[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
CONFRONTING THE CORONAVIRUS: PERSPECTIVES ON THE RESPONSE TO A PANDEMIC
THREAT
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HEARING
before the
COMMITTEE ON HOMELAND SECURITY
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
SECOND SESSION
__________
MARCH 4, 2020
__________
Serial No. 116-65
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Printed for the use of the Committee on Homeland Security
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
41-985 PDF WASHINGTON : 2021
COMMITTEE ON HOMELAND SECURITY
Bennie G. Thompson, Mississippi, Chairman
Sheila Jackson Lee, Texas Mike Rogers, Alabama
James R. Langevin, Rhode Island Peter T. King, New York
Cedric L. Richmond, Louisiana Michael T. McCaul, Texas
Donald M. Payne, Jr., New Jersey John Katko, New York
Kathleen M. Rice, New York Mark Walker, North Carolina
J. Luis Correa, California Clay Higgins, Louisiana
Xochitl Torres Small, New Mexico Debbie Lesko, Arizona
Max Rose, New York Mark Green, Tennessee
Lauren Underwood, Illinois John Joyce, Pennsylvania
Elissa Slotkin, Michigan Dan Crenshaw, Texas
Emanuel Cleaver, Missouri Michael Guest, Mississippi
Al Green, Texas Dan Bishop, North Carolina
Yvette D. Clarke, New York Jefferson Van Drew, New Jersey
Dina Titus, Nevada
Bonnie Watson Coleman, New Jersey
Nanette Diaz Barragan, California
Val Butler Demings, Florida
Hope Goins, Staff Director
Chris Vieson, Minority Staff Director
C O N T E N T S
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Page
Statements
The Honorable Bennie G. Thompson, a Representative in Congress
From the State of Mississippi, and Chairman, Committee on
Homeland Security:
Oral Statement................................................. 1
Prepared Statement............................................. 2
The Honorable Mike Rogers, a Representative in Congress From the
State of Alabama, and Ranking Member, Committee on Homeland
Security:
Oral Statement................................................. 3
Prepared Statement............................................. 4
Witnesses
Dr. Tom Inglesby, Director, Center for Health Security, Johns
Hopkins University, Bloomberg School of Public Health:
Oral Statement................................................. 4
Prepared Statement............................................. 6
Dr. Ngozi O. Ezike, Director, Illinois Department of Public
Health:
Oral Statement................................................. 10
Prepared Statement............................................. 11
Dr. Julie Louise Gerberding, Co-Chair, Commission on
Strengthening America's Health Security, Center for Strategic
and International Studies (Former Director of The Centers for
Disease Control and Prevention):
Oral Statement................................................. 13
Prepared Statement............................................. 15
For the Record
The Honorable Sheila Jackson Lee, a Representative in Congress
From the State of Texas:
Article, Washington Post....................................... 44
Article, Washington Post....................................... 46
Article, National Geographic................................... 49
CONFRONTING THE CORONAVIRUS: PERSPECTIVES ON THE RESPONSE TO A PANDEMIC
THREAT
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Wednesday, March 4, 2020
U.S. House of Representatives,
Committee on Homeland Security,
Washington, DC.
The committee met, pursuant to notice, at 10:05 a.m., in
Room 310, Cannon House Office Building, Hon. Bennie G. Thompson
(Chairman of the committee) presiding.
Present: Representatives Thompson, Jackson Lee, Langevin,
Richmond, Correa, Rose, Underwood, Slotkin, Clarke; Rogers,
King, Katko, Walker, Higgins, Lesko, Green of Tennessee, Joyce,
Crenshaw, and Bishop.
Chairman Thompson. The Committee on Homeland Security will
come to order.
The committee is meeting today to receive testimony on
confronting the coronavirus.
Without objection, the Chair is authorized to declare the
committee in recess at any point.
Good morning. Today the committee is meeting to hear from
medical experts about how our country can best confront the
coronavirus. Americans are justifiably concerned about the
virus, which has spread around the world, and claimed the lives
of thousands. Understandably, they have questions about how it
may affect them, their loved ones, and their communities.
How concerned do we need to be about the virus? Who is most
at risk? What can communities do to prepare? What can Americans
do to protect themselves and their families? What is the
Federal Government doing? What more should it be doing? When
might we have a vaccine or other treatment? My constituents are
looking to the Federal Government for leadership, guidance, and
expertise, and I am sure my colleagues' constituents are, too.
I am concerned the Trump administration has downplayed the
threat, overstated how close scientists are developing a
vaccine, and silenced experts who disagree with him. Instead,
we must acknowledge the threat and allow doctors and scientists
to offer candid assessments of the situation, and direct the
Federal response.
We are fortunate to have a distinguished panel of
physicians to offer their expert opinion today. I look forward
to hearing from them about what the Federal Government must do
to support State and local efforts, help hospitals and health
care providers, and protect the lives of Americans. Input like
theirs will absolutely be essential to confronting this threat.
I appreciate their willingness to join us today.
[The statement of Chairman Thompson follows:]
Statement of Chairman Bennie G. Thompson
March 4, 2020
Today, the committee is meeting to hear from medical experts about
how our country can best confront the coronavirus.
Americans are justifiably concerned about the virus, which has
spread around the world and claimed the lives of thousands, including
at least 9 people here at home.
Understandably, they have questions about how it may affect them,
their loved ones, and their communities:
How concerned do we need to be about the coronavirus?
Who is most at risk?
What can communities do to prepare?
What can Americans do to protect themselves and their
families?
What is the Federal Government doing?
What more should it be doing?
When might we have a vaccine or other treatment?
My constituents are looking to the Federal Government for
leadership, guidance, and expertise, and am sure my colleagues'
constituents are too.
I am concerned the Trump administration has downplayed the threat,
overstated how close scientists are to developing a vaccine, and
silenced experts in his own administration who disagree with him.
Instead, we must acknowledge the threat and allow doctors and
scientists to offer candid assessments of the situation and direct the
Federal response.
We are fortunate to have a distinguished panel of physicians to
offer their expert opinions today.
I look forward to hearing from them about what the Federal
Government must do to support State and local efforts, help hospitals
and health care providers, and protect the lives of Americans.
Input like theirs will be absolutely essential to confronting the
threat posed by the coronavirus, and I appreciate their willingness to
join us here today.
Chairman Thompson. When the Ranking Member comes, we will
allow him an opportunity to read his statement into the record.
We will go forward.
I welcome our panel of witnesses.
Our first witness, Dr. Tom Inglesby, is the director of the
Center for--you want to----
Mr. Rogers. Go ahead.
Chairman Thompson. OK--is the director of the Center for
Health Security of the Johns Hopkins Bloomberg School of Public
Health. His work is internationally recognized in the fields of
public health preparedness, pandemic and emerging infectious
disease, and prevention and response to biological threats.
I now recognize the gentlelady from Illinois, Ms.
Underwood, to introduce our next witness.
Ms. Underwood. Thank you, Mr. Chairman. I want to welcome
Dr. Ngozi Ezike, the director of the Illinois Department of
Public Health. Dr. Ezike is a board-certified internist and
pediatrician who has dedicated her career to improving health
outcomes and health care access for the people of Illinois. She
has served in public health roles for the past 15 years in my
home State of Illinois.
Dr. Ezike received her undergraduate degree from Harvard,
and her medical degree from the University of California, San
Diego. She completed her internship and residency at Rush
Medical Center, where she is an assistant professor of
pediatrics.
I want to thank Dr. Ezike and her team for working around
the clock to respond to the recent coronavirus outbreaks in
Illinois, and sincerely appreciate her taking the time to share
her expertise with us today.
Thank you.
Chairman Thompson. Thank you very much.
Finally, we have Dr. Julie Gerberding, who has served as
the director of the Centers for Disease Control and Prevention
from 2002 to 2008. She currently serves as executive vice
president and chief patent officer for strategic
communications, global public policy, and population health at
Merck. She is also co-chair of the Center for Strategic and
International Studies Commission on Strengthening America's
Health Security.
Without objection, the witnesses' full statements will be
inserted in the record.
At this point I would like to defer to the Ranking Member
for an opening statement.
Mr. Rogers. Thank you, Mr. Chairman. I apologize for being
late, I got 2 hearings going on simultaneously. But this is a
great panel, and I look forward to their testimony.
As I said yesterday, our hearts go out to those who have
lost their loved ones, and those who are currently undergoing
treatment.
This is a global event that requires global response. I
know many of our international partners are working diligently
as part of a united effort to understand and address COVID-19's
spread. Unfortunately, some of the actions taken by other
countries may have hindered a comprehensive response to this
new virus. I remain concerned that Chinese officials knowingly
withheld essential information from both the public and
international health community in the most critical stages of
this outbreak. I am sure that the early days of this outbreak
will be under intense scrutiny, once this crisis is over.
My deepest concern for the moment is the level of
preparedness at the State and local level. I have heard
directly from State and local responders, medical
professionals, and emergency managers that are dealing with an
increasingly concerned public.
We have a very distinguished panel of medical professionals
here today. I am interested in hearing from them on what
assistance front-line health professionals need from the
Federal Government to effectively deal with this crisis.
I am also pleased that Dr. Gerberding is here today. Dr.
Gerberding was director of CDC for most of the Bush
administration. She has led a very effective response to the
anthrax attacks and the outbreak of SARS, and managed more than
40 other emergency responses. I am very interested in hearing
about her experience, and how lessons learned from managing
those public health emergencies can be applied to the COVID-19
outbreak.
Finally, I am interested in the panel's honest assessment
of the risk from the virus. Your expert medical opinion is
invaluable in reassuring the public during times like this.
It is also very important for political leaders to avoid
fanning the flames of hysteria. Our job should be to support
the medical community, and provide them with the resources they
need to handle this and future outbreaks. That is why I am very
pleased we will be considering a supplemental appropriations
bill today. Hopefully, this funding will help speed along these
important diagnostic treatment and vaccination resources that
will alleviate this crisis.
Thank you, Mr. Chairman.
[The statement of Ranking Member Rogers follows:]
Statement of Ranking Member Mike Rogers
Mar. 4, 2020
As I said yesterday, our hearts go out to those who have lost their
loved ones and those who are currently undergoing treatment.
This is a global event that requires a global response.
I know many of our international partners are working diligently as
part of a united effort to understand and address Covid-19's spread.
Unfortunately, some of the actions taken by other countries may
have hindered a comprehensive response to this new virus.
I remain concerned that Chinese officials knowingly withheld
essential information from both the public and the international health
community in the most critical stages of this outbreak.
I'm sure that the early days of this outbreak will be under intense
scrutiny once the crisis is over.
My deepest concern for the moment is the level of preparedness at
the State and local level.
I've heard directly from State and local responders, medical
professionals, and emergency managers that are dealing with an
increasingly concerned public.
We have a very distinguished panel of medical professionals here
today.
I am interested in hearing from them what assistance front-line
health professionals need from the Federal Government to effectively
deal with this crisis.
I am also very pleased to have Dr. Gerberding here today. Dr.
Gerberding was the director of the CDC for most of the Bush
administration. She led a very effective response to the Anthrax
attacks, and the outbreak of SARS and managed more than 40 other
emergency responses.
I'm very interested in hearing about her experience and how lessons
learned from managing those public health emergencies can be applied to
the Covid-19 outbreak.
Finally, I am interested in the panel's honest assessment of the
risk from this virus. Your expert medical opinion is invaluable in
reassuring the public during times like this.
It is also very important for political leaders to avoid fanning
the flames of hysteria.
Our job should be to support the medical community and provide them
with the resources they need to handle this and future outbreaks.
That's why I am very pleased we will be considering a supplemental
appropriations bill today. Hopefully, this funding will help speed
along important diagnostic, treatment, and vaccination resources that
will alleviate this crisis.
Thank you, Mr. Chairman.
Mr. Rogers. I do have one UC request we enter this into the
record.
Chairman Thompson. Without objection.*
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* The document has been retained in committee files.
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Mr. Rogers. Thank you, sir. I yield.
Chairman Thompson. I now ask each witness to summarize his
or her statement for 5 minutes, beginning with Dr. Inglesby.
STATEMENT OF TOM INGLESBY, MD, DIRECTOR, CENTER FOR HEALTH
SECURITY, JOHNS HOPKINS UNIVERSITY, BLOOMBERG SCHOOL OF PUBLIC
HEALTH
Dr. Inglesby. Chairman Thompson, Ranking Member Rogers, and
Members of the committee, thank you for the chance to testify
today about COVID-19. My name is Tom Inglesby, and I am the
director of the Johns Hopkins Center for Health Security.
COVID-19 was first recognized in Wuhan, China at the end of
last year and, as of yesterday, has infected somewhere between
85,000 and 90,000 cases world-wide, and killed over 3,100
people across 65 countries. Patients who become sick with
COVID-19 most often have cough, fever, and in the more serious
cases underlying viral pneumonia. In China approximately 80
percent of those with this illness had mild symptoms, 15
percent required hospitalization, and 5 percent develop
critical illness. The virus has a 1-14-day incubation period,
and is spread primarily via respiratory droplets between
persons at close contact. The elderly and those with underlying
medical conditions are at highest risk.
As of yesterday, the United States had confirmed 118 cases
of COVID-19, including 8 deaths. The majority of those cases
are returning travelers or repatriated persons from China. But
for about 20 cases, there is no connection between any known
case of COVID-19, which suggests that in those places there is
some level of community transmission of COVID going on.
An emergency supplemental appropriation is currently being
negotiated between Congress and the administration. In 2014/
2015 Congress appropriated $5.4 billion for the Ebola response.
In my view, COVID-19 will require perhaps twice as much or
more, given its respiratory transmission and the likelihood
that it is going to be wide-spread around the country, and so
all jurisdictions will need to prepare and respond.
Health care systems should be planning to provide care for
large numbers of critically ill patients, as we have seen has
been required in China and in South Korea and Italy. They will
also need very strong infection control strategies, including
access to personal protective equipment, as well as other kinds
of engineering and administrative controls and hospitals.
The Federal Government should be engaging at the highest
level of industry regarding PPE manufacturing and maximizing
the supply of this critical medical material.
Steps should be taken to make sure that routine medical
care is not disrupted, as it has been in China, where we saw
that clinics entirely unrelated to COVID-19 were disrupted,
including cancer clinics, dialysis clinics, and other important
medical facilities.
Public health agencies are working to isolate suspected
cases around the country, and to help ensure isolation of high-
risk contacts. If cases increase significantly, it may not--may
no longer be possible to isolate all cases and contacts. There
may need to be a shift, probably will need to be a shift in
strategy. At that point public health agencies will need to
focus on surveying the population for the overall level of
COVID-19, advising how the public can be tested, and how it
needs to be isolated when sick, and working with political
leaders at the State and local level to consider social
distancing policies that will be--that will do more good than
harm.
CDC has been doing all lab testing until this week, but
testing is now getting going in public health labs around the
country. I believe we will see considerably more cases
diagnosed around the United States in the coming days, as we
have seen in the last week. Large-scale testing at clinical
sites around the country will require clinical diagnostics
companies to create high-throughput clinical tests because CDC
and public health labs were not designed for the kind of high-
throughput clinical testing that will ultimately need to take
place.
Vaccine development is likely to take at least 12 to 18
months. One of the world's experts is to our left, so you will
hear more about that. We should be developing--as we develop an
effective vaccine, we should also be developing means to mass
manufacture it, which is not necessarily the normal process for
vaccine manufacturing. Ideally, that should be occurring at
multiple sites around the world. Even if the United States is
the country to develop the vaccine, there will be huge demand
for the vaccine around the world.
Antiviral or antibody-based medications could also be
developed far sooner than a vaccine. Similarly, plans for mass
manufacture of those products should also be under way, should
those be successful.
One of themes of our preparedness in this country needs to
be close partnership between Government and industry, because
industry is the place where diagnostics on a large scale--PPE,
medicines, vaccines, hospital equipment--are being
manufactured. So there is no way around having a very close
effective partnership, and making sure that those industries
are well aware of the support that they will receive from the
Government to do that work.
Finally, I would say that it is very important from this
point forward for the Federal Government to be speaking in a
single consistent voice about what is happening. I think a
daily briefing, as we did in 2009 H1N1, about what is known,
what is unknown, how we are learning to fill the gaps in
information should come out of the Government on a daily basis.
I do think that should come from our health officials, either
at HHS or CDC, because they are closest to the science and to
local and public health agencies around the country.
Thank you for the chance to testify today, and I look
forward to your questions.
[The prepared statement of Dr. Inglesby follows:]
Prepared Statement of Tom Inglesby
March 4, 2020
Chairman Thompson, Ranking Member Rogers, and Members of the
committee, thank you for the chance to speak with you today about
COVID-19 and the Federal Government's response to it. My name is Tom
Inglesby. I am the director of the Center for Health Security of the
Johns Hopkins Bloomberg School of Public Health and a professor of
public health and jointly in medicine at Johns Hopkins University. The
opinions expressed herein are my own and do not necessarily reflect the
views of The Johns Hopkins University.
Our Center's mission is to protect people's health from major
epidemics and disasters and build resilience. We study the
organizations, systems, and tools needed to prepare and respond. Today,
I will provide comments on the status of the COVID-19 pandemic and the
U.S. Government's response efforts. My testimony will provide
recommendations regarding what I believe should be top priorities of
the U.S. Government.\1\
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\1\ Please see https://www.nytimes.com/2020/03/02/opinion/
coronavirus-prepare-test.html and https://jamanetwork.com/journals/
jama/fullarticle/2762690 which were the basis of a good portion of this
testimony.
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The COVID-19 pandemic presents the United States and the world with
a serious health security threat. As such, it is critical that the U.S.
Federal Government continue to lead a robust response effort that
supports State and local governments, public health agencies, health
care systems, industry, and the public in order to prevent the worst
case outcomes in terms of health effects, economic damage, and societal
impacts.
epidemiological update
As you know, coronavirus disease 2019 (COVID-19) was first
recognized by astute clinicians in the Chinese city of Wuhan at the end
of last year. As of March 3 it had infected over 92,000 people and
killed over 3,100 across 65 countries.\2\ On January 30, the World
Health Organization declared a Public Health Emergency of International
Concern (PHEIC).\3\
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\2\ https://www.who.int/docs/default-source/coronaviruse/situation-
reports/20200229-sitrep-40-covid-19.pdf?sfvrsn=7203e653_2.
\3\ https://www.who.int/news-room/detail/30-01-2020-statement-on-
the-second-meeting-of-the-international-health-regulations-(2005)-
emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-
ncov).
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Patients who become sick with COVID-19 most often present with a
cough, fever, and in the more serious cases, an underlying viral
pneumonia. In China, approximately 80 percent of those with illness
developed mild symptoms, 15 percent require hospitalization and 5
percent became critically ill.\4\ The virus has a 1-14-day incubation
period, most often in the range of 5 days. We know that before China
put in place its many efforts to slow the spread of the disease, each
infected person infected between 2 and 3 others, an epidemiological
parameter known as R0. That number will be different in different
places and conditions over the course of the outbreak. The primary
route of transmission is via respiratory droplets between persons at
close contact (within 6 feet).
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\4\ https://jamanetwork.com/journals/jama/fullarticle/2762130.
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Some people who get infected have no symptoms--it will take time to
understand the proportion of people who are infected that do develop
illness as compared to those who do not. Tests called serology studies
will need to be created for that, and the CDC and other labs are
working to get those tests ready. There is some evidence that some
people who are infected but do not develop symptoms can pass along
their infection to others--a phenomenon referred to as asymptomatic
transmission, which complicates public health's ability to control the
disease.\5\ There are many uncertainties at this point, including how
severe the disease will be in the United States (it has a case fatality
rate of about 2 percent in China), what percent of the population will
be affected (also known as the attack rate), who develops severe
disease, and how quickly it will spread in the face of public health
interventions intended to slow it. In China the median age of the
infected is about 51, and the case fatality rate increases with people
in their 70's and 80's, and in those with pre-existing conditions.
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\5\ https://jamanetwork.com/journals/jama/fullarticle/2762510.
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As of March 3, the United States has 100 recognized confirmed cases
of COVID-19, including 6 deaths in 15 States. That number includes
evacuees from the Diamond Princess cruise ship. The total includes
returned travelers and their close contacts, as well as cases of people
recognized in California and Washington State who do not appear to be
related to those Americans who traveled in China or their close
contacts. When a patient tests positive, and no known contacts with
previously identified cases are found, this mean that there is likely
at least some level of transmission happening in those communities.
Public health laboratories have now been given the go-ahead to
begin using the CDC developed diagnostic test, and they are beginning
to start testing patients around the county. We should now expect to
see new cases confirmed in different States as diagnostic testing is
expanded around the country this week. New cases confirmed in the next
week or so could feasibly be in the hundreds and will likely continue
to grow as more testing is performed.
u.s. response efforts
An emergency supplemental appropriation is currently being
negotiated between the administration and Congress to fund the COVID-19
response. In terms of an appropriate funding level, comparisons to past
infectious disease responses might be useful. In 2009, Congress
appropriated $7.7 billion for the H1N1 influenza pandemic, and in 2014,
$5.4 billion was appropriated for the Ebola response. COVID-19 will
require perhaps twice as much money as Ebola or more. On February 28,
our Center sent a letter signed by 32 leading public health and health
care organizations and individuals to the Chairs and Ranking Members of
the House and Senate Appropriations Committees urging them to act
swiftly to pass emergency supplemental funding sufficient for a
comprehensive National and international response.
HHS will have major responsibilities for COVID-19. The CDC is
leading the public health response, including the development, conduct,
and promulgation of diagnostic testing; issuing technical guidance; and
supporting Federal, State, and local partners in screening and contact
tracing. The NIH's National Institute for Allergy and Infectious
Diseases (NIAID) is supporting medical countermeasure development,
along with efforts at BARDA and FDA. The assistant secretary for
preparedness and response (ASPR) is responsible for ensuring that the
U.S. health care system, including hospitals, EMS, health care supply
chains, and others are well-prepared and able to provide care.
DHS has responsibilities related to Customs and Border Patrol,
working with CDC personnel to screen incoming travelers to the United
States, including assessing travelers who self-report illness and
conducting fever screening at airports. Last weekend, the New York
Times reported that 47,000 travelers have been screened at airports
across the country.\6\ It is worth noting, though, that those efforts
have yet to identify a confirmed case of COVID-19. The provision of
educational messaging and materials at points of entry probably has had
value in getting returned travelers to self-identify and bring
themselves to medical and public health attention.
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\6\ https://www.nytimes.com/2020/02/29/health/coronavirus-
preparation-united-states.html.
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In addition, the National Biodefense Analysis and Countermeasures
Center (NBACC) is conducting research intended to provide answers to
some operationally relevant questions, including the stability of the
SARS-COV-2 virus in different media and characterizing the best
decontamination methods.
The Department of State has major responsibilities related to
international agreements we have with other countries in terms of
travel and trade, and it will need to navigate their disruptions. The
Department of Commerce too will be involved in that work, given the
interruption of supply chains that have already emerged.
The Department of Defense will have responsibility for protecting
the health of the military from COVID-19 and dealing with the
operational implications of the epidemic and has had responsibilities
for working with those persons who have been repatriated and kept on
military bases.
response priorities
Health care systems should be planning to provide care for large
numbers of critically ill patients. Measures that could be taken
include the cancellation of elective surgeries if critical care demands
rise to the point when ventilators or ICU space becomes limited,
changing staffing patterns to accommodate for higher patient volumes in
these units, and seeking additional ventilators from the National
stockpile if necessary.
Health care institutions will also need very strong infection
control strategies and responses. In China there have been thousands of
health care workers infected, although it is unclear to what extent
those infections occurred before HCWs were properly trained or whether
they were properly equipped. To prevent that in the United States there
will need to be good administrative and engineering controls, and ready
access to personal protective equipment by all staff that interact with
patients. The manufacturers that make personal protective equipment
should be assured by the Federal Government that they will be
compensated for increasing their output to the maximum extent possible,
even if hospitals do not end up needing all supplies that are produced.
In addition, readiness at other health care facilities will need to
be strengthened. In China, there have been disruptions to dialysis
centers and cancer clinics caused by COVID-19, and it will be important
in the United States for planning to ensure that routine medical and
surgical care is not grossly disrupted by this disease.
In particular, it will be important to prevent infections in long-
term care facilities, given the risks faced by the elderly and those
with pre-existing conditions, and the propensity for this disease to
spread within closed systems, such as the Diamond Princess cruise ship,
which had over 600 cases and in prisons in China, where they have been
reported large outbreaks. We have already seen the consequences of this
disease in a long-term care facility in Washington State where a number
of people have died and a number of others are potential or confirmed
cases.
Public Health agencies around the country will also play a pivotal
role throughout the course of COVID-19. They are now working to isolate
suspected cases, and track and help ensure the isolation of high-risk
contacts. If the numbers of cases increase significantly, it may not be
possible to find and isolate all cases and contacts, any more than that
is possible with seasonal influenza. At that point, public health
agencies will need to focus on surveying the extent of COVID-19 in the
larger population, advising how the public can be tested, and
communicating to the public about the importance of staying isolated
when sick, including having positive cases stay home when not sick
enough to be in the hospital.
Public health professionals will also need to work with political
leaders to decide whether and under what conditions social distancing
plans should be put in place--for example, whether large events should
be canceled, workers should telecommute, or schools should close.
Public health agencies typically run on shoestring budgets and have no
cash surpluses on hand. This work is expensive and will require some
24/7 work, all of which will need to be supported by Federal and State
governments.
Up until this week, the CDC has been doing all the lab testing for
this virus which has limited the National capacity. Technical
challenges have slowed the distribution of this test around the
country, but 54 public health labs had the capacity to do testing as of
March 3, with all of the more than 100 public health labs around the
country being likely ready to start testing by the end of the week.
Testing should ideally be available now for those who have a clinical
picture consistent with coronavirus infection, but bandwidth limits on
testing mean that for the immediate future we should be focusing on the
sickest hospitalized patients who might have this disease.
Large-scale testing will ultimately require clinical diagnostics
companies to develop testing in the way that they have done for high
throughput testing for other diseases. The Federal Government should
make commitments to these companies that will ensure their development
and manufacturing work will be fully compensated. These companies
should not be wondering about the market size or if they will be left
holding the bag for the costs of development. They should be working
full-speed ahead in making clinical diagnostics that can be used on
large scale.
medical countermeasure development
Leading vaccine scientists have said that in a good-case scenario
it will take 12 to 18 months to develop a vaccine against COVID-19.
Even as all possible actions are being taken to develop a safe and
effective vaccine in a highly-funded Federal Government effort, the
Federal Government and its industry partners should be planning to mass
manufacture the vaccine when it is developed, ideally in multiple sites
around the world. Vaccine will need to be made on large scale in a
short period of time, and the developers of the successful vaccine(s)
will have enormous pressure to share it around the world.
Antiviral or antibody-based medicines could be developed far
sooner. Some candidate antiviral products are already in use or were
developed for other purposes. It is too soon to say if they will be
effective. There are a number of companies that are proposing to
develop antibody-based therapies. Such therapies, if able to diminish
the morbidity and mortality of the very sickest patients could be very
valuable. As with vaccines, the Federal Government should be strongly
supporting the development and testing of a full range of candidate
therapies, and it should be planning for the rapid and mass production
of these therapies--should they prove safe and effective.
communication with the public
Given the quickly changing and complex daily developments around
COVID-19, it will be important for the Federal Government to speak with
a consistent voice. It will be important for the Federal Government on
a daily basis to describe what is new, describe what new uncertainties
or problems have developed, and explain what the Federal Government is
doing in response. It is important that the White House is involved in
coordinating the efforts of the various agencies of government involved
in the COVID-19 response. However, it should be HHS/CDC that are
responsible for the daily public briefing, given their many overriding
responsibilities in this public health emergency and their strong
connections to the public health and health care organizations and
leaders that are running the response locally around the country.
It is also important to say that the response to COVID-19 will be
stronger if it is nonpartisan and highly inclusive. Epidemics can
result in division and in scapegoating. The country will get through
this with less damage if we are all pulling in the same direction.
In conclusion, the United States has many tools at its disposal to
slow and reduce the overall impact of COVID-19. What is needed now is
to bring our substantial resources and expertise to bear quickly and
decisively. Thank you for the opportunity to testify today, and I would
be happy to answer your questions.
Chairman Thompson. Thank you for your testimony.
I now recognize Dr. Ezike to summarize her statement for 5
minutes.
STATEMENT OF NGOZI O. EZIKE, MD, DIRECTOR, ILLINOIS DEPARTMENT
OF PUBLIC HEALTH
Dr. Ezike. Chairman Thompson, Vice Chair Underwood, Ranking
Member Rogers, and distinguished Members of the committee, my
name is Ngozi Ezike, I am the director of the Illinois
Department of Public Health, and I thank you for inviting me to
speak about the novel coronavirus and the preparedness and
response efforts of the Illinois Department of Public Health.
Even before our first Illinois case was identified in
January, a strong Federal, State, county, and local coordinated
effort was enacted, and enabled our State to be a leader in
addressing this rapidly-developing outbreak. The CDC quickly
deployed a team to Illinois after our first case was announced,
and was essential in partnering with us through the response.
They have been equally responsive with our recently-announced
third and fourth cases.
The Illinois Congressional delegation supported our request
for immediate approval of an emergency use authorization for
the COVID-19 test, which has been invaluable in the effort to
containing illness. Illinois was the first State in the United
States to validate this test, and to begin testing in-house, a
capability that we have had for the last 3 to 4 weeks.
We began sentinel surveillance testing this week, enabling
Illinois to better determine how much COVID-19 is circulating
within our community. Our success in testing raises a new
concern, however: Will we have enough reagent to maintain and
increase our testing?
We are requesting that CDC provide an uninterrupted supply
of testing materials. The ability of States like Illinois to
test samples lessens the burden on the CDC. We encourage CDC to
expedite additional reagent shipments to Illinois and other
States.
Illinois has utilized and proven its capabilities in the
past when responding to the domestic cases of SARS, H1N1, Zika,
and Ebola. IDPH recently participated in Crimson Contagion.
This is a National tabletop exercise that used a COVID-19-like
outbreak that was said to have originated in China in the
United States. However, surge capacity remains something that
is not able to be sustained for extended periods of time.
Therefore, emergency supplemental funding is necessary.
Illinois encourages Congress to appropriate funds enough to
reimburse Illinois and other States for the costs associated
with this aggressive response. Public health infrastructure
such as data management, information sharing, and operations
management are essential just for day-to-day function, but they
are vital in the settings of public health emergencies.
For example, during this response the State health
department is closely monitoring the availability of airborne
infection isolation rooms. These isolation rooms are
providing--are proving critical in the treatment of these
patients by controlling the spread of the virus to the public
and health care workers. We inventory these beds daily as an
indicator of disease rates, and to adjust surge capacity
estimates. An important support for this capability came from
ASPR's Hospital Preparedness Program.
Given the transmissibility of COVID-19, isolation sites are
required to house affected persons. It is challenging to find
establishments willing to take on isolation or quarantined
patients. When COVID-19 began in Illinois, the city of Chicago
was given very little time to set up screening operations at
O'Hare and establish a requisite quarantine site. Chicago has
continued to maintain both its screening operation and
quarantine site at an enormous cost. Without reimbursement and
on-going money for future expenses, governments will likely
struggle to maintain these critical public health
interventions.
Additional attention must be given to mitigation strategies
of the State. We are also working closely with long-term care
facilities to implement mitigation strategies aimed at
protecting what would be our most vulnerable citizens.
In addition to these community mitigation approaches, we
encourage the public to employ their own strategies to keep
themselves healthy. We have said it over and over: The frequent
hand-washing, the staying home when ill, sanitizing frequently
touched services--surfaces. Individuals should take care to
rely on trusted sources of information such as the CDC.
Public health security is homeland security. Our country is
nothing without the health of its people. We can all work
together to ensure that we continue to support this response,
and decrease the potential negative effect and impact on the
people of this country.
In closing, I wish to again thank the committee for its
invitation and the attentiveness to Illinois's successes and
opportunities in responding to COVID-19. Thank you.
[The prepared statement of Dr. Ezike follows:]
Prepared Statement of Ngozi O. Ezike
March 4, 2020
Chairman Thompson, Vice Chair Underwood, Ranking Member Rodgers,
and distinguished Members of the committee thank you for the inviting
me to speak about the novel coronavirus or COVID-19 the preparedness
and response efforts of the Illinois Department of Public Health
(IDPH).
Since the first Illinois case was identified in January a strong
Federal, State, county, and local coordinated effort ensued and enabled
our State to be a leader in addressing this rapidly-developing
outbreak.
In the aftermath of 9/11 Illinois steadily built a remarkable
emergency response network, including a comprehensive public health
emergency response system lead by IDPH and inclusive of our certified
local health departments and Illinois' hospitals. With on-going Federal
support, Illinois has been able to conduct exercises such as last
year's Crimson Contagion, that prepared Illinois for outbreaks like
COVID-19. A true reflection of our preparedness is found in the
containment efforts at Chicago's O'Hare airport and contact tracing of
potentially exposed citizens; Illinois has demonstrated that its public
health infrastructure is strong and prepared. We encourage Congress to
continue and increase its financial support of State-lead preparedness
and response through Federal emergency supplemental legislation.
Resources are essential to any response effort. Human and financial
support are irreplaceable and necessary to protect the lives of all
Americans. Understanding the costs and where extra support is needed is
integral. As an example of this, IDPH and the Illinois Emergency
Management Agency began tracking the costs of the outbreak at its
inception. Similarly, local health departments, like the city of
Chicago and Cook County are doing the same. While preliminary, the
Illinois combined spending tops $20 million dollars for the first 5
weeks of the outbreak. This committee may know that Illinois is a State
with serious financial concerns; not unexpectedly, COVID-19 response
was not in any of our budgets. Under the leadership of Governor JB
Pritzker, IDPH has been able to take every step necessary to address
COVID-19 recognizing that we would need to figure out how to pay for
the response efforts at a later date, but our priority at the moment is
protecting the health of the people in our State. The State of Illinois
encourages Congress to appropriate funds enough to reimburse Illinois
and other States, territories, and local health departments for the
cost associated with COVID-19 response.
With respect to IDPH's working relationship with the Federal
Government, Illinois is pleased with the responsiveness and
collaboration with Federal agencies including the Centers for Disease
Control and Prevention (CDC) and the U.S. Food and Drug Administration
(FDA). Illinois is grateful that CDC quickly deployed resources to
Illinois in response to the first 2 cases in the State and has been
equally supportive now that there are third and fourth cases. The FDA's
prompt response when Illinois' Congressional delegation requested
immediate approval of an Emergency Use Authorization for the COVID-19
Rapid PCR test has been invaluable in the State's approach to
containing illness. Illinois was the first State in the United States
to validate CDC's COVID-19 test and now has all 3 of its State
laboratories running samples. These 3 laboratories began State-wide
sentinel surveillance testing this week, enabling Illinois to determine
if COVID-19 is circulating in the community among persons with no
travel exposures and no known exposures to confirmed cases.
Our success in testing raises a new concern, whether we will have
enough reagent to maintain or increase our testing in Illinois. Even
so, Illinois has a finite amount of reagent on hand and needs assurance
that CDC can provide an uninterrupted supply of testing materials. The
ability of States like Illinois to test samples lessens the burden on
the CDC, especially at this moment when not every State is able to test
samples. To support this, the State of Illinois encourages CDC to
expedite additional reagent shipments to Illinois and other States.
Federal funding to Illinois, and other States, territories, and
local health departments supported us in our current ability.
Preparedness funding ensures that Illinois has plans in place that are
exercised and ready to deploy when necessary. From both virtual and
actual exercising of the State's public health emergency response,
there was immediate action to address COVID-19. Historically, Illinois
has utilized and proven its capabilities in the past when responding to
the domestic cases of, SARS (2002), H1N1 (2009), MERS (2014), Ebola
(2014), Zika (2016), and other high-profile diseases. IDPH recently
participated in Crimson Contagion, a National exercise that used a
COVID-19-like outbreak in the United States. The training and
preparation have been decades in the making and Illinois is capably
managing the current and anticipated workload. However, surge capacity
remains something that States like Illinois are not able to sustain for
extended periods of time and therefore emergency supplemental funding
is necessary.
Public health infrastructure such as data management, information
sharing, and operations management are essential for day-to-day
function in public health, but vital in a public health emergency.
Illinois can now resource public health emergencies and track key
indicators. For example, during this response, the State health
department is closely monitoring the availability of airborne infection
isolation rooms or AIIR beds. These isolation rooms are proving
critical in the treatment of COVID-19 patients by controlling the
spread of COVID-19 to the public and health care workers. IDPH
inventories AIIR beds daily as an indicator of disease rates and to
adjust surge capacity estimates. An important support for this
capability comes from the Assistant Secretary of Preparedness and
Response Hospital Preparedness Program (HPP). The department of health
has partnered with Illinois' health care industry over the years in a
way that was not there 20 years ago. Understanding where to send
patients, and adjust accordingly, in a cohesive response, saves time,
lives, and valuable resources.
Available isolation and quarantine space are another area where
Federal support is needed. When a person under investigation is put in
isolation or quarantine, it is sometimes not possible to house that
person in their home. It is incumbent upon the local and State health
departments to find housing for the person until they are cleared.
Given the transmissibility of COVID-19, quarantine sites are required
to house these persons. It has been challenging to find commercial
establishments willing to take quarantine patients for the required 14-
day period. When COVID-19 began in Illinois, the city of Chicago was
given very little time to set up screening operations at O'Hare and
establish a requisite quarantine site. Chicago has continued to
maintain both its screening operation and quarantine site at an
enormous cost to the city. Without reimbursement and on-going money for
future expenses, Chicago and governments like it will struggle to
maintain these critical public health interventions. The Federal
Government should increase its assistance to States in meeting the
housing and isolation needs of citizens exposed to COVID-19.
IDPH partners with State-certified local health departments and
hospitals to ensure Illinois has a robust and effective health care
system. That relationship requires IDPH to provide personal protective
equipment (PPE) to its partners when usage rates drain normal
inventories. This highlights another concern that Federal authorities
should soon act upon, the PPE Shelf Life Extension Program (SLEP).
Illinois and perhaps all other States have significant stores of
Federally-supported PPE. As a recipient from the Strategic National
Stockpile (SNS), Illinois is required by law to preserve outdated PPE
until dispositioned by the Federal Government. In most cases, the
original manufacturer's expiration date has past, rendering the PPE
unusable. The SLEP allows the Federal Government to test certain lot
numbers for efficacy and then extend the expiration date of successful
lots allowing the PPE to be used. Let me be clear, IDPH has not
exhausted its stores of in date PPE, however, usage rates could change.
We urge the Federal Government to evaluate the SNS and provide States
with extensions for COVID-19-intensive supplies, namely N95
respirators, isolation gowns, latex gloves, and eye shields.
As COVID-19 is anticipated to spread throughout the country,
additional attention must be given to mitigation strategies that State
and local public health employ. Illinois for example has a pandemic flu
plan that IDPH will utilize during the upcoming month. Illinois is
evaluating triggers for changing public behaviors and implementing
community mitigation strategies. We understand that these triggers may
be local or regional based upon population and other factors, making a
one-size-fits-all approach infeasible for Illinois. COVID-19 appears to
impact the elderly population with co-morbidities and therefore we are
working with long-term care facilities to implement mitigation
strategies aimed at protecting our most vulnerable citizens.
In addition to community mitigation approaches we encourage the
public to employ their own strategies to keep themselves healthy such
as frequent handwashing, staying home when ill, eating and sleeping
well. Individuals should take care to rely on trusted sources of
information such as CDC or their State and local health department in
order to get the most up-to-date and accurate information as possible.
In the public health community we are gravely concerned that
misinformation and fear will spread faster than the illness itself.
Public health security is homeland security. Our country is nothing
without the health of its people and we can all work together to ensure
that we continue to support this response and decrease the potential
negative impact on Americans.
In closing, I wish to again thank the committee for its invitation
and attentiveness to Illinois' successes and challenges in responding
to COVID-19.
Chairman Thompson. Thank you for your testimony.
I now recognize Dr. Gerberding to summarize her statement
for 5 minutes.
STATEMENT OF JULIE LOUISE GERBERDING, MD, MPH, CO-CHAIR,
COMMISSION ON STRENGTHENING AMERICA'S HEALTH SECURITY, CENTER
FOR STRATEGIC AND INTERNATIONAL STUDIES (FORMER DIRECTOR OF THE
CENTERS FOR DISEASE CONTROL AND PREVENTION)
Dr. Gerberding. Thank you, Chairman. I am very honored to
be here, and also to testify with such distinguished experts at
the table.
I am here wearing several hats. I am currently the chief
patient officer at Merck, where I have served as the president
of the vaccine business for a number of years, and more
recently as the chief patient officer who contributed to the
development and deployment of the Ebola vaccine in the
Democratic Republic of the Congo, which is now licensed, even
though it was created on the fastest possible track. So far we
have been able to contribute about 300,000 doses of the
vaccine. This week the director general of the WHO indicated
his optimism that that outbreak has finally come under control.
I am also witnessing, as the co-chair of the CSIS
Commission on Global Health Security, which submitted this
report to the record--the commission is a bipartisan--it
includes bipartisan Members of the Senate and the House, and
has the stated purpose to advise the Congress on steps that can
be taken to improve our global health security. The report was
written before coronavirus was recognized, but I think many of
the recommendations which are summarized in my written
testimony are prescient, and really apply to the situation that
we are experiencing today.
I would be remiss if I didn't mention that I am also on the
executive committee of BIO, the Biotechnology Innovation
Organization. Today many of the CEOs of BIO are here in
Washington to brief Members of Congress. About 40 of these
companies have innovations and molecules and platforms, and are
stepping up to try to contribute to the prevention and
treatment of this coronavirus outbreak. So we are lucky that we
live in a country that has such a vital biotechnology
organization.
Finally, I am the former CDC director. In past life, where
we were dealing with anthrax and SARS and many other outbreaks,
the first coronavirus outbreak, SARS, challenged the United
States and challenged the world. I think we learned many, many
lessons which are relevant to where we are today.
I don't have time to give the full picture of the U.S.
public health situation, and I think my colleague has expressed
it from a State view very eloquently. But I would say that it
is important to remember where we are in the outbreak right
now, from a U.S. perspective.
There are really 3 main phases of outbreak response.
The first is detection, and that happened in China, and was
reported fairly early in the process, but we don't have full
detection because we haven't had full testing, and we still
don't know whether the cases we are detecting represent the tip
of the iceberg, and how much of the iceberg is undetected yet
because we haven't tested, or because many patients are
asymptomatic, which I, in fact, suspect.
The second phase is the phase of trying to contain the
outbreak where it starts. I don't think, in the history of the
world, we have seen a more dramatic demonstration of that than
what occurred in China, and then what has occurred in countries
around the world who attempted to keep the virus out of the
country. It was a heroic effort. It wasn't perfect, but it
probably did buy us some time, and for that I think we should
all be grateful.
Where we are now is in the phase of slowing the spread of
the virus. It is here. We are doing everything we can on the
front lines of public health to identify and isolate cases, to
quarantine people who may be exposed or incubating, and to
managing the social system that promotes spread.
But we have to balance that effort to slow things down by
recognizing that we also need to sustain our essential
services. Our businesses need to run, our medical supply chain
needs to operate, and our security and safety need to be also
part of our overall response capability. So we are going to be
seeing a lot of local decision making. If you are looking at it
from a high-level view, what is going on in Chicago might look
different from what is going on in some other part of the
country. But you know that each individual location has to make
decisions in the best interests, given the state of the
outbreak in their particular community.
One of the most important lessons that I wanted to
emphasize in my opening statement is something we have learned
in every outbreak, and that has to do with the importance of
trust. We must have credible leadership at every level:
Federal, State, and local. We must have clear and consistent
communication from trusted individuals who are knowledgeable
about public health, health care, and the science and evidence
of public health interventions. We must have a spirit of
collaboration, not combat, a spirit of health protection, and
not politics.
Thank you.
[The prepared statement of Dr. Gerberding follows:]
Statement of Julie Louise Gerberding
March 4, 2020
Chairman Thompson, Ranking Member Rogers, and other distinguished
Members of the committee--I am truly grateful for the opportunity to
appear before you today on the topic of ``Confronting the Coronavirus:
Perspectives on the Response to a Pandemic Threat''.
I have been engaged in professional activities related to the
prevention and control of infectious disease threats throughout my
entire career, from the early response to AIDS during my tenure as a
faculty member at the University of California, San Francisco, to years
as CDC director during the anthrax, SARS, West Nile virus, avian
influenza, and other outbreaks, and now as the chief patient officer at
Merck & Co., Inc. where I led the Vaccine Division for several years
and more recently supported the development and deployment of Ervebo,
our Ebola vaccine that is currently deployed in the Democratic Republic
of the Congo outbreak.
I also co-chair with former Senator Kelly Ayotte the Center for
Strategic International Studies (CSIS) Commission on Strengthening
America's Health Security, which recently released a report entitled
Ending the Cycle of Crisis and Complacency in U.S. Global Health
Security. Members of Congress who also serve on the Commission include:
Senators Murray and Young, and Representatives Bera, Brooks, Cole, and
Eshoo, in addition to several security experts. I am pleased to review
the recommendations of the full report and its implications for the
COVID-19 outbreak that we are dealing with now and pandemics that will
inevitably strike in the future.
We began the Commission's work with a simple understanding: Health
security is National security, in a world that is increasingly
dangerous and interdependent. Biological threats--outbreaks from
natural, intentional, and accidental causes--are occurring more often,
and at the same time, the world is increasingly insecure, violent, and
disordered, and it is exactly in these danger zones where an increasing
number of biological outbreaks occur.
Globalization and the rise of international trade and travel mean
that an outbreak in a disordered setting with a compromised health
system can quickly become a pandemic, threatening the United States and
the rest of the world. Policy makers increasingly recognize these
threats can undermine the social, economic, and political security of
nations.
Unfortunately, this recognition occurs when a health crisis
strikes--coronavirus, measles, MERS, Zika, dengue, Ebola, pandemic
flu--and U.S. policy makers rush to allocate resources in response.
Yet, all too often, when the crisis fades and public attention
subsides, urgency morphs into complacency. Investments dry up,
attention shifts, and a false sense of security takes hold.
That realization led us to conclude that the U.S. Government needs
to break the cycle of crisis and complacency and replace it with a
doctrine that can guarantee continuous prevention, protection, and
resilience. Accordingly, the Commission advocates for a package of
strategic, affordable actions to advance U.S. health security.
The Commission commends the recent advances in U.S. health security
and biodefense policy, including the release of the National Biodefense
Strategy last fall and the Global Health Security Strategy this year.
These are positive steps forward, which we should build upon.
1. We recommend that health security leadership at the White House
National Security Council (NSC) be restored.--Health security is
National security. Strong, coherent, senior-level leadership at the NSC
is essential to guarantee effective oversight of global health security
and biodefense policy and spending, speed, and rigor in decision
making, and reliable White House engagement and coordination when
dangerous pandemics inevitably strike. Leadership on the NSC can bring
about key, targeted new investments while achieving much-needed reform
of fragmented programs and higher efficiencies in the use of scarce
resources.
2. We need to invest directly and consistently, over the next
decade, in the capacities of low-income countries.--The best approach
to protect the American people is to stop outbreaks at the source. The
Global Health Security Agenda has a proven track record in building
health systems and health security preparedness in low- and middle-
income countries, financed through a $1 billion Ebola emergency
supplemental funding. We recommend sustaining that success, not
disrupting or curtailing it.
We recommend that the U.S. Government expand the Defense Threat
Reduction Agency's (DTRA) geographic authorities to operate in all
continents where health security threats exist. Furthermore, support
for military overseas infectious research laboratories should be
sustained. The Department of Defense's (DOD) biological research and
development programs often focus on diseases not studied in other
venues and result in medical countermeasures that would otherwise be
delayed or not developed at all.
3. We need to exercise multilateral leadership to persuade partner
countries to invest more of their own resources in preparedness.--We
recommend that Congress advocate for U.S. leadership to launch a 5-year
challenge at the World Bank that would incentivize long-term investment
by fragile and conflict-affected countries in their own basic health
security capacities.
The Commission recommends that Congress increase contingency
funding levels for the CDC and the United States Agency for
International Development (USAID), and that the U.S. Government make
annual contributions to the World Health Organization's (WHO)
Contingency Fund for Emergencies so we can access adequate, quick-
disbursing resources when a health or biosecurity crisis strikes.
4. The Commission advocates for the establishment of a U.S. Global
Health Crises Response Corps.--This organization would build upon and
integrate existing CDC and USAID capabilities, and work with local
partners to respond early to outbreaks and biosecurity incidents in
disordered and insecure settings.
5. The Commission also advocates for the U.S. Government to
strengthen and adapt programs and capacities to deliver health services
in fragile settings that meet the special needs of acutely vulnerable
populations, especially women and children.--This means ensuring the
continuity of immunization programs, the protection against and
response to gender-based violence (GBV), and the strengthening of the
delivery of maternal and reproductive health and family planning
assistance.
6. The last area of priority concern is to plan strategically, with
strong private-sector partners, to support targeted investments that
will accelerate the development of new technologies for epidemic
preparedness and response.--We assert that the U.S. Government should
directly invest in the Coalition for Epidemic Preparedness Innovations,
or CEPI, an international alliance that finances and coordinates the
development of new vaccines to prevent and contain epidemics. The U.S.
Government should also redouble its efforts to develop a universal flu
vaccine.
In addition, to ensure that the United States has a sufficient
arsenal to treat the secondary infections that will occur from the
coronavirus now and similar public health threats in the future,
Congress should advance reimbursement reforms to incentivize the
development of new antibiotics. The current antibiotic market is
broken; if Congress does not act to ensure that antibiotics are valued
appropriately, we will continue to see small biotechnology companies
declaring bankruptcy and large pharmaceutical manufacturers exiting
this arena.
Thank you for the opportunity to address you today, and I look
forward to hearing your perspective. It is my sincere hope that we can
work closely together to advance the U.S. health security agenda.
Chairman Thompson. Thank you very much. I must add we hear
from a lot of witnesses on this committee, and what you have
told us has been quite sobering, to say the least, but quite
informative. So I would like to compliment you at the beginning
of the questions.
But one other thing that each one of you talked about was
the need in a situation like this to have effective
communication. There seems to be mixed messages to the public
from the administration at this point regarding the severity of
this outbreak. Many of my constituents have repeatedly called,
asking for clarity on many issues, citing inconsistency,
inconsistencies made by the high-level administrative
officials.
How would you assess the U.S. Government's communication
with the public regarding the risks presented by this outbreak?
What can the Federal Government do better?
Dr. Inglesby, we will start with you.
Dr. Inglesby. I think that the state of the outbreak has
changed a lot in the last month, and we have a very big Federal
Government with many different people working on this. So there
have been days when, within the Government, there have been
different messages issued. I don't think that was necessarily
intentional. I think that is partly its people kind of catching
up to where we are in the outbreak. But I do think it will be
very valuable for the Government to be speaking with as much
as--of a single and consistent voice as they can, as is
possible in a big government.
I do think it is--on the one hand, I think it is very
important to say what the risk is at this moment. I think many
of the risk statements have been said from the Government,
``Today the risk is very low for any particular American,'' and
that may be accurate for today.
But I think it would be helpful for Americans to understand
risk going forward. What do health officials believe is likely
to happen in their communities? Not in an alarmist way, but
just so that people can be informed to begin to take measures,
as we heard--my colleagues talked about, to try and diminish
their own risks, to make sure that they are staying home when
sick, to make sure that they are washing their hands properly,
disinfecting after they touch public services--public surfaces.
So I think consistent messages that empower the public
would be useful. Even if we don't know exactly what will happen
next, we do expect this disease to continue to spread in the
country at this point. It would be useful for people to know
that.
Chairman Thompson. Dr. Ezike.
Dr. Ezike. In Illinois our intersection with the Federal
Government has been primarily with the CDC, and we have had
intense communication and collaboration. We are on hours of
calls together every day, 7 days a week. We have had Federal
CDC staff come on-site to help us directly with our
investigations.
So--and then, with the FDA, they were the ones that gave us
the authorization to be able to test, and that ability to test,
and being the first State being able to do that, has been very
instrumental in being able to quickly identify our positive
versus our negative cases.
So we have seen how good communication, collaboration, and
coordination between the Federal, State, and our local health
departments, how that integration has been successful in giving
us a pretty good response in Illinois.
Chairman Thompson. Dr. Gerberding, you have gone through
this in another life. Can you kind-of talk about that, the same
issue as it relates to communication and the public needing to
hear a consistent voice?
Dr. Gerberding. Sure, I will try to share a couple of
things that I think I learned along the way.
The one that was the hardest for me was that you can't
communicate enough, that it really does take, like you said,
daily, regular, what do we know today that we didn't know
yesterday? What don't we know? What are we doing to find out?
Then, what can you expect going forward?
One of the hardest things about being in the very early
phases of an outbreak like this is that we don't really know
what to expect. This is new, and we are learning as we go. So
preparing people for change, for decisions that we make today,
might be different from decisions that we make next week. These
are very important things, and we should just acknowledge them.
People don't panic if they are given straightforward
information. They panic when they hear confusing and
conflicting information, and they don't know who to trust or
who to believe.
I think the other important lesson that I learned was the
importance of Governors in the communication. We tend to think
that everything is Washington and Federal and, if we do our job
right, it will just automatically flow through the system. But,
as you know, Governors have a great deal of authority in their
States, and they need to be brought into the communication and
information flow, because they influence a whole number of
important decisions at the State and local level. So making
sure that they are connected to the Federal response is
critical.
Chairman Thompson. Well, and I thank all of you for saying
that, because yesterday the administration's coronavirus task
force held a press briefing that was closed to cameras and
audio recordings. That is troubling in a time like this,
because information is very important. So if you hold
briefings, I think they should be public, they--recordings to
be--should be made, because it is the consistency of the
message that provides the confidence that is so important
during these troubling times.
So my plea to the administration is, going forward, please
allow at the briefings to have the press there, have the
cameras rolling, have the recordings being made, because all
this adds to a--strengthening the level of communication
required in a situation that we are in now. So I wanted to make
sure that the administration hear us so future press briefings
will be open, from a transparency standpoint, to the public. I
think all three of you have kind-of said that that is so
important in situations like this.
I yield to the Ranking Member.
Mr. Rogers. Thank you, Mr. Chairman.
Dr. Gerberding, you made a, in your opening statement, a
reference to the fact of lessons learned from your time in your
previous life. What lesson have we most learned from this
outbreak, given that it is in its early stages, that we need to
take heed of? Can you think of one, in particular, that stands
out?
Dr. Gerberding. I will say the global lesson is that we are
going to see infectious diseases spill over from the animal
kingdom on an increasing basis for a number of reasons, and
that there are common-sense things that the global community
needs to rally behind, like not having wet markets, where live
animals are congregated together and create the opportunity for
this spillover to occur.
I think, from a U.S. response perspective, the lessons are
summarized in this report, and that is that we do a pretty good
job of stepping up when there is a crisis. Our response
machinery takes time to get in place, but eventually we get
there, and we do a pretty good job of managing an outbreak. But
we shouldn't have to do it in a crisis mode. We need to invest,
we need to take our counter-measures across the finish line.
We still don't have a SARS vaccine, we do not have a MERS
vaccine, we do not have a Zika vaccine. We are partially there,
but then the effort gets abandoned. So we need to stay the
course, and complete the job so that we can take some of these
threats off the table.
Mr. Rogers. Dr. Ezike, you talked about quarantine, and--
tell me more about what you think the appropriate facility
would be styled like to be a good quarantine facility.
Dr. Ezike. So thank you for the question, and let me start
by distinguishing the quarantine sites versus the isolation
sites. So----
Mr. Rogers. Define those two.
Dr. Ezike. Yes. So ``quarantine'' we use to talk about
people who don't have symptoms, who are asymptomatic. When I
talk about isolating people--maybe we needed some sites for
home isolation for people who maybe are already showing
symptoms--the goal would be for people who are already sick, to
actually keep them out of the hospital. If they don't require
hospital-level care, ICU care, we really want to keep those
people out of the hospital, so that we don't pose that
additional risk to the health care workers and sicker people in
the hospital.
Mr. Rogers. They need to be exposed in any way to other
individuals who have no symptoms?
Dr. Ezike. Please--can you please repeat the question?
Mr. Rogers. Do those individuals who are starting to show
symptoms need to be exposed to anybody else that doesn't have--
--
Dr. Ezike. We would--that is what we are trying to avoid.
Mr. Rogers. Right.
Dr. Ezike. So, in cases where a person has contracted the
virus but they are not sick enough to require hospitalization,
we would like to have a space, an isolation location, where
that person could be safely housed until they were no longer
infectious.
Mr. Rogers. What are the characteristics of a place that
would safely house somebody who is showing symptoms?
Dr. Ezike. Right. So if someone lived alone, there would be
no problem, they would just be in their home. But if someone
had a family, we wouldn't want to infect them. We wouldn't want
to expose them to their family.
So we are--the settings that we have used or looked to use
are--we need a, like, motel, where you have individual rooms
with their own entrance, where the air is not shared, where
there is not a common lobby where people would have to
congregate. So you want individual settings where they can
minimize exposure to other people.
Mr. Rogers. What if somebody had to go to the hospital?
What should a hospital prepare for, as far as rooms or
capacity, that does not expose people to other emergency room
personnel or patients?
Dr. Ezike. Yes. So again, it comes around coordination.
Ideally, if you knew someone was concerned, or the clinician
who had talked to the person, hopefully by phone, and
identified them as an--at risk for having the virus, that we
would have a system in place where they could be safely
transported to the ED, and--or whatever location, but not be
exposed to people, where the initial people who are interacting
with this suspected person could already be in full personal
protective equipment.
We have had, you know, hundreds of people who were just
taking--doing business as usual, and then after the fact found
out that the patient they were taking care of had the
coronavirus. That has resulted in them having to be at home for
14 days, waiting to see if they developed symptoms.
So ideally, we would have robust communication, be able to
bring them into a safe space--ideally, not even into the
hospital. If we could create some kind of, you know, drive-
through testing sites that are away from the hospital, if there
was some off-site location where you avoid contact with, you
know, sick people in the hospital and health care workers, we
don't want to do anything to compromise our capacity, in terms
of health care workers, where they are all home, waiting to see
if they contracted something, and not able to provide front-
line services.
Mr. Rogers. Thank you. I yield back.
Chairman Thompson. Thank you very much. The Chair
recognizes the gentleman from Rhode Island, Mr. Langevin, for 5
minutes.
Mr. Langevin. Thank you, Mr. Chairman. I want to welcome
our witnesses here today. Thank you for your testimony.
Dr. Gerberding, in particular, welcome back before the
committee. You testified before us many times when you were the
head of the CDC, including hosting me and a Congressional
delegation at CDC for a site visit there. So I deeply
appreciate your leadership.
I would like to continue on this line of State preparedness
and what States should be thinking about right now.
Yesterday I spoke with the Governor of Rhode Island,
Governor Raimondo, about the emerging public health threat to
our State, which has already seen one confirmed case of
coronavirus and several presumptive cases. So any additional
thoughts, in terms of States' preparedness right now, what they
should be thinking of right now, in terms of surge or
alternative sites? Because that has been my concern, is that
people are sick, they are going to go to the hospital, that
could very easily overwhelm the public health system, in
addition to infecting sick patients already that are at the
hospital, or, equally important, the health care providers that
are caring for people.
So any additional thoughts, in terms of what States can be
thinking of right now, preparing for the eventuality that this
might become community spread, and that we should have
alternative sites?
Dr. Ezike. So that is, of course, exactly what we are
working on throughout our agency. We are trying to develop--we
are developing guidance for different locales. We are
developing guidance for our local health departments, so that
they can advise schools. We want schools to start thinking
about contingency plans.
So we can't be over-prepared. I think the adage is if you
fail to prepare, you are preparing to fail. So just thinking
through possibilities, thinking through the options for
telework, looking at your agency, your company, and seeing
which people in your agency, if this surge--could stay home and
still maintain the operations of the company or the business,
which people don't have to come in. How do we minimize those
situations?
So going through different scenarios, looking at our--
again, worried--have a top-of-mind--our long-term care
facilities, because there is a very high-risk population, and
making sure that all the long-term care facilities, assisted
livings, that they are looking at their infection control
programs, that they are making sure that they are following
them, that they teach and re-educate their staff on infection
control measures.
Think now about how--what are the appropriate ways to co-
house people if there is more than a person in a room. So
thinking through all the possibilities, that is the
preparedness part.
Mr. Langevin. Let me ask you this, if I could. As we know,
of course, the workplace is an area of particular concern with
respect to bio-transmission. To that end, the CDC and State
leaders, including our Governor, strongly recommend that people
stay home from work who are sick, which is common sense.
However, for many people, especially hourly workers,
staying at home can mean choosing between putting food on the
table or paying bills or stopping the spread of the virus. So I
know Governor Raimondo is trying to look at creative solutions
to make sure that the Rhode Islanders are not forced to make
this impossible choice.
But Dr. Ezike, how is Illinois addressing this problem, and
what should the Federal Government be doing to help?
Dr. Ezike. Yes, that is a really--real concern. I am
thinking of one person in particular who actually wanted to
leave the hospital before we had test results, because they
expressed that exact concern, that ``I only get paid when I
show up to work, and being here is costing me, and I am the
primary breadwinner for the family.''
So we know in the hospital setting we have had great
collaboration with our hospital leadership. So when they have
told employees to stay at home, they know that they will be
paid. But we need to have some kind of pay-back for people who
are set up to stay home. If we want people to comply with our
public health interventions, it can't be at a detrimental cost
to them and their family, in terms of their economic
subsistence.
So making funds available to reimburse people for the time
that they have to be at home to comply with our public health
measures will help people to follow our public health measures,
as opposed to avoiding being tested because they don't want to
incur the resultant isolation.
Mr. Langevin. Hopefully, that is going to be addressed in
the supplemental that Congress is dealing with, and we will
have a mechanism for that.
Dr. Gerberding, any thoughts before my time runs out?
Dr. Gerberding. I just wanted to say one thing about
schools, because we learned, in studying the previous influenza
pandemics, that early school closure was a critical component
to helping to slow down spread in many communities.
This outbreak is somewhat puzzling, because less than 1
percent of the cases are in kids. So that may be because they
have very mild disease, and they don't get tested, or they are
not noticed to have the disease, or perhaps they have some
immunity from prior normal coronavirus, common cold-type
exposures. We really don't understand that. Until we have
serologic testing we won't really understand that whole tip of
the iceberg.
But I think we will see situations where school closure
makes sense, in the short run. But we very quickly need to
learn what is the role of children in spreading the diseases
with this coronavirus, because it makes a huge difference
whether or not schools are closed. Closing schools is extremely
disruptive. It may be necessary, but we need to, I think, build
the evidence base to understand how to use that tool.
Mr. Langevin. Very good. Thank you all.
Chairman Thompson. Thank you very much. The Chair
recognizes the gentleman from New York for 5 minutes, Mr. King.
Mr. King. Thank you, Mr. Chairman. Let me thank all the
witnesses for your testimony today.
There is a report from New York this morning, which, I
think, shows the rolling impact of this disease. It was a
lawyer from Westchester County who was diagnosed yesterday.
This morning it turns out that his wife and 2 children and the
neighbor who drove him to the hospital for the test all have
it. One of the sons is a student at Yeshiva University, and the
school is being shut down now because of that. So this is, you
know, the growing impact it can have.
In a metropolitan area like New York or Chicago, Los
Angeles, Boston, any of them, how quickly could this spread?
I am not trying to spread fear here, because I think this
can be controlled. But when you just see that one impact of one
person and one family, and his neighbor and students, how
quickly that could spread--and I assume he took--he may have
taken the train or the subway to--you know, to work that day.
He works in lower Manhattan, where he, just by being on an
elevator, walking through a hallway, he runs into hundreds of
people.
Dr. Inglesby. So in Wuhan, where this first occurred, the
estimate by some of the most prominent modelers in the world
was that the epidemic was doubling every week. We don't know
whether that will be the same here. But we do see most--we saw
very prominent clustering in families and in people who have
close contact.
So I think we should presume that there will be relatively
rapid spread in our communities. We are beginning to take
measures to try and change that. But I think it could spread
rapidly in communities around the country.
Fortunately, I think this--that many of the cases that you
just described will have very mild illness. They won't even
have--if they didn't have a contact with their father, they may
never have been recognized. They might have had the illness and
then never had it diagnosed. So we are going to learn a lot
about the illness, and what it looks like in America in the
coming weeks, and we should be prepared to kind-of move in
different directions.
I do think that some of the social distancing measures need
to be considered in places where we have high exposure and loss
of cases recognized, such as the communities in Washington
State, which are having a lot of disease recognized.
But at some point I don't believe those measures will--some
of those measures will scale any further. We won't be able to
quarantine and isolate in the way that we are doing now. It
will be too many people to do that. So we will have to shift
strategies to things that are more community-based.
Mr. King. Doctor.
Dr. Ezike. So, in the cases that we have seen in Illinois,
we have seen how a single individual, after being diagnosed,
when we try to look back at the time that they could have been
incubating, the places they would have been, the different
settings, you know, maybe if they interacted with the health
care system as an outpatient, and then, you know, was sent
home, and then maybe came back, one person could have contacted
up to, I mean, in our cases--and I am just thinking of specific
examples--150 people. So then those people are all looked at.
But--and that--you know, if someone happened to have, you
know, flown or gone to, you know, a mass gathering, then the
numbers could be a lot. So absolutely to your point, a single
case can spread to many people.
But we have also seen, as the doctor mentioned, that it has
been the closest contacts that we have seen so far--you know,
we have not had any of the health care workers who have been
exposed to the patients before they were detected, before they
were in full personal protective equipment, none of those
people have come back positive.
So we hope that that is a sign that will continue. But the
idea is to minimize the number of cases, because it does have
the potential to spread exponentially.
Mr. King. Doctor.
Dr. Gerberding. Just think about the very first patient
diagnosed in the United States who had traveled to China and
came back with the virus, and was a good citizen and stepped
forward when he just didn't feel well, long before he had fever
or pneumonia. So they were able to sample his respiratory tract
as he was developing progressive illness, and learned that
early on, when you might not have even recognized that you were
very sick, his upper airway was full of virus. So he was
probably potentially quite infectious early--even early in the
course of his disease.
Later he went on to develop pneumonia and, of course, with
pneumonia, with your coughing or you are getting procedures in
a health care setting, you have the risk of becoming a super-
spreader, which means that your respiratory secretions are
being disseminated into the environment. We saw that with SARS
and with MERS.
The good thing about that in the United States is that we
are pretty good at hospital infection control, and we can
usually minimize that kind of spread.
But stepping back and thinking about the transmissibility
of this coronavirus versus the community transmission of SARS,
this is a much more transmissible situation. We saw very little
community transmission.
Another way of thinking about it is in SARS, in 8 months,
we had 8,000 global cases. With coronavirus there were 8,000
cases in 2 weeks.
Mr. King. I just feel sorry for the guy who drove him to
the hospital for the test. He ended up--I guess no good deed
goes unpunished. You know, the neighbor who drove him to the
hospital has come down with it now, too, so----
Dr. Gerberding. Yes.
Mr. King. Anyway, thank you very much for your testimony. I
appreciate it very much.
Chairman Thompson. Thank you. The Chair recognizes the
gentleman from California, Mr. Correa, for 5 minutes.
Mr. Correa. Thank you, Mr. Chairman. I want to thank you
for holding this most important and timely hearing.
In January, Orange County--my county--the first patients
who tested positive for coronavirus in the United States, one
of the first ones--now we have 43 of these cases in California.
I was looking at my phone right now, we just reported the
second case in Orange County.
Yesterday, in response to the news report, I wrote to the
Center of Disease Control and Prevention, asking them to please
share clinical information on the coronavirus patients with
medical professionals to help doctors diagnose, evaluate, and
treat coronavirus.
I would presume that, right now, we don't know how many
folks are infected out there, so we really don't know the death
rate out there. We don't know if this is worse than flu--yes or
no? Am I correct on that?
Dr. Inglesby. You are correct. At this point, in China, the
overall number of people who have died have been about 3
percent, close to 3 percent, between 2 and 3. We don't think
that that will be, ultimately, the case fatality rate of this
disease, because there are, as Dr. Gerberding said, probably a
substantial number of people who haven't been diagnosed, who
have mild illness, which would mean the case fatality rate will
go down. But we don't have any surety about that yet.
So we believe it is--and, as a comparison, seasonal
influenza is somewhere on the order of 1 in 1,000 people die
from that disease or less, depending on the year.
Mr. Correa. So, as we get more information, we have a
better picture and----
Dr. Inglesby. Yes.
Mr. Correa [continuing]. Therefore, possibly this is a
better evaluation, a better handle on this emergency.
Dr. Inglesby. Right.
Mr. Correa. So Dr. Ezike, are we doing enough at the
Federal level? Are we working--Homeland Security, with local
States, to address this issue? Are the resources,
communication--they can do a better job to get a handle on this
crisis?
Dr. Ezike. I think, at the forefront of what you just
mentioned, and in terms of identifying the details and the full
picture is the ability to broadly test. We can't know what the
rates of infection are if we don't diagnose the infection.
So I think that that is so critical. The sentinel
surveillance that would be a helpful tool involves looking at
people, just generally in the community, to see if there are--
what the levels are in the community without a known travel
history, without a known exposure to a confirmed case.
Currently in Illinois, we are trying to start that process,
but we have to tread lightly, because we don't want to run out
of testing supplies that--and we need also test the people who
are connected to the last 2 cases that we just recently
identified.
So I think making sure that testing supplies are available
broadly, where people can test without reservation, I think, is
an important thing that the Federal Government needs to give
the States and hospitals the ability to do. I think that is
pretty central to the effort, being able to diagnose in the
first place.
Mr. Correa. Dr. Gerberding, you said something that really
bothered me, which is we have had past pass similar crises,
similar situations, yet we don't finish the job. We haven't
developed vaccines, treatments for these other cases in the
past. Yet, as you said, we are going to continue to have these
kinds of situations and jump from animal infections to humans.
What can we do at the Federal level to compare and be very
consistent, in terms of addressing these crises so they don't
turn out to be such a major challenge, as we move forward?
Dr. Gerberding. Thank you. You know, I am so grateful that
the Congress is going to provide an emergency supplemental for
this. But if we were investing properly for our broad homeland
security and the issue of health threats, infectious disease
threats, we would not need emergency supplementals anywhere
near the scope and magnitude that you are facing right now.
So we need to improve the support for the CDC's
surveillance capability. I think we have learned that we also
need to make sure that they can scale testing as quickly as
necessary to avoid the bottlenecks that we have seen. I think
we need to make sure that our State and local health
departments have the capacity. They will soon run out of
laboratory time, space, and people to be able to do all of
these tests, and they will need support from the Federal
Government to scale their capabilities. They will be working
24/7, literally.
So we haven't built into our system of preparedness that
surge capability. It might be fine if this were a rare
situation, but let's just think back for a few years. We have
had SARS, we had avian influenza. We had a pandemic in 2009. We
have had Zika. We have had to worry about Ebola. And now, here
we are with this new coronavirus. This is not a one-off
situation; this is going to be our new reality, and we need to
upgrade the investment that we are making in the front line of
public health.
Mr. Correa. Thank you.
Mr. Chair.
Chairman Thompson. Thank you. The Chair recognizes the
gentleman from North Carolina, Mr. Walker.
Mr. Walker. Thank you, Chairman Thompson.
Dr. Ezike--first of all, let me thank you, panel, for being
here today. But Dr. Ezike, yesterday my home State of North
Carolina announced its first case of coronavirus. The patient
in North Carolina had recently returned from Washington State,
where an outbreak had occurred. How is your State monitoring
patients arriving from areas that have many confirmed cases?
Dr. Ezike. So right now, for interstate travel within the
United States, there is not a specific mechanism, a formalized
mechanism to say, oh, this person came from California. Where
that information would be used is if the person developed
symptoms and, hopefully, a very astute clinician is taking a
travel history, and then would notice, in asking questions
about where you have been recently, somebody would say, ``I was
in Washington,'' or, ``I was in California,'' and so that would
raise the level of suspicion, the index of suspicion, that, oh,
that could be maybe a higher risk.
So, at that point, they would, you know, reach out to the
local health department to get the PUI number to get the
authorization to test.
So we have, you know, more formalized processes that--where
we--through the, you know, Customs and Border Control, and the
Department of Global Migration and Quarantine, where they come
from, you know, China or Iran, certain countries that we would
get that and automatically do the monitoring. But for
interstate, that is not in place now.
Mr. Walker. Yes, and I am--anybody on the panel can speak
to this--is it--I believe it is my understanding that the
deaths that we have seen in Washington State, for the most
part, are senior adults with maybe some respiratory issues. Is
that your understanding?
Dr. Ezike. I don't know of all of them, but I think the
majority--I know for a fact the majority of them are. I can't
speak for every single case.
Mr. Walker. All right. And Illinois, successfully what are
you doing to maybe limit the spread of viruses that States like
North Carolina can emulate?
Dr. Ezike. So we--again, the--right now, some of the--we
don't have other counter-measures besides the standard public
health measures, in terms of, you know, self--you know, self-
quarantine, or staying home when you are sick and, you know,
using hand sanitizer, and washing your hands. So we are giving
that message out broadly.
But I think, again, our sentinel surveillance will be
helpful, so that we can identify if there are pockets of the
State that actually have circulating virus that we are not
aware of. I know that the whole State might not see some kind
of surge at the same time, it is going to be focal and local in
certain communities. So we just want the ability to identify
that----
Mr. Walker. All right, thank you.
Dr. Ezike [continuing]. As soon as possible.
Mr. Walker. Dr. Inglesby, you discussed the incubation
period as 5 days, and someone who gets infected has no
symptoms. The question is this: What do you suggest the
Government does to minimize the risk of asymptomatic
transmission?
Dr. Inglesby. I think that is a very difficult question. I
am not sure there is anything in specific that we can do about
asymptomatic transmission, because all of us are asymptomatic--
I don't believe any of us are necessarily infected with
coronavirus, but we wouldn't know.
I think, ultimately, the goal of communities, as this virus
begins to spread, is to try to lower the peak of the epidemic,
to slow it down, so our health care system is not over-burdened
with very sick people. So some of the measures that public
health agencies and local governments are going to start to
consider will be should we cancel public gatherings, where
people--where thousands of people get together for a sports
event, or a concert, or something else. Should we begin to
recommend to our communities that they telecommute, if they
can?
Mr. Walker. OK.
Dr. Inglesby. Those kinds of things.
Mr. Walker. Well, a lot has been talked about the
quarantine time period of 14 days. Is that a sufficient amount
of time? How did medical professionals come to that number?
Should patients stay in quarantine any longer?
Dr. Inglesby. I think that number was based on what we have
seen from China and the World Health Organization, and
supported by CDC, and it is based on the longest we have seen,
in terms of incubation.
I do think, when people come out of isolation, that local
health authorities are working with them directly to make sure
that they are safely coming out of isolation if they have
actually been infected.
Mr. Walker. One last question for you. There have been a
few reports of people testing positive after having recovered
from an earlier infection, which is very troubling. That
means--that brings in other things we won't get into today, as
far as concerns, as far as where it was actually based, or how
it was created.
If you become infected and recover, is it possible to be
infected again? Or is this a larger issue with testing, such as
false positives?
Being married to a nurse--family nurse practitioner, we--
this has been part of our discussion this past week. Would you
address that?
Dr. Inglesby. I think it is the latter. I don't--I think
the numbers are too small to say anything about reinfection.
Our judgment is that it is probably a testing phenomenon: Test
1 day, and then the next, and the test picks it up the next
day, but the person was consistently recovering for that whole
time.
Mr. Walker. Last question, just real--yes or no. This is
something we are debating at home. Washing your hands, of
course, is crucial. With anti-bacterial soap, is that better
than hand sanitizer?
Dr. Inglesby. I don't think there is any evidence that it
is.
Mr. Walker. OK, all right. Thank you.
Chairman Thompson. Thank you. The Chair recognizes the
gentlelady from Illinois, Ms. Underwood.
Ms. Underwood. Thank you, Mr. Chairman, and thank you to
all of our witnesses for being here today.
Coronavirus requires a whole-of-Government response, which
means Federal, State, and local governments must work closely
together to fulfill their different roles. But it also requires
a public health approach, one that prioritizes risk
communication, as you all both--or all 3 of you just clearly
expressed. It uses smart strategies to minimize the impacts of
the virus, and keeps communities that we all serve educated and
safe.
Dr. Ezike, can you tell us more about your Department's
day-to-day work with the CDC in response to the coronavirus?
Dr. Ezike. So we have lots of interaction with the CDC.
There are hours of calls per day, where we get updates, where
they will interact with--whether it is the State health
officials, or the State epidemiologist, or the State
preparedness and response, there are all departments of the CDC
talking to all departments at State and local government.
We have on-site support, in terms of Epidemiologic
Intelligence Service officers, we have go-teams that have been
deployed to help us with the actual investigations. They have
guidance that they are continually putting out and updating to
help us disseminate information to our communities, in terms of
ways that they can get prepared.
So there is a robust coordination and collaboration. They
are listening--the calls--they are listening to us to identify
what our needs are. When we say, ``Oh, we are missing a
guidance related to this,'' then they say, ``Yes, we will take
that back,'' and then they work with their teams, and solicit
our input, and put out guidance in as timely a manner as
possible. So there has been a robust coordination, and we are
happy to partner with the CDC.
Ms. Underwood. Then, is IDPH working with any other Federal
agencies in this response?
Dr. Ezike. That is--at my level, that is the primary point
of contact. I know that my Governor has been--we are in contact
constantly, and he is also in contact with the Federal
Government. They have--they outreach directly to him, as well,
to give him the overview, and the summaries. So there is
communication directly with the Governor, as well as with the
different parts of the public health department.
Ms. Underwood. Are there any areas where additional
assistance would be helpful, from your perspective?
Dr. Ezike. Sure. So we can't reiterate enough the need for
funding, both to make sure that we can accommodate all the
employee--whether it is the overtime, whether it is--we had
to--in one instance in our State we had to rent an RV, because
we couldn't find a motel that would agree to take one of the
people that needed to be isolated. So we need assistance to pay
for the housing options for people who don't have it. I think
funds for people who are displaced from work temporarily,
assistance with that.
So there are--you know, our lab, you know, the--to run the
lab, the lab equipment, a single piece of lab machinery is up
to $500,000 or more. So there is a list of resources that need
financial support to maintain our operations.
Ms. Underwood. In your testimony you wrote that Illinois
conducted an exercise last year, the Crimson Contagion. Can you
tell us more about those kinds of exercises, and why they are
such an important part of your preparation to respond to
potential outbreaks?
Dr. Ezike. So in the aftermath of 9/11, we started getting
funding for what our offices call the Office of Preparedness
and Response. So, in that office, it is gearing up, as the
doctor mentioned, trying to prepare for what are the eventual
situations that can arise.
So, table-top exercises, where you convene with the Federal
Government, multiple States, local health departments,
businesses, schools, communities, all--you know, we had a
almost week-long exercise, where the event, which was created,
was a novel virus that came from China, and was spreading
throughout the world. So that was the scenario that was played
out with all these partners at the table.
So, thinking through the what-ifs, if you will, is part of
the preparedness. So, when you--the more prepared you are, then
when you see something similar to that, then you switch into
response.
Ms. Underwood. Sure. So in your testimony you wrote that
responding to the coronavirus has cost the State more than $20
million in the first 5 weeks. We have heard from our local
public health officials the importance of stable, long-term
funding. So we are so pleased to be able to, you know, at least
have a supplemental to get a downpayment, and hope to continue
to work with our colleagues to make sure that these efforts are
well-funded.
We know that too many Americans have chosen to skip a visit
to the doctor because their costs are too high, their out-of-
pocket costs are too high. So, when dealing with an unknown
infectious disease, that decision making has consequences, not
only for their patient and their family, but for the entire
community. So it is our hope that addressing those kind of out-
of-pocket costs, in addition to your public health costs, is
going to be an important solution to this epidemic.
Thank you for being here. I yield back.
Chairman Thompson. Thank you very much. The Chair
recognizes the gentleman from Pennsylvania for 5 minutes, Mr.
Joyce.
Mr. Joyce. Thank you, Mr. Chairman, and thank you for the
esteemed panel for being with--here with us today.
Of utmost importance, it is imperative that we work
together, as you have stated, on a Federal, local, and every
level to fight this problem that we are facing with the
coronavirus.
To briefly review the time line, President Trump has taken
action, decisive action, to protect Americans and to prevent
the spread of COVID-19. In January President Trump declared a
public health emergency, initiated travel restrictions, and
mandated quarantines for those returning from affected areas.
He also formed the Corona Task Force to ensure a coordinated
response among all U.S. agencies and experts. Since then the
Trump administration has expanded travel restrictions, explored
innovative medical solutions, and requested additional funding
for COVID-19 response resources.
Vice President Pence has also been elevated to lead the
response, and has been appointed corona response coordinator.
Vice President Pence also announced just yesterday that
Medicare and Medicaid will be covering the coronavirus testing.
The most important questions we need to be asking are where
do we go from here, and what can be done to mitigate the future
threats of the same nature?
Dr. Gerberding, your expertise and extensive experience in
this field, serving as CDC director during the anthrax, the
SARS--which is also a coronavirus--the West Nile virus, and the
avian flu outbreaks, if you could, please prioritize and talk
to us about the development of a vaccine. Specifically, you had
mentioned that we had not yet completed the SARS evaluation for
vaccines, but yet that process has been initiated. SARS, too,
is a coronavirus. Does that put us steps ahead in the vaccine
development?
Dr. Gerberding. One optimistic point of view is that
science has actually evolved considerably since 2003, when the
first SARS outbreak occurred, so that the time line and the
ability to have the molecular tools and the immunology tools to
speed up manufacturing has significantly improved.
At the WHO leadership meeting on vaccines for this
coronavirus there were 31 innovators there talking about their
approach to vaccine development. Unfortunately, all of that
development was pre-clinical. None of those vaccine candidates
were in people yet. But the ability to have that much
innovation already on the table really speaks to the importance
of our biotechnology industry and capability. I think that is a
positive perspective.
The reality check--and I know this from the experience we
have had at Merck, working on the Ebola vaccine--is that
getting a candidate vaccine is somewhat straightforward;
getting it through the safety testing, through the clinical
testing, and front-line conditions, getting those data
together, getting it through several regulatory processes,
manufacturing it and, in this case, not just for a relatively
small number of people in a localized Ebola outbreak, but for
the world, that is a daunting task.
There are 7.7 billion people in the world, and I am not
sure who is going to be left out of access to the vaccine. So
it is a big undertaking to have the full completed preparedness
accomplished in the vaccine arena, and what concerns me about
our current outlook is that we are seeing some over-promising,
and we need not to alarm people when those promises don't
actually come to fruition on the time line people are
expecting. We need to be straightforward about the challenge
ahead. Work hard, invest, support the people who are doing
innovative work, but at the same time be cognizant that this
vaccine is not going to be in people's arms for a long time.
Mr. Joyce. I have always been impressed by American know-
how, innovation, our approach to science, and specifically to
medicine. Dr. Gerberding, and could you please comment to us
what immediate actions can we be taking in Congress to assist
and to inform our constituents while we are still awaiting the
results of negotiations on the emergency funding package?
Dr. Gerberding. Well, obviously, funding is a big piece of
the effort in almost any direction that you look.
But I also think that there is an opportunity here for
Congress to provide its own leadership on the communications
front. You are members of State delegations. You do interact
with Governors and State leaders. Really, coming together as a
unified whole-of-Government opportunity to get on the same
page, for you all to understand what is needed at the State and
local level, that creates an informed platform for decision
making. I think, as we have heard from our colleague in
Illinois, you will learn a lot about what is really needed at
the local level.
Mr. Joyce. I thank all the panelists for being here today,
and I yield my time.
Chairman Thompson. Thank you. The Chair recognizes the
gentlelady from New York for 5 minutes, Ms. Clarke.
Ms. Clarke. I thank you, Mr. Chairman. I thank our expert
panelists for bringing your expertise to bear today. It is
refreshing to hear facts.
So let me start by saying that yesterday in New York it was
confirmed that we had a second COVID-19 coronavirus case. As
Mr. King has stated, we are now dealing with sort-of the
fallout and the rapid spread of this illness as a result of a
gentleman who had traveled from Westchester County into the
city of New York. We can expect more to come.
But this is not the time for fear. It is time for facts.
That is why I am so happy you are here today.
This crisis is serious, but we can mitigate the coronavirus
if we put science over scoring points. Doctors, not
politicians, need to be in the driver's seat as we combat this
global outbreak. This isn't a hoax, in the words of the White
House. It is not an apocalypse, either. It is a public health
emergency, but one we can address with funding resources and
sound science.
As of yesterday, we know of 105 cases, and a death toll of
9 persons in the United States. As testing is expanded, the
numbers will continue to rise. The Federal Government and the
State and local partners must also rise to the occasion and
give each American not only the care they need if infected, but
also the knowledge they need to avoid infection. I look forward
to our continued conversation as we guide the American people
through this impending crisis.
So, Dr. Gerberding, according to the recent article in May
2018, Donald Trump ordered the NSC's entire global health
security unit shut down, calling for reassignment of Rear
Admiral Timothy Ziemer, and dissolution of his team inside the
agency. What were the consequences of this action?
Dr. Gerberding. Thank you for the question. I honestly
don't know the answer to your question. I am a champion of a
whole-of-Government approach. I know Dr. Ziemer, he is an
amazing leader, and served us well first in malaria, and then
in subsequent public health emergencies. So he was
extraordinarily effective, a whole-of-Government leader, and I
was sorry to see him go.
Ms. Clarke. Yes, it is important that we have institutional
knowledge, and that, as you have stated in your testimony, we
follow the course to its natural end. Unfortunately, when we
dismantle or disrupt, we don't benefit from that institutional
knowledge.
The Center for Strategic and International Studies
established the Commission on Strengthening America's Health
Security to examine the U.S. preparedness to respond to global
health threats. The commission published in its final report
last year--Dr. Gerberding, you served as co-chair of the
commission. The commission's first recommendation was, ``to
restore health security leadership at the White House National
Security Council.''
Why did you believe that restoring senior-level leadership
at the National Security Council is so important to ensuring
our Nation is prepared to combat a potential pandemic?
Dr. Gerberding. Let me share my personal experience while
we were involved in a very serious whole-of-Government effort
to prepare for an influenza pandemic.
At the time, the Secretary of Health and Human Services was
Secretary Mike Leavitt, and Secretary Leavitt believed that we
needed to have all of the cabinets of the Federal Government
participating in the preparedness. So he took us, all of us, as
leaders of parts of HHS, to every Cabinet. We sat down with
every Cabinet Secretary with the book on the 1918 pandemic, and
we went through, highlighted sections, and asked the question,
``What will your Cabinet need to do in the context of a serious
emergency?''
What that really taught me was that the Federal Government
in every Cabinet level has something to contribute, whether it
is education and school closures, or commerce and keeping our
businesses operational, or transportation. Whatever the Cabinet
has authority over, it is relevant in a serious public health
crisis, and we need to have the whole-of-Government
collaborating. The only way to really do that is to bring an
uber-leader, somebody who really sits above and has the
authority of the President.
Now, I will also acknowledge that there is a bipartisan
blue-ribbon panel on biodefense that Secretary Ridge--former
Governor Ridge and Senator Lieberman have co-chaired for
several years. That panel's recommendation, sort-of parallel to
what CSIS recommended, is that the Vice President should chair
that whole-of-Government process. So I think what that tells
you is the idea is the same. You need an empowered person to
oversee complex, inter-Government--inter-Governmental agencies
and the Government strategy. But how you go about doing that
may vary from one administration to another.
Ms. Clarke. Very well. Mr. Chairman, thank you. My time has
run out. I yield back.
Chairman Thompson. Thank you very much. The Chair
recognizes the gentleman from North Carolina, Mr. Bishop.
Mr. Bishop. Thank you, Mr. Chairman.
Dr. Ezike, you mentioned in your written and spoken
testimony the phrase ``sentinel surveillance testing.'' What is
that, ma'am?
Dr. Ezike. Thank you for the question. So sentinel
surveillance, once you have the ability to test, involves
testing people who don't have a direct connection to a
confirmed case, do not have a direct travel to a specific place
that would put them in a--in our higher risk to be a
coronavirus suspect.
So this is going to your average person with no connection
to a case or to a hotbed, if you will, and then them developing
a flu-like illness, an influenza-like illness, and going to
their doctor, and the doctor identifying that, ``Oh, you don't
have the flu, you don't have any of the other common viruses on
the respiratory virus panel. Maybe this is coronavirus, despite
you having no connection.''
So testing people with no connection, and seeing what the
ground percentage of coronavirus--if it is there and, if so,
how much. So, if you can do that broadly, you can see if there
are pockets within your State that have coronavirus in people
that you wouldn't specifically suspect to have.
Mr. Bishop. Thank you, ma'am.
Dr. Gerberding, the CDC, after initially, I understand, in
early February releasing test kits, determined that there was a
flaw in them. I have understood, from speaking to someone else,
that those tests are referred to as an RT-PCR test, and there
are 3 components, and what was flawed was the--what is called
the negative control component.
Do you have any information about that, or how that came to
pass? Because that is sort-of alarming if we need to respond
quickly. If somewhere in CDC's function this test kit was
created and then didn't work because of what I understand to be
a very basic error, how does that take place? Do you have any
insights about that?
Dr. Gerberding. I don't have insight into the specifics.
I can tell you that, long before I was part of the CDC, the
one thing I understood and saw from my front line at San
Francisco General Hospital was that the CDC is the best at
testing. Their diagnostics are usually gold standard. So it
just seems to represent a highly unusual and exceptional
situation, and I am sure they will get to the bottom of it. I
know they have had a great deal of consternation about their
inability to be out there with a--not just an accurate test,
but with the volume of tests that people really need.
Mr. Bishop. Following up with that, Dr. Gerberding, or
whoever else may want to comment, my understanding is that
there was a question about who had access to this test. Could a
line doctor, an emergency room doctor, decide to administer
this test?
It was limited to--at some point to public labs, perhaps
because of supply. But now the Vice President has made it clear
that anyone will be allowed to order a test, any doctor, and
that there is a distribution going on of, like, 2,500 or 25,000
kits that will enable testing of up to 1,000,000 people,
something like that.
Can you speak to those details?
Dr. Gerberding. Yes, this is not unusual at the very
beginning of a situation with a new pathogen that we have never
seen before. You know, we don't have a test on the shelf for
it, so it is being invented in real time. So it does not
surprise me that early on there was a limited number of tests
that were available.
We typically use what is known as the Laboratory Response
Network, because those people are highly trained. They have the
standardized equipment. Part of our public health system. They
are best able to judge in their own communities who should be
tested.
The State health officers also contribute to the decisions
about what is a case definition and who should be tested. So it
is not just an order from above, it is a collaborative process.
But, you know, when we are sitting in the United States, and
the disease is in China, and we are not suspecting a large
number of cases, it makes sense that you would focus your
testing, your limited testing, on a traveler who had just come
back from China.
Obviously, we are in a very different situation now, where
we are seeing community spread. So it is normal that we would
expand the indications for testing.
I completely agree with the notion that, if a doctor
suspects coronavirus, they ought to be able to order the test.
Mr. Bishop. I--given the limited time--my friend, Ms.
Clarke, made a comment that the President called the
coronavirus a hoax. I guess, since that was said in public, I
wanted to say that he didn't say any such thing. But--and I
don't want to alter what I think has been a very good tenor of
this hearing.
I guess my last question, having said that, is I understand
that, for the testing to be done rapidly enough, we need to be
able to empower or bring in private lab infrastructure into
that picture. I don't know who met--Dr. Gerberding, I am not
trying to pick on you, but just--given I have got a couple of
seconds left, if you could, comment on what is needed to make
that happen.
Dr. Gerberding. I think that is well under way. I am going
to be spending some time this afternoon with colleagues,
including the CEO of one of the important diagnostic companies,
so I will have a better answer by the end of the day.
But I think the first thing is that FDA, through the years,
has really liberalized the process for getting an emergency
authorization for new tests to get out there into the
community. You know, compared to 20 years ago, our ability to
do this fast has significantly improved.
Once we know what we are looking for, it is a simple matter
for diagnostic companies to pick up on that. They have the
scale and the capacity to ultimately build much larger capacity
than the public health system. But they do have to demonstrate
the sensitivity and specificity of their tests. When you don't
have the disease, it is a little bit harder to do that, because
you don't have enough case material to really know if you are
accurate in the results that you are receiving.
Mr. Bishop. Thank you, ma'am.
Chairman Thompson. Thank you very much. The Chair now
recognizes the gentleman from Staten Island, Mr. Rose.
Mr. Rose. Mr. Chairman, thank you.
Thank you all so much for being here. I want to start off
just with what I am seeing, some business leaders making
decisions around employee travel, halting international
flights, halting domestic flights, really getting ahead of
unnecessary or necessary--that is my question here--ahead of
guidance from the Federal Government.
So what should our business leaders be doing, people
running global companies?
Dr. Gerberding. I can share what our philosophy has been.
We are a global company, and we have 8,200 people in China, and
many of them were on lockdown for an extended period of time. I
am so glad that our offices are back open, and our systems are
operational there.
But we recognize that, when we have people in several of
the hotspots where community transmission is occurring, and we
are responsible for essential medicines and vaccines, that we
have to keep our supply chain open and running. So people need
to be coming to work. Those critical employees are especially
cautioned about non-business essential travel, and to self-
quarantine if they have any recent travel to a hotspot, and to
not come to work if they are sick.
So we don't have a decision that you can't travel. We are
just simply saying, while we are working on slowing spread and
understanding what is going on here, let's err on the side of
caution----
Mr. Rose. Well, what about----
Ms. Gerberding [continuing]. And minimize unnecessary
travel.
Mr. Rose. What about domestic travel?
Dr. Gerberding. Domestic travel is more in this--in the
spirit of the slowing down the spread that Dr. Inglesby was
talking about, that if we are in a situation where we really
can't isolate and quarantine each individual, and we are trying
to reduce the peak of transmission, it does make sense that we
begin to think about avoiding crowds and minimizing our
movement and our----
Mr. Rose. And flying?
Ms. Gerberding [continuing]. Maintaining our distance----
Mr. Rose. Flying, as well?
Dr. Gerberding. Flying, as well. So we are just, you know,
trying to use some common sense. I am flying, we are on the
move when we think it is important to our business. But we are
certainly emphasizing now is a good time to be more comfortable
using digital communication, and being more thoughtful about
how we travel.
Mr. Rose. Sure. Would anyone else like to speak to that?
Dr. Inglesby. Yes, I think the CDC guidance on travel at
this point seems logical. It is now describing what--countries
where they think there is elevated risk, and making
recommendations to Americans about where they should travel
internationally. That seems sensible.
I think one of the challenges is that we have seen things
change very rapidly in a week. So 10 days ago Italy had 0
cases. Now it is kind of among the countries with the highest
cases. So it is challenging for business leaders to think ahead
about a conference in 3 weeks or 4 weeks, where things can
change quite a bit.
So at this point, I think the best recommendation is to
follow U.S. Government guidance, but also be aware that
something could change, literally, in a day or 2, as countries
begin to start testing.
Mr. Rose. Understood. Would you like to add something,
ma'am?
Dr. Ezike. I think I echo what these two experts are
saying, that this is an emerging situation, and advice and
counsel given today may not be applicable tomorrow. So,
continuing to follow the most recent guidance----
Mr. Rose. Sure. So I want to move on to our lower-wage,
hourly workers. I am very concerned that they will not--
rightfully so, or at least rationally--respond to quarantine
suggestions because of immediate economic concerns.
What can the Federal Government do to step in, to support
people so that they respond to quarantines?
Dr. Inglesby. One thing that can be done, which I know is
being discussed actively here, is to make sure that there are
no barriers to testing or to getting medical care or isolation,
and that--we have already begun to refer to that. I think that
that is--that sounds like that is beginning to occur through
your CMS----
Mr. Rose. Sure.
Mr. Inglesby [continuing]. Or discussions with insurance
companies.
So that is really important, because we have seen actual
evidence of people who have had $3,000 bills after they went in
to get a test, and that has been publicized, and people will
potentially avoid getting tested.
I think it is a harder challenge--and that maybe Congress
and the administration can solve together about workplace----
Mr. Rose. Should we consider expanding unemployment
insurance?
Dr. Inglesby. I think if that is a way of helping people in
the gig economy or lower-wage workers make good decisions,
public health decisions, I think that should be considered.
Mr. Rose. Anything else?
Dr. Ezike. I would agree that there should be a mechanism
for people who would be economically disadvantaged if they
don't have any benefit time, if they don't have any kind of
paid leave, that there should be a way for them to be
compensated so that they don't have to make the decision
between following public health measures that will help the
entire community versus being able to pay their next month's
rent.
Dr. Gerberding. I just want to add something, because it
hasn't come up yet, but in the context of this conversation we
also have to be mindful of stigma. This happened during SARS,
where the Chinese community----
Mr. Rose. Yes.
Ms. Gerberding [continuing]. Was profoundly stigmatized. I
think it is an opportunity for leaders and House Members, as
well, to really stand up and make sure that we are including
everyone in the benefits that we can provide to help protect
Americans, but also that we speak out against the
stigmatization that often follows in the wake of an outbreak.
Mr. Rose. Great. Thank you very much.
Chairman Thompson. Thank you. The Chair recognizes the
gentleman from Tennessee, Mr. Green.
Mr. Green. Thank you, Mr. Chairman, and thank you to all of
you guys for being here today. It is--I greatly appreciated
your involvement in this process.
Very quick, my questions, I am going to try--because I got
lots of them--mortality rate, it appears to be about 3 percent
in China. Outside of China it appears to be about 0.7 percent
is what I saw in a JAMA article that was just published.
You know, what are your thoughts about that delta? The
Journal of the American Medical Association seemed to imply
that it was attributable to China's smoking rate, other
reasons. But why is their mortality 3 percent, and outside of
China it is 0.7? In South Korea it was .12 percent. So your
thoughts on that?
Dr. Inglesby. It is too soon to say, because things are
changing rapidly in other countries, and they don't have as
much data being published as there is in China.
One of the factors--and Wuhan does seem to be--the surge in
hospitals, it does seem like some of the people who could have
used ventilators did not get them because they ran out of
ventilators. So that is one possibility.
There is a possibility that there is some underlying health
conditions, or pollution, or smoking, or something else that
will fall out in analysis. But I don't think we have strong
understanding of that yet.
Mr. Green. OK.
Dr. Inglesby. It also--the other thing that is important is
that there is a time lag from when countries discover cases and
begin to see them, and the time that people begin to die from
this illness, sometimes as long as 2 weeks. So if it is a
country just beginning to report illnesses and deaths, it is
really two----
Mr. Green. OK.
Dr. Inglesby [continuing]. Weeks later when we see----
Mr. Green. That makes sense.
Dr. Inglesby [continuing]. A real--a better sense of
deaths.
Mr. Green. Sure, that makes sense. I just know the end is,
like, well over 3,000 now for outside the country. So you would
think that that would give you some degree of confidence. But--
and there is such a huge delta between 3 percent and 0.7
percent.
This, obviously, based on the way it is hitting the--you
know, those who have co-morbidities, and the elderly, probably
a very good virus to tackle with the vaccine, but I am--you
know, I am also aware that this attacks the lung tissue
directly, so that makes it concerning. We need to be very safe
as we develop this vaccine.
Sort-of in the interim time frame, there is remdesivir and
the monoclonal antibodies. I just wondered if either--anyone
could comment first on remdesivir and some of the other
antivirals that we developed for Ebola and their usefulness. I
know there is a test in Nebraska. Then, on monoclonal
antibodies, because of the ability to blunt the tissue--the
lung tissue's damage with monoclonal antibodies, and they can
be spun up so much more quickly than a vaccine.
Dr. Gerberding. So I will start with the anti-viral
question. Yes, I am hopeful. I really want these antivirals to
work. But at the same time, you got to think about what we have
learned about respiratory infections and antivirals so far. I
mean we have several antivirals for influenza, and they might--
--
Mr. Green. Sure.
Dr. Gerberding [continuing]. Mitigate a little bit, but
they are not curative. So we need to not over-promise on what
we might ultimately see. So hope for the best, but I won't be
surprised if we are a little bit disappointed.
In terms of monoclonals, again, almost every outbreak that
I have dealt with, the first thing people do is use serum from
recovered people, and try to see if it is helpful. So that is
the, you know, the intellectual background for using
monoclonals. They may very well be useful, but on this kind of
situation, where the severe pulmonary disease is caused by a
cytokine storm----
Mr. Green. Right.
Dr. Gerberding [continuing]. Which basically means broad
inflammation that is very tissue-damaging, you have to test the
safety of the monoclonals very carefully, because what you
wouldn't want to have happen is put an antibody in there and
actually make that cytokine storm worse.
Mr. Green. Sure, sure.
Dr. Gerberding. So it has got to be tested. I hope, again,
but--and I agree with you, these approaches to treatment can
happen much faster than a vaccine. So they are definitely a
high priority.
Mr. Green. Well, thank you for that.
One of the things that concerns me, there is lots of
legislation in Congress about price fixing for pharmaceuticals.
I know Merck is one of those companies that would be hurt by
that. My concern is, particularly those smaller companies, the
bio, you know, companies, biomed companies that, you know, when
they have an idea, they have to go get capital in order to
advance that idea. They are not going to get capital if we
price-fix.
So I wondered if someone, particularly ma'am, you, because
you are from the industry, could comment about how damaging
price-fixing might be on some of the innovation that is out
there----
Dr. Gerberding. I----
Mr. Green [continuing]. That could address this issue.
Dr. Gerberding. Yes. You know, first of all, as I said
earlier, 40 biotech companies have stepped up on coronavirus.
But understandably, the entrepreneurs are very apprehensive
about what this will mean to investors. Price-fixing is the
thing that investors hate the most. They made that very clear
when the subject came up on another topic.
I live it in the world of antimicrobial resistance, because
we don't have a market for antibiotics. There is no
reimbursement appropriate to the danger of multi-drug-resistant
infections. Last year we saw three companies that had new
antibiotics that failed, and went out of business because their
investors pulled back.
Mr. Green. Right.
Dr. Gerberding. So it is a real issue, and we need to keep
our biotech industry alive.
Mr. Green. Thank you for sharing that.
Thank you, Mr. Chairman, I yield.
Chairman Thompson. Thank you. The Chair recognizes the
gentlelady from Texas Ms. Jackson Lee, for 5 minutes.
Ms. Jackson Lee. Mr. Chairman, thank you so very much.
Thank you very much for your hearing yesterday. I was detained
in my district for civic matters that occurred on that date. In
tribute to my constituents and the necessity for America to
ensure that people can vote, I was at a college voting precinct
at 1 a.m. in the morning, where people had remained on-line to
vote at 1:29 because they could not vote because of shortages
of machines and broke-down machines.
I say that because this is the greatest country in the
world, and I am disappointed you are not Government witnesses.
I am disappointed in the slow response to the coronavirus.
We have dealt with Ebola, one of the first cases was in the
Dallas hospital in Texas. We dealt with H1N1. So I am going to
pose the question and hope--as straightforward as possible.
There were two briefings, unclassified. One briefing was
complete denial, everything was fine, top-level leaders of our
government in health and emergency issues. Shortly--as the
first Member, I think, to do a press conference questioning
everything was fine with airport personnel and others, at that
time TSA officers had no gloves, they had mismatched gloves and
mis-matched masks. I know there is a discussion about masks.
But I would like to ask Dr. Ezike--and am I close to the
pronunciation--the need for preparedness and awareness when the
obvious is occurring, I would like to be prepared months or a
year out, or regularly having a preparation for this to occur.
When I say ``this,'' an infectious episode to occur. But the
fact that China was quite public, they couldn't hold it any
longer--can you comment on the preparedness of this Nation?
Dr. Ezike. I think Dr. Gerberding also has eloquently
described the situation, and has highlighted the importance of
having increased surveillance capacity for the CDC.
We have been--as a State health officer, every year we try
to come to Washington and encourage increased funding for the
CDC to keep up with these surveillance efforts, to keep up with
our preparedness and response. All of our preparedness and
response----
Ms. Jackson Lee. So do you have an assessment of whether or
not we were prepared on the Federal level for the coronavirus?
Dr. Ezike. I think we can always be more prepared. I think
there is levels of preparation, and the more prepared we are,
the better.
Ms. Jackson Lee. I am going to go to Mr. Inglesby--forgive
me as I watch my time go out, and I appreciate it.
Is that Inglesby, Doctor?
I meet regularly with my local health agencies, and I
appreciate the director of the Illinois Department of Health. I
understand that you are always lobbying to make sure that there
is direct funding to both State and local. This is a particular
instance where that would be important. I understand our
appropriations is something that we have all requested, is
going to enhance dollars going to State and local entities.
How do you translate that into helping you and your local
communities be prepared for something that appears now to come
from CDC, that it is either an epidemic or a pandemic? Now they
are willing to say that.
How are you doing with the test kits, and how would that
help you with the test kits? My community does not have them
yet, and that is a real problem. Most communities, I think, do
not.
Dr. Inglesby. Yes, I think, first of all, that every year
there are public health emergency preparedness grants that are
given to States from CDC, and they are very important grants
for States and locals, and need to be supported by Congress and
the administration. They are crucial for long-term
preparedness. They are separate and distinct from the emergency
response funding that is coming out through--that we hope will
come out through these appropriations. You can't build a
firehouse the day before the fire, you have to build it a long
time ahead of time. That is what those preparedness grants do.
In terms of expanding diagnostic capacity testing, that is
now happening over the course of this week, and State health
labs around the country are going to be able to start testing,
hopefully within Texas, as well. But ultimately, to really
expand into clinics and hospitals, we are going to need
diagnostic companies to be fully invested, just like----
Ms. Jackson Lee. That is very important, right?
Dr. Inglesby. [Nonverbal response.]
Ms. Jackson Lee. And the preparation of our hospitals, as
well.
Dr. Inglesby. Yes.
Ms. Jackson Lee. Quickly, can I--if we go into a moment in
time of quarantine, closing schools, restaurants, et cetera, do
you think we should also be concerned about, in this instance,
hourly wages--hourly wage workers who would be caught up in
that quarantine who don't get paid, and may have a devastating
impact on the family?
So that would be a part of what we need to do in this
moment to be able to provide for people's livelihood and
survival, if they are quarantined for a period of time.
Dr. Inglesby. I do agree with that. I think people could
be--especially if a quarantine is prolonged, if--there are many
people in the country who receive a check every week, and they
need that check that week. So if we are telling people they
cannot go to work, or cannot go to school, and have to stay
home to take care of their kids, we need to make sure the
incentives for doing that are aligned with what we want done,
and that people aren't having to, basically, not be able to
provide for their families.
Ms. Jackson Lee. I thank the Chairman. I thank the
witnesses very much for your----
Chairman Thompson. Thank you very much. The Chair
recognizes the gentlelady from Arizona for 5 minutes, Mrs.
Lesko.
Mrs. Lesko. Thank you, Mr. Chairman. Thank you, Mr.
Chairman, for having this meeting, an important issue, and
thank you, all of you, for being here.
Debbie Lesko from Arizona. Our State--Dr. Christ heads up
our Arizona Department of Health Services, and she is very
competent. We just started testing with--in-house, ourselves.
It is very important, obviously, that we are prepared. But
also, we have to balance that with panicking people. I think it
may be a little bit too late, because you turn on the news and
this is all you hear about, right? My husband went to Sam's
Club last night, and said that all of the, you know, Purell, or
whatever brand of the hand sanitizers totally sold out. I mean
all that was sold out.
So my question is kind-of a basic one. So many people die
from the flu, more than I even realized until just recently.
So, is this worse than the flu? I mean we need to be concerned,
but I am concerned about people panicking.
So I guess I will ask Dr. Gerberding--if that is how you
pronounce your name--is this worse than the flu? Should we be
more panicked than the flu? Tell me about that.
Dr. Gerberding. I think we are learning that this is
probably as transmissible as the flu. The rate of transmission
seems to vary, depending on how much testing goes on in the
background to really figure that out. So we still have to learn
what the true transmissibility dynamics are. But it is,
obviously, spreading from person to person, especially in
families, and on cruise ships, and other closed environments
with a great degree of efficiency.
The question is, how fatal is it? And who is vulnerable? I
think Dr. Inglesby has pointed out earlier that we don't know
the true case fatality rate yet. Part of that is because of the
differences in medical care that influence that. Part of that
is because we don't know the denominator of the less-sick
people. Part of it is because the testing is just not available
to sort out who is actually a case. So we will learn more about
that.
But I think what we could say today is that it looks very
much like the case fatality rate is significantly greater than
the fatality rate for seasonal flu. I think that is the
distinguishing issue here that makes me so concerned, that it
is the death rate that is high. The death rate is highest, the
older you are, and the more underlying disease, particularly
respiratory disease, that you have.
So this nursing home outbreak, for example, that is a
significant concern, and we need to prioritize getting
infection control precautions and other things to slow down or
prevent spread in those settings as one of our highest public
health priorities right now.
Mrs. Lesko. Thank you very much. My next question has to do
with face masks, so anybody can answer this.
What is the answer? Should people that don't have a cold or
aren't coughing, should they wear face masks?
I have been--I have Googled it, and said no, you shouldn't
wear a face mask unless you are coughing. It won't help. But
then why is it that health care workers wear it? So that is my
question to anyone.
Dr. Inglesby. In hospitals people are exposed to the
sickest people, and we do see a correlation between level of
illness and the ability to spread the disease. So walking
around in the community, most of the people are well in the
community. Even if they are asymptomatic, we don't think they
are the fundamental largest drivers of infection.
Also, when you wear a mask in the public, you know, you end
up fussing with it a lot, you end up touching your face often.
You are untying the strings, moving it around. It may be that
you are actually touching your face even more often than you
are normally.
So the bottom line is that we don't have evidence that face
masks in public are going to do any good, and we are worried
that, if everyone goes out and buys a mask, that that will
diminish the number of masks that are available in the
hospital, where the people are the sickest, and are
transmitting at the highest levels. We need our health care
workers to stay healthy, because they are going to be--it is
going to be a long period of time--a marathon, probably--of
high COVID patients in hospitals.
Dr. Gerberding. Just to real quickly add to that, there are
different kinds of masks, as well, and the masks that are worn
on health care workers, they are trained and they are fitted to
their face so they don't leak air around them. But when people
on the streets buy those, or buy the regular surgical masks,
they are breathing all kinds of air in around the mask, and it
really doesn't offer the level of protection that health
workers need. That is why they have to be trained to use them
properly.
Mrs. Lesko. Well, so what I think I hear is that face masks
do help if they are put on properly, even--they do help from
getting it, it is just that you advise against it in community,
because people don't know how to use it properly, they touch
their face a lot because of the mask. Is that what you are
saying?
Dr. Gerberding. Just to add one additional thing is that I
have had to wear N95 respirators for many, many, many patient
encounters, and you can't wear them for very long. They
increase your work of breathing. They are incredibly
uncomfortable. So you go in the room, you do something, you
take the mask off when you come out. To walk around with one of
those on all day is impossible.
Mrs. Lesko. So if you don't mind one more question on this
mask issue, why do you think it is a lot of the Asian
countries, everybody is wearing masks? Is it a cultural thing?
Do they think it is going to help, or does it--do they know how
to wear it properly?
Dr. Gerberding. In China right now they are being required,
so that is the main reason why you tend to see a lot of people
on the streets of China wearing, basically, usually, surgical
masks. But I don't think that they are there because they are
having a significant impact on disease spread.
Mrs. Lesko. Thank you. I yield back.
Chairman Thompson. Thank you very much.
A question for the committee is, Dr. Gerberding, have you
any assessment of how long it will take before we actually will
have a vaccine?
Dr. Gerberding. I would probably defer to Dr. Fauci's
statements on this topic, the head of the NIAID. I think Dr.
Fauci has said we will get vaccines into testing in a matter of
several weeks to a few months, but that we won't have an
approved vaccine for at least a year, and probably longer. If I
am not paraphrasing him correctly, I will get back to you for
the record.
But, you know, realistically, it is not a rapid track, even
with all of the permissions and the energy that we are putting
into it. Part of the reason for that is safety. We really need
to make sure----
Chairman Thompson. Oh, absolutely.
Dr. Gerberding [continuing]. The vaccine is safe.
Chairman Thompson. Absolutely.
Dr. Inglesby, a couple of comments have come up relative to
capacity for the virus, whether we were as robust as we needed
to be, as a Federal Government. Have you looked at the capacity
issue, or are we just basically caught with something that we
just wasn't prepared to handle?
Dr. Inglesby. I think it depends on what kind of capacity
we are talking about. I think our public health agencies have
been training for these kinds of things for a long time. But
even as well-trained as they are, there are enormous resource
challenges and personnel challenge when they are working 24/7,
and they are having to create new quarantine sites.
So I think, in principle, there has been a lot of
preparedness, there has been a lot of drilling, and grants for
States and locals around the country. But I still think this is
a challenge that they haven't faced before. So we do have major
capacity challenges ahead in public health and in hospitals.
Chairman Thompson. Thank you very much.
The gentleman from Texas, Mr. Crenshaw.
Mr. Crenshaw. Thank you, Mr. Chairman, and thank you all
for being here on this important topic.
Dr. Gerberding, I will start with you. Given your lengthy
experience in this field, director at CDC, you dealt with
threats from anthrax, SARS, West Nile, avian flu, other
outbreaks, I am assuming you all compile constantly and
persistently a best practices list and lessons learned. To your
knowledge, are those lessons carried over, administration to
administration, even when folks like you leave the
administration? Are those being implemented now?
Dr. Gerberding. Thank you. When I was directing the CDC we
implemented very formal after-action reviews, starting with
anthrax. Dr. Jim Hughes had the National Center for Infectious
Disease at that time, and it was one of the things that we did
first, was just bring in anybody who we interacted with in the
response, and learn what did we do right, what did we do wrong,
and what do we need to do better. So that mechanism is
consistently practiced, as far as I know, to this very day at
CDC. Yes, those lessons are passed forward.
But, you know, each one of these situations brings in a
unique challenge. So it is hard to extrapolate from one after-
action review to the next one. The constant themes that go
through them all are communication, the need for collaboration,
and the consistency approach, whole-of-Government, but also
Federal-State level. Those lessons come up, and I think we have
still opportunities to improve in how we coordinate that, as a
country.
Mr. Crenshaw. Absolutely. This administration has taken a
lot of heat in the media and from politicians. Do you see any
big differences in the response that this administration has
given, compared to, say, what a previous administration would
have done?
Dr. Gerberding. Well, since I left the Government I have,
you know, of course, watched from the outside in, so I don't
really know what is going on in the sausage factory. But I do
see that, broadly speaking, I think the way--the 2009 influenza
pandemic was handled quite well. I think Zika was hard, but
people did a pretty good job with that. There were lots of
missteps in the early days of Ebola.
Now, here we are with this one. I think many of the people
who are acting as leaders of the response here are the same
people that I worked with when I was in the Government. Dr.
Azar--or, excuse me, Secretary Azar--was part of the Department
when we were planning for a flu pandemic. Bob Kadlec was
involved in the Government in his role, and now he is heading
the--as assistant secretary of preparedness and response. BARDA
has certainly stepped up and funded many things that--BARDA
funded the CDC--I mean, excuse me, the Merck Ebola vaccine. So
components of the Government, I think, are doing exactly what
they have been prepared and designed to do.
Mr. Crenshaw. Do you think the level of outrage over the
response is really proportional to any actual shortcomings in
the response?
Dr. Gerberding. Well, earlier I had a chance to talk about
trust, and what is necessary for people to really trust what is
going on. I think the person delivering information is critical
at Federal, State, and local levels.
So that is something that we need to really be mindful of,
the consistency of the communication, and, in my view, that the
leader, the leading edge of the communication, is about
science, not politics. So I think that is a really important
thing that would help a lot to calm people's criticism and get
us on track, where people have confidence that their whole
Government is doing the right thing.
Mr. Crenshaw. Yes, I would just note that I think a lot of
the criticism is not based in science or facts, or any of the
things that you just noted, but, in fact, based on politics,
which is the problem. I hope that the goal of that is not to
create fear, simply for the sake of getting political points,
although that is what I have seen, frankly, from the media and
others.
I want to talk--and you hit on this before--about
innovation in creating vaccines, in creating treatments, and
how important the subject of innovation is. But I am running
out of time, aren't I?
The--can you hit on--can--with respect to innovation, if--
can you hit on again--on the issue of price controls, and what
that might do to some of these biotech firms that generally
rely on investments from venture capitalists or the larger
pharmaceutical companies, and some of the work they have been
doing in the past decade?
In fact, I have heard Johnson and Johnson, for instance,
has been looking at a coronavirus vaccine for a decade. Would
that research still happen if there were no incentives because
of price controls?
Dr. Gerberding. Well, I am not involved in a small biotech
company, but, you know, one of the things that I have learned
in my role in the BIO executive committee--and I interact with
some of these amazingly creative people--is that a lot of times
the company is based on just one idea, or one really good
leading approach to a critical innovation. If there isn't the
promise of reward to the investors who put their money in what
is a really high-risk situation, they are gone.
So if you take away the incentive for the investments to
come forward, you have really diminished interest in pushing
the envelope on innovation. That is true in coronavirus, the
same as it is in antibiotics, the same as it is in any of the
other things that we wish we had and we don't.
Mr. Crenshaw. Thank you. Thank you, Mr. Chairman.
Chairman Thompson. Thank you very much. I would like to
have entered into the record articles from the Washington Post
and National Geographic on the coronavirus subject.
[The information follows:]
Article from the Washington Post Submitted by Hon. Sheila Jackson Lee
how is the coronavirus outbreak going to end? here's how similar
epidemics played out.
https://www.washingtonpost.com/health/2020/03/02/how-is-coronavirus-
outbreak-going-end-heres-how-similar-epidemics-played-out/
By William Wan, March 2, 2020.
As stock markets plunge, travel is disrupted and new coronavirus
infections are diagnosed across the United States, one question on
everyone's mind is how the outbreak is going to end.
No one knows for sure, but virologists say there are clues from
similar outbreaks. Here are three scenarios:
Health officials control coronavirus through strict public health
measures
When severe acute respiratory syndrome (SARS) hit Asia in 2002, it
was pretty scary--with a fatality rate of about 10 percent and no drugs
shown to be effective against it. (The current coronavirus by
comparison has an estimated fatality rate of 2.3 percent.) But within
months, SARS was brought under control, and for the most part stamped
out, by international cooperation and strict, old-school public health
measures such as isolation, quarantine, and contact tracing.
This would be an ideal outcome. But the difference is that SARS had
more severe symptoms than the current coronavirus, so people went to
the hospital shortly after being infected.
Cases of coronavirus will be harder to catch and isolate, said
Stuart Weston, a postdoctoral virologist at University of Maryland.
Weston is one of a small group of researchers who have received samples
of the coronavirus and are studying it. Weston and other experts warn
the outbreak in the United States and other countries is more
widespread than tracked because many people with mild symptoms don't
know they have been infected.
Coronavirus hits less developed countries, and things get worse before
they get better
One of the grim lessons from the 2014-2016 Ebola outbreak in West
Africa is how an epidemic can grow when it hits countries with weak
health infrastructures. This is why the World Health Organization and
others have been preparing countries in sub-Saharan Africa for the
coronavirus, even though few cases so far have been reported there.
Compared to the coronavirus, Ebola was less contagious and
transmitted mainly by bodily fluids. The coronavirus can be transmitted
in coughed and sneezed respiratory droplets that linger on surfaces.
And yet Ebola infected more than 28,000 people and caused more than
11,000 deaths. Ebola is more lethal, and shortages of staff and
supplies, poverty, delays by leaders and distrust of government
exacerbated the outbreak.
WHO leaders have been urging countries to prepare. On Friday, the
organization raised its assessment of coronavirus to the highest level.
``This is a reality check for every government on the planet: Wake up.
Get ready. This virus may be on its way, and you need to be ready,''
said Michael Ryan, WHO's director of health emergencies. ``To wait, to
be complacent, to be caught unawares at this point, it's really not
much of an excuse.''
The new coronavirus spreads so widely, it becomes a fact of life
This is in essence what happened with the 2009 H1N1 outbreak, also
called swine flu. It spread quickly, eventually to an estimated 11 to
21 percent of the global population. The WHO declared it a pandemic,
and there was widespread fear.
H1N1 turned out to be milder than initially feared, causing little
more than runny noses and coughs in most people. And H1N1 is now so
commonplace, it's simply seen as a part of the seasonal flus that come
and go every year around the globe.
Early estimates on the fatality rate for H1N1 were much higher than
the roughly 0.01 to 0.03 percent it turned out to be. Still, the
Centers for Disease Control and Prevention estimates that H1N1 killed
12,469 people in the United States during that first-year period from
2009 to 2010, infected 60.8 million cases and caused 274,304
hospitalizations. The true number is hard to ascertain because many who
die of flu-related causes aren't tested to see whether it was H1N1 or
another flu strain. As context, the seasonal flu has killed at least
18,000 people in the United States so far this season, according to the
CDC.
H1N1 is a particularly good parallel, epidemiologists say, because
while it had a lower fatality rate than SARS or MERS, it was deadlier
because of how infectious and widespread it became.
Not to be alarmist, but another possible parallel might be the 1918
Spanish flu, which had a 2.5 percent fatality rate, eerily close to
what's estimated for the coronavirus.
CDC calls Spanish flu ``the deadliest pandemic flu virus in human
history,'' because it infected roughly one third of the world's
population and killed an estimated 50 million people worldwide. Spanish
flu was deadly to young and old, while coronavirus has proven to be
most lethal to the elderly and left young people relatively unscathed.
Florian Krammer, a virologist specializing in influenzas, noted
that the world was vastly different in 1918.
``We didn't have the tools to diagnose diseases or antibiotics to
fight secondary infections. Hospitals back then were places where you
went to die, not to get treatment. And in 1918, the world was at war.
And a lot of the people infected were soldiers stuck in trenches,''
said Krammer, of the Icahn School of Medicine at Mount Sinai. ``That's
hopefully not how this is going to play out.''
Ultimately, how many people die of coronavirus depends on how
widely it spreads, how prepared we are and what the virus's true
fatality rate turns out to be.
A few more key things will affect the coronavirus endgame
If the coronavirus does indeed become ubiquitous like H1N1, it will
be crucial to develop a vaccine. After the 2009 outbreak, experts
developed an H1N1 vaccine that was included in flu shots people
received in subsequent years. This helped protect especially vulnerable
populations during following waves of infection.
In the immediate future, anti-viral drugs may help, and labs around
the world are testing their effectiveness against the coronavirus.
No one knows if the coronavirus will be affected by seasons like
the flu, despite President Trump's claims that it could ``go away'' in
April with warmer temperatures.
``We're still learning a lot about the virus,'' said WHO
epidemiologist Maria Van Kerkhove. ``Right now there's no reason to
think this virus would act differently in different climate settings.
We'll have to see what happens as this progresses.''
Coronaviruses are zoonotic, meaning they spread from animals to
humans. Experts believe SARS spread from bats to civet cats to humans.
The deadly Middle East respiratory syndrome (MERS) in 2012 was probably
transmitted from bats to camels to humans. With the coronavirus, no one
knows what animals caused the current outbreak. And it's a mystery
scientists will need to solve to prevent it from repeating in the
future.
One prime suspect is an endangered creature called the pangolin
that looks like a cross between an anteater and an armadillo and whose
scales are trafficked illegally.
``With SARS, once they figured out the animals responsible in
China, they were able to start culling them from the live markets,''
said Vineet Menachery, a virologist at University of Texas Medical
Branch. ``It's like a burst water pipe. You have to find the source in
order to shut it off.''
______
Article from the Washington Post Submitted by Hon. Sheila Jackson Lee
trump downplays risk, places pence in charge of coronavirus outbreak
response
https://www.washingtonpost.com/politics/trump-downplays-risk-places-
pence-in-charge-of-coronavirus-outbreak-response/2020/02/26/
ab246e94-58b1-11ea-9000-f3cffee23036_story.html
By Yasmeen Abutaleb, Feb. 26, 2020.
President Trump announced Wednesday that Vice President Pence will
lead the administration's response to the deadly coronavirus in an
attempt to reassure the public amid growing concerns of a global health
crisis and criticism that the United States has been slow to respond to
the fast-moving outbreak.
The move came as a person in Northern California tested positive
Wednesday for the virus, the first case in the United States that has
no known link to foreign travel or contact with someone known to be
infected--a sign the virus may be spreading in at least one location.
Officials have begun tracing the contacts of the resident to find out
how that person may have been infected and who else might have been
exposed.
Trump made no mention of the new case Wednesday as he struck an
optimistic tone about the virus.
``We've had tremendous success, tremendous success beyond what many
people would've thought,'' the president said during a White House news
conference that followed days of mixed messages, tumbling stocks and
rising death tolls abroad driven by the coronavirus. ``We're very, very
ready for this.''
The president declared that the risk to America was ``very low''
and predicted a swift end to the outbreak.
Trump's positive message was at odds with the statements by top
members of his administration in recent days who have warned of an
unpredictable virus that could spread into communities and upend
Americans' daily lives.
The president was contradicted almost in real time by some of the
government experts who flanked him as he stood in the White House press
briefing room.
Do you need a face mask for the coronavirus? An expert explains.
Medical face masks are often used during flu season or a virus
outbreak. Demand for masks has skyrocketed amid the coronavirus
outbreak.
``We could be just one or two people over the next short period of
time,'' Trump said of the virus's impact in the United States.
Minutes later, Health and Human Services Secretary Alex Azar and
CDC Principal Deputy Director Anne Schuchat warned Americans to prepare
for the number of cases to grow.
``We can expect to see more cases in the United States,'' Azar
said.
``We do expect more cases,'' Schuchat said.
The case confirmed Wednesday in California brought the total in the
United States to 60.
As several countries around the world confirmed additional cases
and higher death tolls, Trump tried to seize the reins of his
administration's public response to a crisis that has featured a daily
stream of negative developments.
But his news conference quickly devolved into campaign-style
attacks on Democrats, predictions of a stock market rally and self-
congratulatory assessments of his handling of the crisis.
The president said he would be willing to accept more emergency
funding than the $2.5 billion requested by his administration after
lawmakers pushed for a more robust Federal response. He also said he
would consider new travel restrictions on other countries struggling to
contain the outbreak, including South Korea and Italy.
``At a right time we may do that,'' he said. ``Right now it's not
the right time.''
He partly blamed Democrats for the drop in the stock market and
attacked House Speaker Nancy Pelosi (D-Calif.) as ``incompetent'' after
she had made disparaging comments about his handling of the coronavirus
outbreak, dismissing the traditional bipartisan approach leaders take
in the midst of natural disasters and public health emergencies while
criticizing her for doing the same.
The remarks were the president's most extensive public comments yet
about a crisis that threatens a main component of his reelection
message--the economy. Trump administration officials have said they
expect the virus to hamper economic growth this year, something that
could complicate the president's economy-focused campaign pitch.
The stock market, which Trump has followed closely in recent days,
continued its sharp slump Wednesday, with the Dow Jones industrial
average falling an additional 124 points. After enduring its worst 2-
day slide in 4 years on Monday and Tuesday, Wednesday's decline put the
total losses this week at more than 2,000.
The slog has undermined Trump's attempts to downplay the risk posed
by the virus, which he previously dismissed as a passing problem that
had not significantly affected Americans.
But in the wake of a stock market rout that eliminated more than $2
trillion in wealth, the news conference was intended to be a show of
force, with several top administration officials from a ``coronavirus
task force'' present.
The administration has received criticism for lacking a coherent
message about the virus as its reach and intensity have spread.
Azar faced tough questions from lawmakers Wednesday during hearings
on Capitol Hill.
``While the immediate risks to the American public remain low,
there is now community transmission in a number of places, including
outside of Asia, which is deeply concerning,'' Azar said. ``We are
working closely with State and local and private-sector partners to
prepare for mitigating the virus's potential spread in the United
States as we expect to see more cases here.''
Trump has made a direct connection between the virus and his
political fortunes, accusing Democrats and the media of trying to harm
his reelection chances by focusing on the outbreak.
Trump took to Twitter early Wednesday to accuse cable news channels
of ``doing everything possible to make the Caronavirus look as bad as
possible, including panicking markets, if possible.''
The president's efforts to downplay the virus have focused on the
fact that the United States has seen relatively few cases and, so far,
no confirmed deaths. Trump has also contended that the virus was ``very
much under control'' and has indicated it would be gone by April.
Multiple public health officials from the administration have
contradicted that prediction. Asked if he agreed that the coronavirus
would be gone by April, CDC Director Robert Redfield told Congress he
didn't.
``Prudent to assume this pathogen will be with us for some time to
come,'' he said Wednesday.
As the virus has spread to more than 30 countries, Trump's
``America First'' doctrine has come under increasing strain. While
Trump instituted travel restrictions to block travelers from China--the
epicenter of the outbreak--the virus has spread rapidly in several
additional countries.
``When we did the initial China ban, we were very clear: We can't
hermetically seal the U.S. off,'' Azar told lawmakers.
Still, the Trump administration was considering adding new travel
restrictions for South Korea, the country with the second-largest
number of cases after China. South Korea reported 334 additional cases
of the coronavirus Wednesday, raising the national tally to 1,595. That
number is expected to rise in coming days as the country begins the
mass testing of more than 200,000 members of a messianic religious
movement at the center of an outbreak in the city of Daegu.
An American soldier stationed in South Korea has tested positive
for coronavirus, the first service member to be infected, the military
said Tuesday. The U.S. military on Wednesday restricted all
nonessential travel to South Korea for service members, civilians and
contractors under its authority. The CDC has advised against any
nonessential travel to South Korea.
Trump, who has boasted that his travel restrictions on China were
prudent, is likely to authorize new limitations on South Korea if the
number of coronavirus cases there continues to increase, a senior
administration official said.
South Korea has lobbied against such restrictions, pledging
cooperation and heightened prevention measures to allay U.S. concerns,
officials said.
The ban could extend to all foreigners traveling to the United
States from South Korea, according to an official with knowledge of the
deliberations. The restrictions would allow U.S. citizens to return to
the United States but would require them to be quarantined for a period
of time, as is the case with U.S. citizens coming to the United States
from China. Thousands of U.S. service members and students live in
South Korea.
Trump, who repeatedly asserted that the United States should ban
flights from Africa during the 2014 Ebola crisis, is also considering
travel restrictions on other countries that have seen large outbreaks
of coronavirus, an official said.
The president has been reluctant to call for any significant
preventive measures within the boundaries of the country, even as other
nations have discouraged large gatherings or closed some schools as a
precaution.
Trump indicated he would go ahead with a planned political rally
Friday in South Carolina, his first since returning from India.
``Big Rally in the Great State of South Carolina on Friday,'' Trump
wrote on Twitter. ``See you there!''
Democrats have criticized the president for his handling of the
coronavirus crisis, emphasizing what they see as a key weakness for
Trump in the eyes of many voters.
In a new campaign ad titled ``Pandemic,'' former New York mayor
Mike Bloomberg's Presidential campaign described Trump's administration
as unprepared and ill-equipped to manage the country through a public-
health emergency.
The administration has faced bipartisan criticism for its handling
of the crisis, as lawmakers have publicly complained about the lack of
consistency and clarity from senior officials involved in the response.
Congressional leaders on Wednesday began putting together a large
emergency spending package to deal with the outbreak, seeking to spend
far more than the $2.5 billion the White House requested earlier this
week.
Administration officials have sparred internally in recent days
over the emergency budget request, with Azar and others seeking a much
larger package and White House aides calling for a less ambitious
approach, according to officials with knowledge of the dispute, who
like others spoke on the condition of anonymity to discuss the
sensitive issue.
Trump, who praised Azar publicly Tuesday, has been skeptical of the
secretary's ability to handle the crisis, a senior administration
official said. The president has been reluctant to oust him in part
because he did not want to add to the sense of disarray, the official
said.
Azar was blindsided by the decision to put Pence in charge of the
coronavirus response, according to five people familiar with the
situation, who said Azar learned of the decision only moments before
the evening news conference.
Pence is scheduled to run a coronavirus task force at HHS on
Thursday, two sources familiar with the plans said. One senior
administration official said Pence was going to HHS to lead the
meeting, instead of the White House, ``as a show of support to Azar.''
The officials spoke on the condition of anonymity to discuss
internal deliberations.
Late Wednesday, acting chief of staff Mick Mulvaney told other
administration officials that all media requests about coronavirus
should now be routed through Pence's office, two people with knowledge
of his email said. The vice president asked for the email to be sent
out, a senior administration official said.
One of Trump's biggest gripes has been the messaging from
administration officials, both of these people said.
The White House considered appointing a ``czar'' to oversee the
governmentwide response effort, a move that would essentially demote
Azar from his role as the head of the coronavirus task force.
``I don't anticipate one,'' Azar told lawmakers earlier Wednesday
when asked if a czar would be appointed. ``This is working extremely
well.''
Trump said his decision to put Pence in charge was not tantamount
to appointing a czar, despite him taking a role that serves the same
purpose.
``Mike is not a czar, he's vice president,'' the president said.
``I'm having them report to Mike. Mike will report to me.''
Still, at the end of the news conference, Azar walked back to the
lectern to clarify that he remained the chairman of the coronavirus
task force and had not been demoted. He said he was actually
``delighted'' to have Pence overseeing the effort.
As Azar was speaking, Trump walked out of the room.
______
Article From National Geographic
u.s. has only a fraction of the medical supplies it needs to combat
coronavirus
The country could require seven billion respirators and face masks over
the course of the outbreak.
By Nsikan Akpan, published March 3, 2020.
Three hundred million respirators and face masks. That's what the
United States needs as soon as possible to protect health workers
against the coronavirus threat. But the nation's emergency stockpile
has less than 15 percent of these supplies.
Last week, U.S. Health and Human Services Secretary Alex Azar
testified before the Senate that the Strategic National Stockpile has
just 30 million surgical masks and 12 million respirators in reserves,
which came as a surprise considering that the stockpile's inventory is
generally not disclosed for national security reasons. Asked by
National Geographic about the discrepancy, a senior official with the
Strategic National Stockpile said the department intends to purchase as
many as 500 million respirators and face masks over the next 18 months.
Even such a promised surge in production may not be enough--and it
may not come soon enough. A widely overlooked study conducted 5 years
ago by the U.S. Centers for Disease Control and Prevention found that
the United States might need as many as seven billion respirators in
the long run to combat a worst-case spread of a severe respiratory
outbreak such as COVID-19.
The outbreak now has entered a new, more potent phase dictated by
local or community transmission. It's no longer just being imported
from China. Coronavirus has started spreading locally in 13 other
countries, including South Korea, Japan, Singapore, Australia,
Malaysia, Vietnam, Italy, Germany, France, United Kingdom, Croatia, San
Marino, Iran, the United Arab Emirates, and the United States. On
Wednesday, the World Health Organization announced COVID-19's global
death rate is 3.4 percent, more than 30 times that of seasonal
influenza, but also stated the coronavirus doesn't spread as easily as
the flu. The global tally of confirmed cases and deaths has risen to
93,000 and nearly 3,200, respectively.
In the U.S., COVID-19 cases without clear ties to China began
dotting the West Coast last week. At the same time, the Nation saw an
uptick in fatalities--nine so far as of Tuesday--with most occurring at
a nursing home in Kirkland, Washington. Among those deaths is one
patient who passed away last week at Seattle's Harborview Medical
Center. Viral tests, made well after his death, revealed a COVID-19
diagnosis and that hospital staff may have been exposed.
Besides confirming the threat posed to the elderly, these deaths,
the community transmission, and genetic analysis suggest the virus has
been spreading unnoticed in Washington since mid-January.
``We will have community spread,'' New York Governor Andrew Cuomo
said Monday at a news briefing about the State's first confirmed case.
``That is inevitable.''
All of these events sparked a run on medical supplies over the
weekend, a worrying prospect given the CDC has indicted there could be
a global deficit of personal protective equipment such as surgical
masks, goggles, full-body coveralls, and N95 respirators, the only CDC-
approved face guard, which are designed to filter 95 percent of
airborne particles.
``We're concerned that countries' abilities to respond are being
compromised by the severe and increasing disruption to the global
supply of personal protective equipment, caused by rising demand,
hoarding, and misuse,'' Dr. Tedros Adhanom Ghebreyesus, WHO director-
general, said at a press briefing at the agency's headquarters in
Geneva on Tuesday. ``Prices of surgical masks have increased sixfold,
and N95 respirators have more than tripled, and gowns cost twice as
much.''
What's more, even if U.S. medical centers obtain the necessary
supplies, a second shortage of medical specialists may emerge if this
respiratory outbreak spreads even more dramatically.
Taking stock
The panicked demand and lack of supplies was predictable. China
manufactures roughly 50 percent more medical and pharmaceutical
supplies than its nearest competitor, the U.S., according to data
supplied to National Geographic by Euromonitor International. But the
Asian country now needs those precious supplies for its tens of
thousands of cases, at a time when manufacturing has slowed across the
country.
``The fundamental point that's exposed in situations like that is
that autarky--the idea of self-sufficiency--is lovely in theory, but it
almost never actually works in practice, because we tend to not
appreciate supply chains,'' says Parag Khanna, a global strategy
advisor and author of Connectography and Technocracy in America.
Much of the world has become accustomed to same-day delivery
without thinking about the bundles of transactions that support such a
system. Some global industries can circumvent major blockages or delays
in supply chains caused by the coronavirus outbreak. But other supply
chains and industries--like automobiles, travel, and medical supplies--
are too tightly bound across borders in what Khanna calls a supply
circuit.
``China's a manufacturer of intermediate products . . . but what
they're really manufacturing on a wider scale is starting material for
active pharmaceutical ingredients,'' says Scott Gottlieb, a former U.S.
FDA commissioner and resident fellow at the American Enterprise
Institute. ``These manufacturers have one to 3 months of supply, so
they're going to be able to continue to manufacture for a period of
time, but eventually they're going to run out.''
``The irony is that some of the other countries who could do these
things very quickly, like Japan or South Korea, are also affected by
the virus,'' says Khanna, who has also noted that the coronavirus
appears to be spreading along China's ``new silk road''--echoing what
happened with the Black Death in the 1300's. He and other experts
expect India, Thailand, Indonesia, and Vietnam to swoop in to
capitalize on China's deficit.
On Friday, the FDA announced the first drug shortage due to the
coronavirus. And for nearly a month, the CDC has warned about the
fragility of supply circuits for personal protective equipment, as
manufacturers struggle to meet orders for face masks and N95
respirators. That's possibly because the CDC conducted a thought
experiment 5 years ago that offers a clear warning for the situation
unfolding today. Back then, the public health agency wanted to predict
how many resources the U.S. might need over the entire course of a
hypothetical outbreak of a severe flu virus. (Learn about how
coronavirus compares to flu, Ebola, and other major outbreaks.)
The result was a series of models built with parameters that bear
an uncanny resemblance to what is currently happening with the
coronavirus. From disease transmission rates down to the lack of
specific antivirals or vaccines, the CDC papers offer a rough guide on
what preparedness needs to look like to combat an emerging respiratory
pandemic.
``In terms of the amount of masks, gowns, gloves, [and] respirators
that would be needed, this influenza model is a good way to estimate
that at this point,'' says Eric Toner, a senior scientist at the Johns
Hopkins Center for Health Security who wasn't involved with the CDC
papers. ``I don't see any reason to think that we would need a
different number of those things than we do for a severe pandemic
flu.''
Based on the models, U.S. health care workers would need two to
seven billion respirators for the least--to most--severe possible
scenarios. That's up to 233 times more than what's currently in the
Strategic National Stockpile.
``The demand that would be required in a severe pandemic is so
unlike the amount that's used on a day-to-day basis,'' says Lisa
Koonin, an epidemiologist and founder of Health Preparedness Partners.
She worked for the CDC for more than 30 years and is a co-author on
these reports. ``For the respirators and surgical masks, we're talking
orders of magnitude greater need for a severe pandemic.''
The WHO has shipped nearly half a million sets of personal
protective equipment to 27 countries, but it says supplies are rapidly
depleting. The global health agency estimates that each month 89
million medical masks will be required for the COVID-19 response, along
with 76 million examination gloves and 1.6 million goggles. The WHO
estimates that supplies of personal protective equipment need to be
increased by 40 percent globally.
Special staff
``In a severe pandemic, we certainly could run out of ventilators,
but a hospital could just as soon run out of respiratory therapists who
normally operate these devices.''--Eric Toner, Johns Hopkins Center for
Health Security
Along with the billions of respirators, the CDC predicted that U.S.
patients and health care workers might need as many as 100 to 400
million surgical masks, as well as 7,000 to 11,000 mechanical
ventilators. The latter are used during life support for the most
severe cases of respiratory disease, after a patient's lungs stop
working on their own. A report published Friday in the New England
Journal of Medicine states that about 2.3 percent of early coronavirus
patients underwent mechanical ventilation.
But ventilators, respirators, and even basic masks are only helpful
when used by expert hands--and that presents another potential
shortfall for the U.S.
``In a severe pandemic, we certainly could run out of ventilators,
but a hospital could just as soon run out of respiratory therapists who
normally operate these devices,'' says Toner. The Bureau of Labor
Statistics estimates that the U.S. employs 134,000 respiratory
specialists, or approximately 20 of these technicians for every
hospital in America. (Will warming spring temperatures slow the
coronavirus outbreak?)
``One of [the CDC's] conclusions was, it's not so much the number
of ventilators as the number of people needed to operate the
ventilators. That's the choke point,'' Toner adds.
Resource demands at a single hospital could also be substantial as
coronavirus cases increase in the U.S. Three years ago, the Mayo
Clinic--a prestigious medical system based in Rochester, Minnesota--
asked Toner and his colleagues to assess what kind of individual
stockpile might be required during a severe influenza pandemic.
Unlike the CDC papers, their model ran through 10,000 scenarios,
each with slightly different settings for epidemiologic variables such
as hospitalization rates, hospital length of patient stays, how much
time patients spend on mechanical ventilation, and case fatality rate.
``A model like this can't tell you the right thing to do. But it
can tell you the range of possibilities,'' Toner says.
For example, if the Mayo Clinic stockpiled 4.5 million gloves, 2.3
million N95 respirators, 5,000 doses of a potent antiviral, and 880
ventilators, those supplies would cover the clinic's facilities for 95
percent of the likely outcomes--everything except the absolute worst-
case scenarios for a respiratory pandemic.
``We go through a lot of gloves in health care, and the numbers can
be staggering,'' Toner says. ``Particularly with a disease like this
where some people are advocating double gloving, you'll burn through
gloves twice as fast.''
But he emphasizes that every hospital's demands would be different.
The Mayo Clinic is large, boasting more than 63,000 staff members that
not only serve Minnesota, but accept specialty patients from around the
world.
``We can't stop COVID-19 without protecting our health workers,''
WHO director-general Ghebreyesus says. ``Supplies can take months to
deliver, market manipulation is widespread, and stocks are often sold
to the highest bidder.''
Resilient circuits
The actual demand and supply for health care equipment during this
outbreak will depend on myriad variables, one of which is an outbreak's
attack rate. As of this moment, that is a mystery for COVID-19.
The attack rate is what percentage of a population catches an
infectious disease overall. If a hundred people live in a city, and a
virus' attack rate is 20 percent, then 20 citizens would be expected to
get sick. Both the CDC papers and Toner's models rely on attack rates
ranging from 20 to 30 percent, a standard estimate for severe
pandemics. (Learn about the swift, deadly history of the Spanish Flu
pandemic.)
But the attack rate for COVID-19 is still unknown because it takes
time to measure. Scientists must develop a test--known as a serology
assay--that can detect whether a person caught the coronavirus even if
they never reported symptoms.
``In terms of quantifying that specifically, it's still quite early
days,'' Maria Van Kerkhove, an infectious disease epidemiologist and
the technical leader for WHO's Health Emergencies Program, said at a
press briefing at the WHO headquarters in Geneva on Monday. Van
Kerkhove added those serologic surveys must be conducted across large
populations, so attack rates can be determined for individual age
groups.
Because the attack rate reveals how much of a population is likely
to catch a disease, it can be crucial in determining how to allocate
resources locally, nationally, and globally. Van Kerkhove added that
the necessary surveys are underway, and the World Health Organization
hopes to see some preliminary results in the coming weeks.
In the meantime, Vice President Mike Pence, the Trump
Administration's newly appointed coronavirus czar, on Saturday
announced a deal with the Minnesota-based corporation 3M to produce 35
million masks a month. And the managers for the Strategic National
Stockpile have asked companies to submit data on their inventories of
personal protective equipment, in case the coronavirus crisis
escalates. They also hope their recent request for 500 million
respirators and masks will promote the growth of local manufacturers.
``This purchase will encourage manufacturers to ramp up production
of personal protective equipment now with the guarantee that they will
not be left with excess supplies once the COVID-19 response subsides,''
says Stephanie Bialek of the Strategic National Stockpile. ``In an
emergency, the SNS can send these products to areas in need as
requested by State health officials.''
Editor's Note: This story has been updated with the latest case
counts as of March 4 and with the new estimate for the global death
rate. The story was originally published on March 3.
Chairman Thompson. Let me recognize Mr. Correa for bringing
this hearing forward. He was the first Member of the committee
to say that we need to bring some experts before the committee
so that we can get first-hand knowledge.
Mr. Correa, you want to----
Mr. Correa. I just have a couple of quick----
Chairman Thompson. Go ahead.
Mr. Correa [continuing]. Follow-up questions.
Incubation period?
Dr. Inglesby. One to 14 days, but, on average, about 5
days.
Mr. Correa. One to 14 days, 5.
Symptoms similar to flu?
Dr. Inglesby. Yes.
Mr. Correa. You don't know if you got the flu, you don't
know if you got corona.
Dr. Gerberding. Just one thing about symptoms was the--I
think the expectation is that fever is the sentinel system, but
a lot of the people who end up in the hospital didn't start
with fever. So about half of them came to the hospital and
hadn't developed fever yet.
Mr. Correa. China, is the rate going down in China? The
infections rate.
Dr. Inglesby. Yes, the numbers reported by China are going
down substantially in the last couple of weeks, both numbers of
cases and deaths.
Mr. Correa. How certain can we be that they are accurate?
Dr. Inglesby. I think the World Health Organization has
said that they believe they are accurate. I think it is
difficult to know, from where we are.
Mr. Correa. Death rate, World Health Organization just had
an article that said higher than the flu. You are saying,
ma'am, that it probably is higher than flu. But yet we don't
know the denominator, so that we really don't know what the
death rate is at this point, we just suspect. Is that correct?
Dr. Inglesby. That is correct. That article that said WHO
has concluded that it is a higher case fatality rate isn't--it
was really a misquote. WHO hasn't said just that. They have
just basically divided the numbers of recognized cases by the
deaths, and come up with--and said it is 3 percent,
approximately 3 percent have died. But we do believe that there
are many cases that are unrecognized, we just don't know how
many there are.
Mr. Correa. Finally, again, best practices, lesson learned.
We have to be consistent, we have to have a system where we
continue to invest, on an annual basis, on the system, research
and development, coming up with vaccines and protocols so the
next time--this will happen again--that we don't have to
scramble and figure out where we get the test kits, the masks,
so on and so forth.
Dr. Gerberding. So I will say two things. One is BARDA is
good value for Americans, and the work that BARDA has done to
push the envelope on counter-measure development is something
that I hope the committee is aware of and knows about, because
that is clearly a National asset.
The second piece is an ask that is included in the CSIS
report, and that is that our Government needs to contribute to
something called CEPI, which is the Coalition for Epidemic
Preparedness Innovation. That is a global effort. It includes
companies, countries, nonprofits, Gates, Wellcome Trust, et
cetera, who are saying we know some of the bad things like SARS
and MERS that may come back. Let's get those vaccines across
the finish line, or at least into the freezer, so that if the
problem comes back, we have got something we can pull out and
test very quickly.
Mr. Correa. So here in this committee----
Dr. Gerberding. That is an investment that----
Mr. Correa [continuing]. You are saying that we have had
those challenges, we haven't come up with the vaccines, and yet
we know they will be back.
Dr. Gerberding. I think we need to expect they will be
back. I hope they don't come back, but they may. Shame on us if
we have another situation where we got started on something and
we didn't bring it across the finish line.
Mr. Correa. Thank you.
Chairman Thompson. Well, thank you. Let me thank the
witnesses again. There is no question about what you brought to
the committee today. That information will be vital toward
ultimate solutions. Some of it, obviously, is investment over
the long haul, with respect to detection and others.
But I do want to, just for the record, highlight the fact
that we should be providing the public the best information we
have. It is not a political issue, it is a health issue. We
want to look at it in that respect. So words do matter when
politicians get in it. So I caution everyone to govern
themselves accordingly as we work through this.
But in the interim, I want to again thank you for an
absolute excellent sharing of information for the committee.
I would like to also say that the Members of the committee
may have additional questions for the witnesses, and we ask you
to respond expeditiously in writing to those questions.
Without objection, the committee shall be kept open, the
record will be kept open for 10 days. Hearing no further
business, the committee stands adjourned.
[Whereupon, at 12:04 p.m., the committee was adjourned.]