencies with core, I mean with Amer or with the Census Bureau to work together and have the state developed their capacity. Some States have relocated state work, some States of National Guard while they begin to do this, but I agree with you and I said it's gonna be a significant effort to build the capacity that we need in this, It will be state by state, but it's gonna need to be. In your state from what you just said five to 10 and we're there to work with the States to help them accomplish that needs to get in place before September. we need to move on that question. Thank you. Thank you. Senator Murkowski. I don't wanna put any senator off, but we have eight more senators who have five minute rounds and it's 1230. so I'd like to request that the Senators and the witnesses. It's the same questions and try to stay within five minutes. We'd appreciate it. Senator. Well, thank you Mister chair. Thank you and the ranking member for having this hearing and thank you to our witnesses today and please pass our thanks along to all of the hardworking women and men in your agencies who I know have been working virtually around the clock to try to improve our response and keep Americans safe and Mister chair. I hope you and all the witnesses are healthy and safe today, as is everybody on your team I wanted to start by echoing comments my colleagues have made about eating a leadership from the CDC and our public health experts on how we are going to use facts and evidence as guidance so that our schools and our daycares and our businesses have the information they need to create safe and sustainable lands to reopen. And of course, that means to that are testing capacity. not only has to be enough, but it has to be flexible enough to meet our needs. The key distinction between South Korea and the United States is not how many tests per capita over a certain amount of time we've done, but the fact that at the onset of this epidemic, South Korea was much more able to do a lot more tests per capita than we were, and then follow that with all the other measures you've talked about so that we continue to need to identify the need and then build our capacity towards the need, not the other way around. I wanted to start with a question to you. Doctor Fuchs. first of all, Thank you for your work and your expertise. I wanted to talk about nursing homes for a minute in New Hampshire and across the country. a huge number of the deaths from Covid- 19 that we are seeing have been in nursing homes. We all know people who have lost a friend or a family member in nursing homes and the reef compounded by the fact that you couldn't be at the loved ones bedside if they died yesterday doctor. Dirks said that all One million nursing home residents should be tested within the next two weeks as well as all nursing home staff Doctor Fuchs as a short-term goal that makes sense to me, but after that, what will be ongoing federal recommendations look like how frequently do we need to test patients and staff on a continuing basis and what other measures will be necessary to keep our loved ones in these facilities. safe. Thank you for the question. Singular Hassan, the the the General plan, as you mentioned that was recommended by Doctor Berks is a sound plan as you said in the immediate question is in the long range we will have to have infection control capabilities in nursing homes that are really pristine and it really unassailable. We have to do the kinds of surveillance and have to have the capability of when you identify someone you get out of that particular environment so that they don't spread the infection throughout so general testing for all, I think is a good start. but when you look where you're gonna go. In the future, it has to be a considerable degree of surveillance capability. Thank you Doctor the White House is now requiring all staff to wear masks and anyone in regular contact with the President to tested daily. Do you think nursing homes should implement those same measures to help make sure that our seniors can get the same level of protection. I think that should be a certain a system in place for the optimal protection of people in nursing homes, and that would be not necessarily testing every person every day. That's one approach that might not be practical when you think of all the nursing homes. A country but we strict regulations and guidelines about who is allowed to go into the nursing home and the staff I believe needs to be monitored very carefully with intermittent testing to make sure that we don't have introduction into the nursing home of infected individuals. I'm not sure you can practically do it test it every day that I don't think would be feasible but something that is much more aggressive than. Been in the past, I believe should be done Well. Thank you. I have one last question for doctor Fetch and Doctor Redfield. I would also just say that if we are able to get masks to everybody in the White House, I hope we can get masks to every nursing home employee who needs it doctor and doctor Redfield US needs to be preparing now to ensure that we have a manufacturer and administer vaccines something you've both touched on both for an eventual hope in 19 vaccine as well as a.