[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
COMMUNITY PERSPECTIVES ON CORONAVIRUS PREPAREDNESS AND RESPONSE
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HEARING
BEFORE THE
SUBCOMMITTEE ON
EMERGENCY PREPAREDNESS,
RESPONSE, AND RECOVERY
OF THE
COMMITTEE ON HOMELAND SECURITY
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
SECOND SESSION
__________
MARCH 10, 2020
__________
Serial No. 116-66
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Printed for the use of the Committee on Homeland Security
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
42-343 PDF WASHINGTON : 2021
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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 Van Taylor, Texas
Elissa Slotkin, Michigan John Joyce, Pennsylvania
Emanuel Cleaver, Missouri Dan Crenshaw, Texas
Al Green, Texas Michael Guest, Mississippi
Yvette D. Clarke, New York Dan Bishop, North Carolina
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
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SUBCOMMITTEE ON EMERGENCY PREPAREDNESS, RESPONSE, AND RECOVERY
Donald M. Payne Jr., New Jersey, Chairman
Cedric L. Richmond, Louisiana Peter T. King, New York, Ranking
Max Rose, New York Member
Lauren Underwood, Illinois Dan Crenshaw, Texas
Al Green, Texas Michael Guest, Mississippi
Yvette D. Clarke, New York Dan Bishop, North Carolina
Bennie G. Thompson, Mississippi (ex Mike Rogers, Alabama (ex officio)
officio)
Lauren McClain, Subcommittee Staff Director
Diana Bergwin, Minority Subcommittee Staff Director
C O N T E N T S
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Page
Statements
The Honorable Donald M. Payne Jr., a Representative in Congress
From the State of New Jersey, and Chairman, Subcommittee on
Emergency Preparedness, Response, and Recovery:
Oral Statement................................................. 1
Prepared Statement............................................. 2
The Honorable Peter T. King, a Representative in Congress From
the State of New York, and Ranking Member, Subcommittee on
Emergency Preparedness, Response, and Recovery:
Oral Statement................................................. 3
Prepared Statement............................................. 4
The Honorable Bennie G. Thompson, a Representative in Congress
From the State of Mississippi, and Chairman, Committee on
Homeland Security:
Prepared Statement............................................. 5
Witnesses
Mr. Ronald A. Klain, Former White House Ebola Response
Coordinator (2014-2015):
Oral Statement................................................. 6
Prepared Statement............................................. 8
Mr. Christopher Neuwirth, MA, MEP, CBCP, CEM, Assistant
Commissioner, Division of Public Health Infrastructure,
Laboratories, and Emergency Preparedness, New Jersey Department
of Health:
Oral Statement................................................. 14
Prepared Statement............................................. 16
Dr. J. Nadine Gracia, MD, MSCE, Executive Vice President and
Chief Operating Officer, Trust for America's Health:
Oral Statement................................................. 17
Prepared Statement............................................. 19
Dr. Thomas Dobbs, MD, MPH, State Health Officer, Mississippi
State Department of Health:
Oral Statement................................................. 23
Prepared Statement............................................. 25
For the Record
The Honorable Cedric L. Richmond, a Representative in Congress
From the State of Louisiana:
Article by Ronald A. Klain..................................... 46
The Honorable Sheila Jackson Lee, a Representative in Congress
From the State of Texas:
Coronavirus Plan of Action..................................... 43
Article From National Geographic............................... 48
...............................................................
COMMUNITY PERSPECTIVES ON CORONA- VIRUS PREPAREDNESS AND RESPONSE
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Tuesday, March 10, 2020
U.S. House of Representatives,
Committee on Homeland Security,
Subcommittee on Emergency Preparedness,
Response, and Recovery,
Washington, DC.
The subcommittee met, pursuant to notice, at 2:04 p.m., in
room 310 Cannon House Office Building, Hon. Donald M. Payne,
Jr. (Chairman of the subcommittee) presiding.
Present: Representatives Payne, Richmond, Underwood, Green,
Clarke; King, Crenshaw, Guest, and Bishop.
Also present: Representative Jackson Lee.
Mr. Payne. The Subcommittee on Emergency Preparedness,
Response, and Recovery will come to order. The subcommittee is
meeting today to receive testimony on community perspectives on
coronavirus preparedness and response.
Without objection, the Chair may declare the subcommittee
in recess at any point.
Without objection, Members not sitting on the subcommittee
will be permitted to participate in today's hearing.
I now recognize myself for an opening statement.
Good afternoon. We are here today to discuss the
coronavirus, also known as COVID-19. We are at a critical point
in responding to the coronavirus crisis that is facing our
Nation. Americans are concerned. Hundreds of Americans are
sick. Sadly, their families mourning the loss of loved ones
from the coronavirus, and our hearts are with them. The Nation
is seeing cases on the rise, and experts say the outbreak is
getting worse.
In New Jersey we were just informed that we had our first
death from coronavirus, and at least 2 dozen schools are
closing for coronavirus preparation, and we have seen an
increase in presumed cases. State and local governments are
working tirelessly to limit the spread of the coronavirus in
our communities. At the Federal level we have seen our experts
at the CDC and others, other agencies, working to address this
issue.
Unfortunately, we have also seen Federal officials offer
mixed messages on the seriousness of the coronavirus. We are
not here today to point any fingers, but we must tell the
truth.
The American public needs to be able to trust the
information coming from all levels of Government. It is now
more important than ever for our leaders to trust science and
speak with clarity and precision so that Americans can trust
what they are hearing. It is unhelpful to the outbreak response
for administration staff to state as recently as last week that
the virus is contained, when we know that is not true, because
cases are on the rise.
Another point of confusion with the administration lies in
the test kits. While the experts at the CDC and even Vice
President Pence have expressed concern about potential testing
shortages, the President, on the other hand, has dismissed
these worries. There have been reports of the White House
rejecting the advice of the CDC, and even going as far as
muzzling experts. These reports are troubling.
Let's be clear. I want the Federal response to the
coronavirus to be robust. No one is rooting for failure. But
what I have seen is leading me to become very concerned.
With that said, the goal of today's hearing is to
understand what, as Members of Congress, we can do to minimize
the coronavirus outbreak for the American public. We need to
hear today how Congress can support State and locals in
preventing the spread of this virus.
I would like to thank the panel of witnesses today, and
look forward to hearing their remarks.
[The statement of Chairman Payne follows:]
Statement of Chairman Donald Payne, Jr.
March 10, 2020
We are at a critical point in responding to the coronavirus crisis
that is facing our Nation. Americans are concerned. Hundreds of
Americans are sick. Sadly, there are families mourning the loss of
loved ones from the coronavirus and our hearts are with them.
The Nation is seeing cases on the rise and experts say the outbreak
is getting worse. In New Jersey, at least 2 dozen schools are closing
for coronavirus preparations and we have seen an increase of presumed
cases. State and local governments are working tirelessly to limit the
spread of the coronavirus in our communities.
At the Federal level, we have seen our experts at the CDC and other
agencies working to address this issue. Unfortunately, we have also
seen Federal officials offer mixed messages on the seriousness of the
coronavirus.
We are not here today to point fingers, but we must tell the truth.
The American public needs to be able to trust the information coming
from all levels of government. It is now more important than ever for
our leaders to trust science and speak with clarity and precision so
that Americans can trust what they are hearing.
It is unhelpful to the outbreak response for administration staff
to state, as recently as last week, that the virus is contained when we
know that is not true because cases are on the rise.
Another point of confusion with the administration lies in the test
kits. While the experts at CDC and even Vice President Pence have
expressed concern about potential testing shortages, the President, on
the hand has dismissed these worries.
There have been reports of the White House rejecting the advice of
the CDC and even going so far as ``muzzling'' experts. These reports
are troubling. Let's be clear. I want the Federal response to the
coronavirus to be robust.
No one is rooting for failure, but what I have seen is leading me
to be very concerned.
With that said, the goal of today's hearing is to understand what
we as Members of Congress can do to minimize the coronavirus outbreak
for the American public. We need to hear today how Congress can support
State and locals in preventing the spread of this virus.
Mr. Payne. Without objection, I now recognize the Ranking
Member of the subcommittee, the gentleman from New York, Mr.
King, for an opening statement.
Mr. King. Thank you, Mr. Chairman. I also want to welcome
and thank all of our witnesses today for taking the time to be
here. All of us have a lot to learn on this, and I look forward
to your testimony.
The novel coronavirus, or COVID-19, has already claimed
thousands of lives across the globe, including over 20 here in
the United States. I think, as we realize those numbers will be
changing by the hour, it can be different by the end of this
hearing, for all we know.
This is not the first time, though, our country has had to
deal with an outbreak, and it likely won't be the last. We have
been preparing for a situation such as this.
Last year the Department of Health and Human Services
conducted the Crimson Contagion 2019 functional exercise, a
multi-State, whole-of-government exercise to assess the
Nation's ability to respond to a large-scale outbreak.
Last summer the President signed into law the Pandemic and
All Hazards Preparedness Act. Since 2015, under Republican and
Democratic leadership, funding for infectious disease response
has increased by 70 percent--that is 70 percent in 5 years.
While the virus is here now in the United States, we didn't
see the first case until mid-January. Implementing travel
restrictions bought us time, and mandatory quarantine helped to
initially contain the spread of the virus.
Unfortunately, through community spread, positive cases for
COVID-19 have now been reported in over 30 States. The New York
State Department of Health is reporting over 140 positive
cases. Again, that is as of this morning. At the rate they are
going, I think there is already several more, just in my county
today, and a state of emergency was declared just this past
weekend.
Blind panic won't help us stop the virus from spreading.
Cooperation, information sharing, and strong leadership are
what is critical to successfully deal with a situation of this
magnitude. We must ensure that proper protocols are put in
place, and the Federal Government works hand-in-hand with our
State and local partners.
As recommended, the National Blueprint for Biodefense by
the Bipartisan Commission on Biodefense--I was pleased to hear
last week's panel of witnesses agree with the President's
selection of the Vice President to lead the coronavirus task
force. To achieve a whole-of-government, coordinated response
to this outbreak, it is important that the person in charge has
visibility of the entire Government and a direct line to the
President. The Vice President is the right choice.
Now, while this has been a vigorous, international--already
been a vigorous, international Federal, State, and local
response, as the situation continues to unfold I encourage
everyone to heed the advice of our medical professionals: Wash
your hands, stay home when sick, and visit the Centers for
Disease Control and Prevention's website for up-to-date
information. I certainly commend the first responders, medical
personnel, and public health officials who responded
courageously for those who were sick.
Also, if I could just add, you know, there are things we
can criticize. I am sure things could have been done earlier at
the start. There is no problem with constructive criticism. But
I think, if we just criticize for the sake of criticizing, to
me that really adds nothing to it. If we can do it in a
constructive way, that is fine.
I will say, in a bipartisan way, in my State of New York,
under--Governor Cuomo struck the proper balance. Also the
county executives in the county I represent have done that
also, saying that this is real, but we shouldn't panic, and
trying to provide the best health facilities possible. I know
that when this does hit a certain stage, they may be overrun.
But I think that is what we should be striving for.
At the Federal level--and I would disagree with the Ranking
Member on this, as far as muzzling--I think it is important to
get a coordinated response out.
Again, there is valid criticism that can be made, but I
think we should try to keep it in focus, and try to find ways
to go forward. Otherwise, you have one side attacking the
other, and then it goes back, and the American people get more
confused than ever.
So, I am not here to make excuses, I am not here to explain
away things. But I think it is important that we try to treat
this as the serious issue that it is. Again, the more briefings
we get, the more serious we realize it is, and we should try to
keep that focus in that way.
[The statement of Ranking Member King follows:]
Statement of Ranking Member Peter T. King
March 10, 2020
The novel coronavirus or COVID-19 has already claimed thousands of
lives across the globe, including over 20 here in the United States.
This is not the first time our country has had to deal with an
outbreak and it likely won't be the last. Luckily, our country has been
preparing for exactly this type of situation. Just last year, the
Department of Health and Human Services conducted the Crimson Contagion
2019 Functional Exercise--a multi-State, whole-of-government exercise
to assess the Nation's ability to respond to a large-scale outbreak.
Last summer, the President signed into law the Pandemic and All-Hazards
Preparedness Act. And since 2015, under Republican leadership, funding
for infectious disease response increased by 70 percent.
While the virus is here now in the United States, we didn't see the
first case until mid-January. Implementing travel restrictions bought
us time, and mandatory quarantine helped to initially contain the
spread of the virus. Unfortunately, through community spread, positive
cases for COVID-19 have now been reported in over 30 States. The New
York State Department of Health is reporting over 140 positive cases
and a state of emergency was declared just this past weekend.
Blind panic won't help us stop this virus from spreading.
Cooperation, information sharing, and strong leadership are critical to
successfully dealing with a situation of this magnitude. We must ensure
that proper protocols are put in place and that the Federal Government
works hand-in-hand with our State and local partners.
As recommended in A National Blueprint for Biodefense by the
Bipartisan Commission on Biodefense, I was pleased to hear last week's
panel of witnesses agree with the President's selection of the Vice
President to lead the coronavirus task force. To achieve a whole-of-
government, coordinated response to this outbreak, it is important that
the person in charge has visibility of the entire Government, and a
direct line to the President. The Vice President is the right choice.
While there has already been a vigorous international, Federal,
State, and local response, as this situation continues to unfold, I
encourage everyone to heed the advice of our medical professionals--
wash your hands, stay home when sick, and visit the Centers for Disease
Control and Prevention's (CDC) website for up-to-date information.
I commend the first responders, medical personnel, and public
health officials who have responded courageously to care for those who
are sick. I look forward to hearing from our panel today to understand
more about the COVID-19 virus and possible response and mitigation
measures moving forward.
Mr. King. So with that, Mr. Chairman, I yield back the
balance of my time.
Mr. Payne. Thank you. Did you mean----
Mr. King. Chairman, I was lost in the past----
Mr. Payne. With muzzling, did you mean the Ranking Member,
or the Chair?
Mr. King. I was lost in the past, in the glorious past,
when I was Chairman and you were Ranking Member.
Mr. Payne. Glory days, glory days. Yes, OK.
[Laughter.]
Mr. King. I certainly commend you, as our Chairman.
Mr. Payne. Thank you, sir.
Mr. King. I see Yvette laughing over there.
Mr. Payne. Other Members of the subcommittee are reminded
that, under the committee rules, opening statements may be
submitted for the record.
[The statement of Chairman Thompson follows:]
Statement of Chairman Bennie G. Thompson
March 10, 2020
As a Nation, we have faced homeland security crises from acts of
terror like the September 11 terrorist attacks and catastrophic natural
disasters like Hurricanes Andrew, Katrina, and Maria. Now, the outbreak
of the coronavirus reminds how important emergency preparedness and
response is for threats of all types.
To date, there have been hundreds of confirmed cases of COVID-19 in
the United States, and unfortunately Americans have lost their lives to
this virus.
Now, more than ever, we need to let sound science guide our
policies. It is clear that the coronavirus is a serious public health
threat to this country and it must be treated as such.
Unfortunately, President Trump has downplayed the seriousness of
the virus and contradicted CDC officials' warnings about the magnitude
of the threat. During President Trump's recent trip to the CDC, which
was abruptly canceled and then just as abruptly rescheduled, he wore a
campaign hat, compared the delay in test kits to his Ukraine scandal,
and spoke against his own officials about the availability of test
kits.
Americans need real leadership from all public officials at all
levels. Moreover, State and local governments need assistance from the
Federal Government. Test kits need to be pushed out for use in
communities. Federal funding needs to be available to assist State and
local agencies, as none of them are budgeted for responding to a global
outbreak.
To that end, I am pleased that Congress moved quickly to get a
supplemental funding package to the President's desk. I am hopeful that
those resources will support coronavirus response efforts and allow us
to make real headway against this threat.
I look forward to hearing from the witnesses today about how the
Federal Government can improve its response and provide more support to
the State and local governments and agencies on the front lines of this
crucial effort. Their success will be our success over the coronavirus,
so Congress and the administration must be with them every step of the
way.
Mr. Payne. I want to welcome our panel of witnesses today.
Our first witness is Mr. Ron Klain, who is--among many
other positions in public service, was the White House Ebola
response coordinator during the Obama administration, and can
provide lessons learned from his time battling a previous
public health emergency.
We also welcome today Mr. Christopher Neuwirth, the
assistant commissioner of the division of public health
infrastructure, laboratories, and emergency preparedness for
the New Jersey's department of health. In his role, Mr.
Neuwirth provides strategic and operational leadership to
coordinate New Jersey's hospital and public health disaster
resilience, laboratory services, and emergency preparedness and
response.
Welcome.
Next we have Dr. Nadine Gracia, the executive vice
president and chief operating officer for Trust for America's
Health, a nonprofit, nonpartisan organization that promotes
optimal health for every person and community that--and
advocates for an evidence-based public health system that is
ready to meet the challenges of the 21st Century.
Welcome, ma'am.
At this time I would recognize the gentleman from
Mississippi, Mr. Guest, to introduce our fourth witness.
Mr. Guest. Thank you, Mr. Chairman. It is an honor for me
today to introduce fellow Mississippian, Dr. Thomas C. Dobbs,
III. Dr. Dobbs is the State health officer at the Mississippi
State department of health. Dr. Dobbs has served in this role
since 2018. Dr. Dobbs has also held previous positions as the
health State officer and the State epidemiologist.
He is board certified in internal medicine and infectious
disease, and practiced in Mississippi before joining the
department of health. Dr. Dobbs holds a doctorate of medicine
and a master's in public health from the University of Alabama
at Birmingham.
Dr. Dobbs, I personally want to thank you for providing
your expertise on this panel today as an infectious disease
physician, and for sharing about the coronavirus preparation
you are leading in Mississippi. I am proud you have joined us
today for this hearing, and look forward to hearing your
remarks.
Thank you, Mr. Chairman. I yield back.
Mr. Payne. I thank the gentleman.
Without objection, the witnesses' full statements will be
inserted into the record.
I now ask each witness to summarize his or her statement
for 5 minutes. We are going to keep strict time today,
beginning with Mr. Klain.
STATEMENT OF RON KLAIN, FORMER WHITE HOUSE EBOLA RESPONSE
COORDINATOR (2014-2015)
Mr. Klain. Thank you, Mr. Chairman, Ranking Member King, I
thank you for having me here today.
Before I begin I would like to make two preliminary points.
First, as frustrating as it may be, there is still a great
deal we do not know about the coronavirus and the disease it
causes. In fact, we know less about the coronavirus today than
we did about Ebola in 2014. Scientists are working at breakneck
speed to improve our understanding, but, as we learn more, our
response to the virus will have to change.
Second, while I am a political partisan, I come here today
in the same way that I approached my tenure as White House
Ebola response coordinator, putting politics aside. There is no
Democratic or Republican approach to fighting infectious
disease, only sound and unsound measures. It doesn't mean
demurring, calling out failures where they appear. I have been
critical of many aspects of the administration's response to
the coronavirus. Likewise, I have praised other steps that the
administration has taken. Putting politics aside is not
putting--does not mean putting judgment aside.
With those 2 preliminary points made, I want to move on to
how we can use the lessons we learned in the Ebola response to
approach the current threat.
To be clear, the Ebola response itself was not without
problems and mistakes. But ultimately, President Obama mustered
an all-of-government response to the challenge, authorized the
first-ever deployment of U.S. troops to combat an epidemic, and
appointed me to lead a team of talented and dedicated
professionals at the White House to coordinate the effort.
In the end, that epidemic was tragic: 11,000 people or more
died in West Africa. But in September 2014 there was a forecast
that a million lives would be lost. America's actions, as part
of a global response, saved hundreds of thousands of lives.
The on-going legacy of this work is enormous. With
Congress's support we implemented a National four-tier network
of hospitals and medical facilities that remain prepared to
this day to identify, isolate, and treat cases of dangerous
infectious diseases. Nothing like that existed in 2014 before
we started. And work on vaccines and therapeutics, as well.
Now the challenge we face from the coronavirus epidemic is
different in many ways, but it contains some similarities. So I
think it is worth thinking about the lessons that can be
applied in this case.
First, in a complex, rapidly-evolving scenario like we are
seeing, there is no substitute for White House coordination and
leadership. At the end of my tenure as Ebola response
coordinator, President Obama accepted my recommendation to
create a permanent pandemic preparedness and response operation
inside the National Security Council that continued through the
first year of the Trump administration. But in July 2018 that
unit was disbanded.
The administration's decision now to go through a series of
different structures, first no task force, and then a task
force led by Secretary Azar, then a task force led by Vice
President Pence, then Ambassador Birx coordinating the response
has produced uneven results, and certainly has contributed to
the largest fiasco in the U.S. response, the failure to
promptly enable wide-spread testing for the virus, which
definitely is a result of some lack of coordination between CDC
and FDA.
There is simply no reason, none, why the United States lags
behind nations like South Korea and Singapore in protecting its
people.
Second, we must ensure that science and expertise guide our
actions, not fear, wishful thinking, or politics. There are
reports, as Chairman Payne indicated, of senior officials in
the Government rejecting the advice of professionals of the
Centers for Disease Control and other aspects of sidelining or
ignoring medical advice. There are many policy decisions to be
made in the days and weeks ahead. Science and medical expertise
must guide them, not politics.
Third, the United States has to lean forward in fighting
this epidemic overseas, as that, I think, will become an
increasing priority. Unlike what happened in West Africa in
2014, the nations of China or Italy, or South Korea--do not
need our help in responding. But this disease could easily
spread to Africa and other countries, where we might have to
step up and do the same kind of things we did in 2014.
Fourth, the administration must move quickly to implement
the emergency funding bill passed by Congress last week.
Congress deserves great credit for acting with unprecedented
speed in funding this response. But passing a funding bill is
only the first step, not the last step. Congress needs to make
sure that the administration is getting that money out, and
getting it out quickly and effectively. Too often bills get
passed and they don't get implemented. That has to be a
priority.
The White House task force should report regularly to the
American people on the pace and deployment of the funding
Congress provided. Where is the money? When is it getting out?
What is going to be done?
Fifth, Congress has to continue to do its own work on the
coronavirus. That includes hearings like this, and ultimately,
work on things like the economic consequences of the virus.
Sixth, both the Executive and the Congressional branch need
to work on the long-standing issues of pandemic preparedness
that remain. It is not clear if this will be the big epidemic
that we have seen coming, like the Spanish flu was 100 years
ago. But, sooner or later, it will come. There is a raft of
bipartisan proposals sitting on shelves that Congress has never
acted on. Let this be a reminder of the need to act on that.
Then finally, I just want to close by saying public
officials at all levels of government need to take steps
against discrimination. We are already seeing discrimination
against Chinese-Americans, Chinese-American-owned businesses
that will spread as this virus spreads. There is--this virus
affects humans, not members of any race or ethnicity. We need
to step up and make sure there are no victims of that
discrimination.
Thank you, Mr. Chairman.
[The prepared statement of Mr. Klain follows:]
Statement of Ronald A. Klain
March 10, 2020
Chairman Payne, Ranking Member King, other Members of the
subcommittee: Thank you for inviting me to participate in this hearing
today. I want to commend the subcommittee for moving quickly to gather
information and educate the public about the coronavirus epidemic that
originated in China and has now spread to countries around the world,
including our own. It is a privilege to be able to present my
perspective on this, and to answer your questions about the emerging
U.S. response.
Before I begin my substantive presentation, I want to make two
preliminary points.
First, as frustrating as it may be, it is important to understand
that what we know about this epidemic and the virus that causes it
remains uncertain. We know much less about coronavirus today than we
did about Ebola in 2014. Scientists in the United States and around the
world are working at unprecedented speed to improve our understanding
about the virus and its spread; new papers are being published every
day, literally. Nonetheless, there are critical questions about the
virus, how quickly it spreads, how infectious it might be, how lethal
it will be--and others--for which we still do not know the answers, and
that--once learned--will have huge impacts on our response. Part of
this is due to a lack of full transparency and cooperation by the
Chinese government. But part of this is due to the fact that it takes
time for science to learn key facts about a new virus. As someone who
was once coordinated the policy making and implementation of a response
to an epidemic, I know that these information gaps are vexing: Many
decisions cannot wait, and have to be made on the best information
available. But it is important that we understand this limitation,
understand that policy choices will have to change as our fact base
changes, and that we be careful not to make definitive or declarative
pronouncements when the science does not justify such statements.
Simply put, at present, we do not know how serious this epidemic
will become, how many people will contract the virus, how many will
die, and how grave the threat is to our country. Such a lack of
knowledge does not counsel a lack of action, indeed, perhaps it
counsels just the opposite. But it does advise modesty in the
forcefulness of our conclusions, and awareness of the need to make
changes in policy choices as we gain more information.
Second, a point about partisanship and the response. I am an
outspoken political partisan--that is well-known. But I come here today
in the same way that I approached my tenure as White House Ebola
response coordinator: Putting partisanship and politics aside. The
coronavirus will not ask any person's partisan affiliation before
infecting them. There is no Democratic or Republican approach to
fighting infectious disease; only sound and unsound measures.
That does not mean demurring about calling out failures when they
appear: I have been critical of many aspects of the Trump's
administration response to the coronavirus epidemic because they
reflect failures in execution and communication. Likewise, I have
praised positive steps taken by the administration, such as bringing in
Ambassador Birx for a leadership role, or getting strong bipartisan
support for the Emergency Supplemental that recently passed Congress.
Putting politics aside does not mean putting judgment aside, both good
and bad.
My point about non-partisan approaches here is illustrated by what
we did during the Obama administration's Ebola response. There, we
relied heavily on lessons learned and expertise acquired during the
Bush administration's efforts to fight AIDS and malaria in Africa. Key
players in the Ebola response were veterans of both Democratic and
Republican administrations. President Obama's emergency funding package
passed this House with strong, bipartisan support; our implementation
of it domestically involved close work with State and local officials
from both parties; and the input of Members of Congress of all
political and ideological camps. Saving lives, abroad and at home,
turns on putting politics aside and allowing science, expertise, and
sound decision making to govern our actions.
With these two preliminary points made, I want to move on to the
subject of my testimony today: How the lessons we learned during the
Ebola response in 2014-15 should shape how our Government--in the
Executive and Legislative branches--approaches the threat now posed by
the novel coronavirus.
To be clear, the Ebola response was not without its own problems
and mistakes. Particularly early on, the danger to Africa and the world
was underestimated; early signs of progress in containing the disease
in the spring of 2014 led to a false sense of security. The fact that
no Ebola outbreak prior to 2014 had ever involved more than 500 cases
of the disease also led to a false confidence that a large-scale
epidemic was unlikely. Early initiatives in West Africa lacked a full
understanding of the complexities of implementation there and cultural
and religious barriers to some aspects of the response. Confusion and a
lack of preparation led to missteps when the first case of Ebola
arrived in Dallas, Texas, in late September, 2014.
But ultimately, the United States got the response organized;
quickly adapted and improved its approach; and made adjustments to what
responders were doing in Africa and here at home. President Obama
mustered an all-of-government response to the challenge, authorized the
first-ever deployment of U.S. troops to combat an epidemic (``Operation
United Assistance''), appointed me to lead a team of dedicated and
talented professionals at the White House to coordinate this effort,
implemented novel and innovative policies on travel screening and
monitoring, and won Congressional approval of a $5.4 billion emergency
package to fight the disease abroad and improve our preparedness at
home and around the world for future such epidemic threats.
In the end, the epidemic in West Africa was tragic: An official
death toll of over 11,000, with the real count likely higher. But the
backdrop for this loss of life must be considered. In September 2014,
experts forecast that the death toll could be over 1 million people;
thus, the response succeeded in helping to reduce the projected loss of
life dramatically. America's actions--as part of a global response,
with Africans playing the largest part, deserving the greatest credit,
and suffering the harshest losses to its health care workers--saved
hundreds of thousands of lives. It was a great humanitarian
achievement.
Here at home, after the initial missteps in Dallas, no one
contracted Ebola on U.S. soil, and Americans evacuated for medical care
in the United States were successfully treated and released, with only
a lone fatality. Once implemented, our monitoring system successfully
insured no domestic transmission of the disease, routed suspected cases
to prepared medical facilities before those patients could be
infectious, and enabled ample time for successful testing and response.
The on-going legacy of this response is likewise enormous. With
Congress' support, we implemented a National four-tiered network of
hospitals and medical facilities that remain prepared to this day to
identify and isolate cases of dangerous infectious disease, and to
provide treatment to those who are infected--nothing like this existed
in 2014 when the Ebola epidemic began, as many earlier investments made
after the anthrax attacks in 2001 had been allowed to dissipate. The
capacity to test for and promptly identify diseases like Ebola grew
from 3 laboratories in the United States in September 2014 to almost
100 by the end of that year. We developed rapid diagnostics that ended
the risky practice of having patients wait days to learn if they were
sick and/or infectious. Vaccines against Ebola were tested and
developed, and as a result of that work, an effective vaccine now
exists and is being used in the field. New therapeutics were developed
that helped reduce the mortality rate of Ebola dramatically.
It is no wonder that this effort--without in any way minimizing the
devastation in West Africa--is seen today as a huge success. Tom
Friedman wrote last year that that West African Ebola response was:
``[President Obama's] most significant foreign policy achievement, for
which he got little credit precisely because it worked--demonstrat[ing]
that without America as quarterback, important things that save lives
and advance freedom at reasonable costs often don't happen.''
From mid-October 2014 to mid-February 2015, I was proud to lead the
team at the White House that coordinated this response. We saw the
weekly new case count in West Africa drop from about 1,000 a week to
fewer than 5 a week, at which point the President announced the end of
Operation United Assistance and began the withdrawal of U.S. troops
serving in that mission.
This was a truly global response, with tremendous contributions by
Government officials, NGO's, and volunteers from around the world, and
particularly close partnership with our allies in the United Kingdom
and France. With regard to the U.S. part of this global effort, special
thanks should go to the men and women on the front lines. This includes
our members of the 101st Airborne (who constituted the bulk of
Operation United Assistance), and also, civilian responders--via USAID
DART teams and CDC employees deployed to the region, and contractors
who supported them. It includes the men and women of the U.S. Public
Health Service who staffed the Monrovia Medical Unit in Liberia. It
includes our career Ambassadors and other diplomats who served in all 3
affected countries with skill and played such a large role in the
response. It includes the doctors, nurses, and other health care
workers--many volunteers--who served in Ebola treatment units,
hospitals, and other facilities--treating the sick under extreme
conditions. It includes the scientists of the NIH and the CDC who
pioneered new diagnostics, therapeutics, and vaccines. The U.S.
response put over 10,000 people--soldiers and civilians, Government
workers and NGO teams, contractors and volunteers--on the ground in
West Africa in 2014-2015. It was a gargantuan undertaking, and a story
in which all Americans should take pride.
To make that effort effective, and to match it with preparation and
protection here at home, it took talented teams in Washington, in
Atlanta at the CDC, and in Government agencies and private health care
facilities around the country. Public servants of all ranks and all
levels worked around the clock. As I mentioned before, Congress acted
swiftly and on a bipartisan basis to approve most of the Obama
administration's request for $6 billion in aid, less than 5 weeks after
it was sent to Capitol Hill.
I would be remiss if I did not say that, of course, President
Obama, too, deserves credit for this success. He weathered sharp
criticism for his actions during the Ebola response, and had to ignore
pressures to put aside the advice he was getting from top scientists
and medical experts. He made difficult decisions about the actions we
took abroad and at home. He communicated openly and directly with the
American people, and chaired repeated meetings of the National Security
Council as the response took shape. He used every tool at his
disposal--from his bully pulpit (to destigmatize survivors by publicly
hugging Ebola patient Nina Pham in the Oval Office after her discharge
from the hospital), to authorizing the massive deployment to West
Africa, to personally engaging numerous world leaders to activate their
resources and support for the response, to pressing Congressional
leaders to approve his emergency spending package, and much more: He
did so much to achieve these results.
The challenge we face from the coronavirus epidemic now rapidly
accelerating contains many similarities, but also, many differences
from the challenge posed by the Ebola epidemic in West Africa in 2014-
15. It would be a mistake to simply repeat what we did at that time,
given those many differences. But likewise, it would also be a mistake
to ignore the lessons that can be learned from that response, given the
similarities. Hence, I am grateful for the opportunity to talk about
the lessons I think are most applicable from this experience, to be
applied in the current circumstance.
Among the many possible lessons that should be employed now, there
are 7 in particular that I would like to call out today. I will do so
briefly, but I am happy to go into more depth on any of them in
response to your questions or any subsequent follow-up from the
subcommittee.
First, in a complex, rapidly-evolving scenario like the one we are
seeing, there is no substitute for White House coordination and
leadership. While the centralization of leadership of the response in
Vice President Pence and his team is an improvement over where things
stood days ago, there remains confusion with the structure, and the
lack of a single, full-time official inside the National Security
Council at the White House overseeing our response.
At the end of my tenure as Ebola Response Coordinator, I said that
there should never be another specific ``Disease Czar'' at the White
House. Instead, I recommended to President Obama that he create a
permanent ``Pandemic Preparedness and Response'' directorate inside the
NSC, led by a Deputy National Security Adviser-level appointee with
direct access to the President as needed, to oversee on-going work to
prepare for the inevitable next time, and to coordinate a response to
an epidemic when it arrived.
President Obama accepted this recommendation, and set up such a
unit in 2015. President Trump continued with the structure, and named
Admiral Tim Ziemer--a respected long-time public servant--to fill this
post. If Admiral Ziemer were still in place, I believe that America
would be much better positioned to respond to the coronavirus threat
today.
But unfortunately, in July 2018, when John Bolton took over as head
of the NSC, he disbanded this unit, and Admiral Ziemer was reassigned
to USAID. As a result, there has been no special unit at the NSC to
oversee preparedness for epidemics, or the current response. In
addition, the Trump administration has dismantled the Homeland Security
Advisor structure that Presidents Bush and Obama used to deal with
complex transnational threats, further undermining our preparedness for
events like these.
The administration's sequential decisions to first say no special
structure was needed to manage the response; then to create a ``Task
Force'' to oversee the response, led by Secretary Alex Azar; then to
replace Secretary Azar with Vice President Pence as the official in
charge of that Task Force; and then to bring in Ambassador Birx as the
coordinator of the response, part-time, reporting to VP Pence, has
produced uneven results. The response is likely to be a massive
undertaking of multiple agencies, State and local governments, private
and public sectors, and international partners. We are still in the
early days, with many tasks left undone.
But it seems that already the largest fiasco in the U.S. response--
the failure to promptly enable wide-spread testing for the virus--is at
least in part a product of this coordination problem, with CDC blaming
FDA, other officials pointing fingers at CDC, and a delayed engagement
of State and local labs and private alternatives. There is simply no
reason--none--why testing in the United States should lag nations like
South Korea or Singapore.
For these reasons, and many more, an effective response to a
challenge like coronavirus must be led by a full-time appointee at the
White House. Ideally that decision would be made by the Executive
branch, but another avenue to achieve this structure would be for
Congress to move ahead on the Global Health Security Act (HR 2166),
introduced by Reps. Connolly and Chabot, as that bill which impose much
of this apparatus by statute.
Second, the administration must ensure that science and expertise
guide our actions, not fear, wishful thinking, or politics. One of the
first casualties in an epidemic is rational thinking, replaced by fear,
bias, and poor decision making. We saw this in 2014 with calls for
needless travel bans and baseless quarantine restrictions; President
Obama was right to reject these misguided calls, and to implement
travel and monitoring policies based on the scientific advice he got
from the Nation's leading experts.
In this case, there are troubling reports that the advice of senior
officials of the Centers for Disease Control have been ignored with
regard to travel advisories and public awareness. The President himself
has suggested that passengers on a cruise ship with many infected
persons aboard are being handled in a fashion--not governed by medical
considerations--but by a desire to keep tallies of U.S. cases low.
Officials who spoke publicly and truthfully of the ``inevitability'' of
spread of the disease in the United States have been sidelined. We do
not yet know whether this mindset--trying to minimize the disease, and
downplay warnings--is contributing to the sluggish response of our
Government. But in my experience, the tone set at the top governs how
key players respond, and it seems unlikely that what we have heard from
the President has been helpful.
More generally, there will be many policy decisions to be made in
the days and weeks ahead. Science, medicine, and expertise should guide
them. The American people are lucky to have the world's leading experts
on infectious disease working in their government, led by men and women
like Tony Fauci at NIH and Anne Schuchat at CDC. They have served
Democratic and Republican administrations, and helped Presidents with a
wide variety of political perspectives save lives and protect our
Nation. This expertise should be paramount in decision making at all
levels of government.
Third, the United States must ``lean forward'' to fight this
epidemic overseas, using all of the tools and leverage that we can
commit to the effort. Unlike West Africa in 2014, today in 2020, China,
South Korea, Italy, Iran, and Japan--the hardest-hit countries to
date--probably do not need, and/or would not accept, thousands of U.S.
responders on the ground treating patients, testing new approaches,
conducting research, providing infrastructure, and helping bring the
disease under control. This is a huge difference.
But that should not get us off our toes, or have us sitting back
and believing that our only sphere of action is the homeland. Dr. Tony
Fauci of NIH has publicly urged the deployment of medical researchers
and investigators to China, and key administration leaders should apply
pressure to encourage the most open access possible. Nations less
advanced or well-resourced than South Korea or Italy may experience
significant coronavirus outbreaks and require more direct forms of U.S.
assistance, akin to what we provided during the 2014 Ebola epidemic. We
should send CDC experts wherever they would be helpful, and task USAID
to determine where DART teams and other assistance could be usefully
deployed. Likewise, we should bolster preparedness in low-income
countries now--before the disease spreads further--to avoid spread in
places where local containment efforts might fail. The danger of a
coronavirus epidemic in Africa is enormous, and its potential
consequences catastrophic. Our diplomats should be empowered and
engaged around the globe, and our Government must press WHO--which has
stronger leadership today under Dr. Tedros Adhanom Ghebreyesu than it
had during the 2014 Ebola epidemic--to do the right thing.
This is a global challenge, and America must provide global
leadership. There is no room for isolationism or withdrawal. The best
way to keep Americans safe is to combat the virus overseas. We should
do this not only because it is generous or humanitarian--though it
would be generous and humanitarian, both great American traits--but
because it will make America safer and reduce the spread of the
epidemic here.
Fourth, the administration must move quickly to implement the
emergency funding package passed by Congress last week, to ensure that
there are no further delays in responding to the coronavirus challenge.
As Congress recognized in passing this bill, fighting the coronavirus
will cost money. Key Federal agencies will have costs. State and local
governments will feel a pinch from monitoring contacts of those who
have the virus, and tracking and monitoring individuals who have been
in affected countries. Hospitals treating patients with the virus will
need assistance of all sorts. Research and deployment of new
therapeutics and vaccines needs Government support, and funding for
private-public partnerships. The list of needs goes on.
As I will discuss in a minute, Congress acted with unprecedented
speed in passing an Emergency Supplemental Funding package to help
address these needs. But passage of that package is only the first
step. As we learned during the Ebola response, that funding only makes
a difference if the administration acts with speed in putting the
funding to work: With focus and pace, and a plan for implementation
that has clear metrics and accountability. At the top of my list would
be testing, and preparing the health care system for an influx of
cases--to increase capacity and to avoid the danger of an overwhelmed
system suffering failure.
The White House Task Force led by Vice President Pence should
report regularly to the American people on the pace of deployment of
the Emergency Supplemental: What has been put to work and where. Not
all of the money will be spent immediately, nor should it be: Our needs
will develop and change in the months ahead. But quick action by
Congress in passing this package must be matched by quick action in
putting it to work.
Fifth, Congress must continue to do its own work in dealing with
the coronavirus. The burden of action does not rest entirely with the
Executive branch; Congress too must do its part.
Congress has already acted admirably in passing with impressive
speed an Emergency Supplemental funding plan to power the coronavirus
response. That this happened in a matter of days after the
administration made such a request, at a level substantially more
robust and detailed than the administration's request, all are to
Congress' credit. It was also encouraging to see that action come with
strong bipartisan support, as it should be.
But Congress' role does not end with acting on the emergency
funding question. There are a number of other elements of the response
that demand Congressional attention. Hearings like today's are
important, to help ascertain how the response is going and where it
needs to be improved. Congress wisely funded the Public Health
Emergency Fund last year--but did so only on a limited basis. Adding to
that funding, and funding a second emergency fund specific to the
development of therapeutics and vaccines in public-private
partnerships, should be considered. In addition, action to address the
economic consequences of the outbreak will also be needed.
Moreover, as I wrote in the Post with Dr. Syra Madad in December--
before the coronavirus hit--Congress is overdue to renew the funding
for the network of ``Ebola and Special Pathogens'' Hospitals. This
network was created during the Ebola epidemic in 2014, and funding for
it expires in May 2020. Pending legislation would fund only the 10 most
advanced such facilities, and would end Federal funding for the 60
other hospitals that screen, test, and provide initial treatment for
these cases. Allowing this funding to expire in May would be a huge
mistake.
Sixth, both the Executive branch and the Congress should take this
as a wake-up call to finish the work we need to do on pandemic
preparedness and readiness. Recently, America marked the 100th
anniversary of the single largest mortality event in our history: The
Spanish Flu epidemic of 1918-19. More Americans died from this epidemic
than from World War I, World War II, the Korean War, and the Vietnam
War--combined. While, on the one hand, science has made great strides
since 1918, on the other hand, increased global travel, human incursion
on animal habitats, and the stresses of climate change have raised the
risk that we will face such a ``great pandemic'' once again, sooner or
later.
At present, it seems very unlikely that the coronavirus poses such
a threat to the United States--but we cannot know for certain.
Moreover, even if this current epidemic is not ``the big one'' that is
coming, it is a reminder that this danger lurks, and our preparedness
for it is lacking. As Dr. Ashish Jha of the Harvard Global Health
Institute often says, ``Of all the things that can kill millions of
Americans quickly and unexpectedly, an epidemic is probably the most
likely . . . and the one in which we invest the least to prevent.''
The Global Health Security Agenda, legislation such as H.R. 2166,
Blue Ribbon Commission reports, table-top exercises, proposals from
Members of this subcommittee--and my own extensive writing over the
past 5 years--have set forth detailed agendas of what we need to do to
prepared for this event. These bipartisan calls for action have been
largely ignored. The current public focus on infectious disease
generated by the coronavirus should spur us into action. The time to
act on this agenda is now. If we wait until the catastrophic pandemic
arrives, it will be too late.
Seventh, public officials of all parties and at all levels of
government need to be on the watch for discrimination against people in
our country of Chinese descent, and speak out strongly against any such
fear-driven racism. The coronavirus strikes humans--not people of any
particular ethnicity or race. Chinese-Americans or Chinese people in
America are no more likely to get the disease, carry the disease, or
transmit the disease, than any other group of people.
Yet we have already seen signs that such people are the targets of
discriminatory fear--with some already being hassled, threatened with
expulsion from schools and other mistreatment. As fears of the
coronavirus accelerate, so too will these incidents. This kind of
discrimination not only is wrong, but also makes it harder to combat
the disease. If some members of the Chinese-American community feel
that they are likely to face hostility, they are less likely to come
forward when symptoms appear, and less likely to heed advice of public
health experts.
It is incumbent on every person in authority in this Nation to
speak out against such racism, and to ensure that this does not become
part of our civic life during the coronavirus epidemic. Americans need
to pull together to fight a disease, not pull apart to fight one
another.
In closing, I want to again thank the subcommittee for holding this
hearing, and for inviting me to participate. I stand ready to answer
your questions about any of these points, or any other aspects of the
response.
America has the tools, the talent, and the expertise to combat the
coronavirus, both abroad and at home. The question now is whether our
leaders, in the Executive branch and the Congress, will deploy them
effectively; act promptly and wisely; rely on expertise--not bias and
fear; organize and implement our response appropriately; and allow
science and medicine to be our touchstone. For the sake of people
around the world, and for the sake of the American people, let us work
to see that it is so.
Mr. Payne. Thank you.
The Chair now recognizes Mr. Neuwirth to summarize his
statement for 5 minutes.
STATEMENT OF CHRISTOPHER NEUWIRTH, MA, MEP, CBCP, CEM,
ASSISTANT COMMISSIONER, DIVISION OF PUBLIC HEALTH
INFRASTRUCTURE, LABORATORIES, AND EMERGENCY PREPAREDNESS, NEW
JERSEY DEPARTMENT OF HEALTH
Mr. Neuwirth. Good afternoon, Chairman Payne, Ranking
Member King, and Members of the subcommittee. On behalf of New
Jersey Governor Phil Murphy and New Jersey Health Commissioner
Judith Persichilli, thank you for inviting the New Jersey
Department of Health to participate in today's hearing.
I am here before you as the assistant commissioner for the
division of public health infrastructure, laboratories, and
emergency preparedness. I am responsible for public health,
emergency management, emergency medical services, and the
public health and environmental laboratories. My goal today is
to share with you New Jersey's experience for preparing for and
responding to the novel coronavirus public health crisis.
More so, I will share with you experience working with our
Federal partners at the U.S. Department of Health and Human
Services and the Centers for Disease Control and Prevention. I
am hopeful that, by sharing with you how New Jersey has
responded to the novel coronavirus public health crisis, that
you will be able to strengthen and enhance the coordination
between critical Federal agencies and all States, including New
Jersey.
Throughout January the department of health actively
monitored the public health situation arising from Wuhan City,
China. Our public health experts and epidemiologists readily
identified a concerning novel pathogen that undoubtedly had the
potential to escalate into a global pandemic.
Under the leadership of Commissioner Persichilli, on
January 27, I established an internal crisis management team
using National incident management system principles to
coordinate preparedness and response activities from across the
department.
Shortly thereafter, on February 3, Governor Murphy signed
executive order 102, creating a State-wide coronavirus task
force led by the commissioner of health. Since their creation,
the crisis management team and coronavirus task force have
provided the State of New Jersey with an incident command
structure that has allowed all departments to effectively
organize, coordinate, and prioritize their preparedness and
response activities.
Simply stated, New Jersey continues to successfully manage
the public health crisis because of our strategic organization,
subject-matter expertise, and our collective institutional
knowledge.
While I certainly could continue describing all of the
great work New Jersey is actively doing, I must draw your
attention to the two most important aspects of any Nation-wide
public health response: Coordination and communication.
On Sunday, February 2, during the afternoon of Super Bowl
Sunday, the New Jersey Department of Health was notified that
Newark Liberty International Airport would officially be
designated as the 11th funneling airport in the United States,
with the first arriving flights arriving within 24 hours with
more than 350 travelers on board from China.
Within moments of receiving this news, our crisis
management team began working feverishly to secure housing,
transportation, and wraparound services for these individuals
potentially facing quarantine. Because we had established a
crisis management team that was well-organized, highly-
disciplined, and remarkably proactive, we were able to
effectively coordinate a measured response in a moment's
notice.
More importantly, as New Jersey begins facing its first
cases of novel coronavirus just last week, the crisis
management team and coronavirus task force continue to
effectively coordinate all aspects of the State's response to
ensure that communications remain organized, timely, and in the
public's best interest.
Throughout the past 8 weeks, my team has been in lockstep
with our friends and colleagues at the U.S. Department of
Health and Human Services and at the CDC, both at headquarters
and within region 2. The daily interactions and near-real time
communications during fast-moving situations has allowed the
State of New Jersey to effectively communicate and coordinate
our activities between all stakeholders.
As novel coronavirus continues to affect New Jersey, the
strong relationships we have with our Federal counterparts
ensures that we can communicate candidly and resolve issues
immediately as they arise. In a dynamic public health crisis
such as this, maintaining tight coordination through
streamlined, clear communications greatly increases the
effectiveness of our collective response.
But despite our great partnership with our Federal
colleagues, the State of New Jersey expends more than $1.8
million per month responding to novel coronavirus. While our
CDC award of $1.75 million is greatly appreciated, it certainly
will not cover the continued expenses incurred by the State or
the health care and public health infrastructure, including our
acute care facilities, EMS agencies, and local health
departments.
Recognizing that medical supplies are facing a historic
shortage, and that health care supply chain is nearly frozen
for respirators, disinfectants, and other personal protective
equipment, we urge you to consider additional funding to New
Jersey and the distribution of items from the strategic
National stockpile.
New Jersey remains committed to fighting novel coronavirus
and protecting the public health and safety of all people
living in and traveling through New Jersey. As the country
continues to respond to this public health crisis, we ask that
you remain attentive to the evolving needs of each State,
specifically New Jersey, and mobilize the information,
resources, and funding needed to protect the Nation's public
health and safety.
Thank you.
[The prepared statement of Mr. Neuwirth follows:]
Prepared Statement of Christopher Neuwirth
March 10, 2020
community perspectives on coronavirus preparedness and response
Good afternoon Chairman Payne, Ranking Member King, and Members of
the subcommittee. On behalf of New Jersey Governor Phil Murphy and New
Jersey Health Commissioner Judith Persichilli, thank you for inviting
the New Jersey Department of Health to participate in today's hearing.
I am here before you as the assistant commissioner for the Division
of Public Health Infrastructure, Laboratories, and Emergency
Preparedness. I am responsible for public health emergency management,
emergency medical services, and the Public Health and Environmental
Laboratories. My goal today is to share with you New Jersey's
experience preparing for and responding to the novel coronavirus public
health crisis. More so, I will share with you experience working with
our Federal partners at the U.S. Department of Health and Human
Services and the Centers for Disease Control and Prevention. I am
hopeful that by sharing with you how New Jersey has responded to the
novel coronavirus public health crisis, that you will be able to
strengthen and enhance the coordination between critical Federal
agencies and all States, including New Jersey.
Throughout January, the Department of Health actively monitored the
public health situation arising from Wuhan City, China. Our public
health experts and epidemiologists readily identified a concerning
novel pathogen that undoubtedly had the potential to escalate into a
global pandemic. Under the leadership of Commissioner Persichilli, on
January 27, I established an internal Crisis Management Team, using
National Incident Management System principles, to coordinate
preparedness and response activities from across the Department.
Shortly thereafter, on February 3, Governor Murphy signed Executive
Order 102, creating a State-wide Coronavirus Task Force, led by the
Commissioner of Health. Since their creation, the Crisis Management
Team and the Coronavirus Task Force have provided the State of New
Jersey with an incident command structure that has allowed all
departments to effectively organize, prioritize, and coordinate their
preparedness and response activities. Simply stated, New Jersey
continues to successfully manage this public health crisis because of
our strategic organizational structure, subject-matter expertise, and
our collective institutional knowledge.
While I certainly could continue describing all the great work New
Jersey is actively doing, I must draw your attention to the most
important aspects of any Nation-wide public health response--
coordination and communication.
On a Sunday, February 2, during the afternoon of Super Bowl
Sunday--the New Jersey Department of Health was notified that Newark
Liberty International Airport would be officially designated as the
eleventh funneling airport in the United States, with the first flight
arriving within 24 hours, with more than 350 travelers on-board from
China. Within moments of receiving this news, our Crisis Management
Team began working feverishly to secure housing, transportation, and
wrap-around services for these individuals potentially facing
quarantine upon their arrival. Because we had established a Crisis
Management Team that was well-organized, highly disciplined, and
remarkably proactive, we were able to effectively coordinate a measured
response in a moment's notice. More importantly, as New Jersey began
facing its first cases of novel coronavirus just last week, the Crisis
Management Team and Coronavirus Task Force continue to effectively
coordinate all aspects of the State's response and ensure that our
communications remain organized, timely, and in the public's best
interest.
Throughout the past 8 weeks, my team has been in lockstep with our
friends and colleagues at the U.S. Department of Health and Human
Services and the CDC--both at headquarters and within Region 2. The
daily interactions, and near-real time communications during fast-
moving situations, has allowed the State of New Jersey to effectively
communicate and coordinate our activities between all our stakeholders.
As novel coronavirus continues to affect New Jersey, the strong
relationships we have with our Federal counterparts ensures that we can
communicate candidly and resolve issues immediately as they arise; in a
dynamic public health crisis such as this, maintaining tight
coordination through streamlined, clear communications greatly
increases the effectiveness of our collective response.
But despite our great partnership with our Federal colleagues, the
State of New Jersey expends more than $1.8 million dollars per month
responding to novel coronavirus. While our CDC award of $1.75 million
dollars is greatly appreciated, it certainly will not cover the
continued expenses incurred by the State or the health care and public
health infrastructure serving on the front lines--specifically local
health departments, acute-care facilities, and EMS agencies.
Recognizing that medical supplies are facing a historic shortage, and
the health care supply chain is nearly frozen for respirators,
disinfectants, and other personal protective equipment--we urge you to
consider additional Federal funding to New Jersey and the distribution
of items from the Strategic National Stockpile.
New Jersey remains committed to fighting novel coronavirus and
protecting the public health and safety of all people living in, and
traveling through, New Jersey. As the country continues to respond to
this public health crisis, we ask that you remain attentive to the
evolving needs of each State, specifically New Jersey, and mobilize the
information, resources, and funding needed to protect the Nation's
public health and safety.
Again, thank you for this opportunity to testify and I welcome your
questions.
Mr. Payne. Thank you, sir. Our next witness, which--I was
told by my staff that I butchered your name, so I will try to
do better.
Ms. Gracia? I am sorry about that. I now recognize you to
summarize your statement for 5 minutes.
STATEMENT OF J. NADINE GRACIA, MD, MSCE, EXECUTIVE VICE
PRESIDENT AND CHIEF OPERATING OFFICER, TRUST FOR AMERICA'S
HEALTH
Ms. Gracia. Thank you, Chairman Payne, Ranking Member King,
and all the Members of the subcommittee. Good afternoon. My
name is Dr. Nadine Gracia, and I am the executive vice
president and chief operating officer at Trust for America's
Health, also known as TFAH.
TFAH is a nonprofit, nonpartisan public health organization
which, among our priorities, has focused attention on the
importance of a strong and effective public health emergency
preparedness system. Over the past nearly 2 decades, TFAH has
published an annual report, called ``Ready or Not: Protecting
the Public's Health from Diseases, Disasters, and
Bioterrorism.''
In our most recent report we identified areas of strength
in our emergency preparedness, as well as areas that need
attention at the Federal and State levels. Discussion of our
report findings, including our State assessments, can be found
in my written testimony or on our website. I would like to
highlight some of TFAH's policy recommendations to build our
Nation's preparedness for our public health emergencies, and
improve the National response to the novel coronavirus disease,
or COVID-19.
First, we applaud Congress for rapidly approving a robust
emergency Federal funding package. Federal agencies should be
preparing now to quickly distribute funds to States and other
partners.
Second, Congress must prioritize on-going investment in
core public health and annual appropriations. The Nation's
ability to respond to COVID-19 is rooted in our level of public
health investment in the last decade. The Nation has been
caught in a cycle of attention when an outbreak or emergency
occurs, followed by complacency and disinvestment in public
health preparedness, infrastructure, and work force. The Public
Health Emergency Preparedness Line, which supports front-line
State and local public health preparedness, has been cut by
over 20 percent since fiscal year 2010, adjusting for
inflation, and on top of steady cuts since 2004.
In addition, we have long neglected our public health
infrastructure. So many health departments are reliant on 20th-
Century methods of tracking diseases such as via paper, fax,
and telephone. Congress should prioritize funding for data
modernization to help with emergencies, as well as on-going
disease tracking.
Third, we need to ready the health care system for
outbreaks. Health systems across the Nation are beginning to
identify, isolate, and care for patients with COVID-19. Health
care must prioritize the protection of patients and health care
workers, including appropriate training on infection control
practices, personal protective equipment, and surge capacity.
Unfortunately, funding for the hospital preparedness program,
which helps prepare the health care system to respond to and
recover from emergencies, has been cut nearly in half since
2003.
Fourth, Congress should support the medical countermeasures
enterprise, including BARDA and the Strategic National
Stockpile, which build the pipeline of vaccines, treatment,
medical equipment, and supplies for health security threats.
Fifth, we must build the pipeline of the public health work
force. Although supplemental funding may help with short-term
hiring, this temporary funding does not allow for recruitment
and retention of workers. Emergency preparedness and response
are personnel-intensive endeavors that require training,
exercise, and coordination across sectors. This experience just
cannot be built overnight.
Sixth, Congress and employers should consider job-
protected, paid sick leave to protect workers and customers
from infectious disease outbreaks. One of the recommendations
we have repeatedly heard is to stay home when sick. For
millions of Americans, that is not a realistic option. They
risk losing a paycheck, and possibly their jobs if they stay
home when sick or to care for a loved one.
In fact, only 55 percent of the work force has access to
paid time off. Congress should pass a Federal law to require
employers to offer paid sick days as soon as possible.
Finally, science needs to govern the Nation's COVID-19
response, led by Federal public health experts who have years
of experience in responding to infectious disease outbreaks.
Keeping the public and partners informed will be critical. We
encourage elected officials and community leaders at all levels
to make policy and communications decisions based on the best
available science, understanding that the situation is evolving
rapidly and messages may change.
Communities that are considering school or business
closures should follow public health guidance, but also
consider unintended consequences. For example, nearly 100,000
schools serve free and reduced meals to 29.7 million students
each day. The U.S. Department of Agriculture should be
implementing flexibility for schools to make grab-and-go meals
and other options available if schools are to close.
The full extent of this outbreak, in terms of public
health, health care, and economic and societal costs remains to
be seen. We do know that taking immediate steps to mitigate the
effects of this outbreak will save lives and prevent harm.
Thank you for the invitation to participate today, and I
look forward to your questions.
[The prepared statement of Ms. Gracia follows:]
Prepared Testimony of J. Nadine Gracia
March 10, 2020
Good afternoon. My name is Dr. Nadine Gracia, and I am executive
vice president and chief operating officer of trust for America's
Health, or TFAH. Our organization is a nonprofit, nonpartisan public
health policy, research, and advocacy organization that promotes
optimal health for every person and community and makes the prevention
of illness and injury a national priority. For many years we have
focused attention on the importance of a strong and effective public
health emergency preparedness system.
I previously served as the deputy assistant secretary for minority
health at the U.S. Department of Health and Human Services (HHS) and
chief medical officer in the Office of the Assistant Secretary for
Health. I was involved in the Nation's responses to emergencies such as
the 2010 earthquake in Haiti, the Flint water crisis, the Deepwater
Horizon oil spill, and the Ebola and Zika outbreaks.
I am here today to discuss TFAH's policy recommendations to build
our Nation's preparedness for public health emergencies and improve the
National response to the novel coronavirus disease, or COVID-19.
tfah's ready or not report
Over the past nearly 2 decades, TFAH has published an annual report
called ``Ready or Not: Protecting the Public's Health from Diseases,
Disasters and Bioterrorism.'' Our most recent report was published in
February. In it, TFAH provides an assessment of States' level of
readiness to respond to public health emergencies and recommends policy
actions to ensure that everyone's health is protected during such
events. The 2020 edition found unevenness in the Nation's readiness for
a major emergency. While there were indications of recent improvements
in some components of preparedness, our report identified areas that
needed attention.
Our report is not intended to be an exhaustive review of health
security data, but instead serves as a checklist of priority issues and
action items for States to address.
State Assessment
In our State assessment, some key findings relevant to the response
to the novel coronavirus:
We do not have a ready system in place to vaccinate the entire
population:
Less than half the population, on average, received the
seasonal flu vaccine.\1\ That low rate is concerning for a
number of reasons--(1) the spread of flu at the same time as
COVID-19 makes it harder for clinicians to recognize COVID-19;
(2) if people have the seasonal flu, they may be more likely to
have severe illness if also infected with COVID-19 and (3) if a
mass vaccination campaign is needed in the future, it is vital
that we have systems in place that can administer vaccines and
a population ready to receive them.
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\1\ https://www.cdc.gov/flu/fluvaxview/coverage-1819estimates.htm.
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There are barriers to the recommendation that workers should
stay home when sick. An average of 55 percent of employed
workers have access to paid time off.\2\ Paid time off,
especially paid sick days, are critical to ensure workers can
stay home when sick, caring for a sick loved one, or if
measures are taken such as school and workplace closures.
Without paid sick time, a worker with flu symptoms might lose
income that is essential to cover basic costs like rent or
food.
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\2\ National Health Security Preparedness Index analysis of Annual
Social and Economic Supplement of the Current Population Survey.
www.nhspi.org.
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The public health system has been weakened by budget cuts and fewer
personnel:
More than 50,000 public health jobs have been eliminated in
the Nation and public health emergency preparedness funds have
been cut by a third. In the last year alone, 11 States cut
their public health funding. Investing in the public health
infrastructure and workforce before an outbreak or emergency
hits is critical to having the systems in place ahead of time.
Hiring in the middle of an outbreak is important but is no
substitute for the training and experience in place ahead of
time.
There are obstacles to cross-State cooperation during a major
outbreak:
A third of the States lack a nurse licensure compact, which
allows nurses to practice across State lines. This can be
relevant when additional clinical staff are needed in an
emergency.\3\ This is particularly useful if some States
experience a greater impact than others.
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\3\ Nurse Licensure Compact in National Council of State Boards of
Nursing, 2019. https://www.ncsbn.org/nurse-licensure-compact.htm.
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More work is needed to ensure hospitals are fully prepared for
emergencies:
Only 30 percent of hospitals achieved an A grade on patient
safety measures, according to The Leapfrog Group.\4\ Hospitals
that excel in safety are often better positioned to handle
public health emergencies and protect the safety of patients
and workers. Hospital preparedness has also been hampered by a
50 percent reduction in the Federal Hospital Preparedness
Program.
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\4\ Hospital Safety Grade State Rankings. Leapfrog Hospital Safety
Grade. https://www.hospitalsafetygrade.org/your-hospitals-safety-grade/
state-rankings.
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There was some good news as well in this year's report. We found
that:
Most States were accredited in the areas of public
health,\5\ emergency management \6\ or both. Such accreditation
helps ensure that necessary emergency prevention and response
systems are in place and staffed by qualified personnel.
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\5\ Public Health Accreditation Board. https://phaboard.org/.
\6\ EMAP Accredited Programs in EMAP. https://emap.org/index.php/
what-is-emap/who-is-accredited.
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Public health laboratories have long planned for the kinds
of surge of testing capacity we might see during this response.
However, their capacity in an outbreak with a novel virus like
the novel coronavirus is dependent upon the availability of
test kits and additional supplemental funding to handle the
increased workload.
These data points are not intended to grade or shame any State but
instead point to areas where policy makers, State agencies, the health
care sector, and even individuals could take steps to improve
readiness.
All-hazards preparedness and response
TFAH's report also includes a review of emergencies of the past
year. We point out how States and localities have responded to many
incidents in the past year, including lung injuries associated with
vaping, measles outbreaks, hepatitis A outbreaks, extreme flooding
throughout the central part of the country, wildfires, and other
disasters. Even with reduced funding and staffing, public health
personnel have taken extraordinary steps to protect the public.
However, what we are seeing with COVID-19 goes beyond what States and
locals can respond to without additional Federal assistance. Health
departments have already begun adding staff, updating laboratory
capacity, implementing isolation and quarantine policies, investigating
cases, and conducting risk communications to the public and health care
facilities.\7\ We need to ensure our front-line public health
departments have the resources they need--as quickly as possible--to
mount a robust response to the virus. And we must remember that other
emergencies as well as essential core public health activities are
occurring at the same time as the novel coronavirus threat. This was
tragically illustrated recently with the tornado in Tennessee. The same
public health personnel who respond to COVID-19, were also responding
to this emergency.
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\7\ Governmental Public Health Leaders Request Emergency
Supplemental Funding for COVID-19 Preparedness and Response Efforts
(press release). Association of State and Territorial Health Officials,
National Association of County and City Health Officials, Association
of Public Health Laboratories and Council of State and territorial
Epidemiologists. astho.org/Press-Room/Gov-Public-Health-Leaders-
Request-Emergency-Supplemental-Funding-for-COVID-19/02-24-20/.
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Report's Policy Recommendations
Finally, TFAH's report includes policy recommendations for
Congress, Federal agencies, State governments, and other stakeholders.
Many of our policy recommendations apply to the current outbreak. Today
I will highlight a few of these and speak to our additional
recommendations for the COVID-19 outbreak response.
Congress must prioritize on-going investment in core public
health as part of the annual appropriations process. The
Nation's ability to respond to COVID-19 is rooted in our level
of public health investment of the last decade. That is, being
prepared starts well before the health emergency is upon us and
is grounded in year-in and year-out investment in public
health. The Nation has been caught in a cycle of attention when
an outbreak or emergency occurs, followed by complacency and
disinvestment in public health preparedness, infrastructure and
workforce. These are systems that cannot be established
overnight, once an outbreak is under way. Programs like the
Public Health Emergency Preparedness Cooperative Agreement,
which supports front-line State and local public health
preparedness, are underfunded compared to a decade ago and in
terms of the increasing number of major crises public health is
facing. PHEP funding has declined by over 20 percent since
fiscal year 2010, adjusting for inflation,\8\ on top of steady
cuts since 2004.
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\8\ Funding for PHEP was $714.949 million in fiscal year 2010, or
$851.16 million in 2020 dollars. https://www.cdc.gov/budget/documents/
fy2011/fy-2011-cdc-congressional-justification.pdf.
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In addition, we have long neglected our public health
infrastructure, so many health departments are reliant on 20th
Century methods of tracking diseases, such as paper, fax, and
telephone.\9\ Congress should prioritize funding for data
modernization to help with emergencies as well as on-going
disease tracking. Public health needs a highly skilled
workforce, state-of-the-art data and information systems and
the policies, plans, and resources to meet the routine and
unexpected threat's to Americans' health and well-being.
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\9\ Statement of Janet Hamilton, Council of State and Territorial
Epidemiologists before House Labor-HHS-Education Appropriations
Subcommittee, April 9, 2019. https://cdn.ymaws.com/www.cste.org/
resource/resmgr/pdfs/pdfs2/20190409_lhhs-testimony-jjh.pdf.
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Accelerate crisis responses by funding standing emergency
response funds, such as the Infectious Disease Rapid Response
Reserve Fund (IDRRRF). We applaud Congress for including $300
million in the supplemental to replenish the IDRRRF. As we have
seen during this crisis, having a ready reserve fund to
jumpstart the public health response can be critical in the
early days of an outbreak, as the Secretary of HHS has tapped
$105 million to support the early response. These funds serve
as a bridge between underlying preparedness dollars and
supplemental funding. Congress should continue to invest in the
IDRRRF in the annual appropriations process.
Ready the health care system for outbreaks. Hospitals,
health centers and other clinical facilities across the Nation
are preparing to identify, isolate, and care for patients with
COVID-19. They must do so without interrupting the routine and
necessary clinical services for those with other health care
needs. This will require training for health care workers on
the identification of COVID-19 cases, on appropriate infection
control practices, and treatment. Health care must prioritize
the protection of patients and health care workers. The health
care sector needs resources for some of these activities and to
ensure it has appropriate personal protective equipment,
necessary clinical supplies and equipment, and surge capacity.
Unfortunately, funding for the Hospital Preparedness Program
(HPP), which provides funding and technical assistance to every
State to prepare the health care system to respond to and
recover from a disaster, has been cut nearly in half since
2003.\10\ Congress should prioritize funding for health care
preparedness even after this outbreak is under control.
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\10\ Funding for HPP has declined from $515 million in fiscal year
2004 to $275.5 million in fiscal year 2020. http://
www.centerforhealthsecurity.org/our-work/pubs_archive/pubs-pdfs/2009/
2009-04-16-hppreport.pdf.
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Provide long-term funding for the end-to-end medical
countermeasures enterprise, including the Biomedical Advanced
Research & Development Authority (BARDA) and the Strategic
National Stockpile (SNS). Together, these programs help build
the pipeline of countermeasures for diseases that do not have a
natural marketplace. We are seeing this play out today, as
companies were not previously researching novel coronavirus
countermeasures, so government partnership is needed to
incentivize participation.
Build the pipeline of public health workforce through
training, loan repayment, and other incentives. Modern
biodefense requires a well-trained workforce before emergencies
take place. Although supplemental funding will hopefully help
with hiring at the State and local levels, this short-term
funding does not allow for long-term recruitment and retention
of workers. Emergency preparedness and response are personnel-
intensive endeavors that require training, exercise, and
coordination across sectors. This experience cannot be built
overnight.
Provide job-protected paid sick leave to protect workers and
customers from infectious disease outbreaks. One of the
recommendations we have heard over and over from public health
leaders is to stay home when sick. For millions of Americans,
that is not a realistic option--they risk losing paychecks and
possibly their jobs if they stay home when sick or to care for
a loved one. Paid sick days are even less available for low-
wage workers and those who are in service industries, such as
food service.\11\ The public health evidence is clear: For
example, when employees who did not have access are granted
sick leave, rates of flu infections decreased by 10
percent.\12\ Employers, especially in the health care sector,
should be adjusting their paid sick days policies now to help
control the outbreak, and TFAH recommends Congress pass a
Federal law to require most employers to offer paid sick days
as soon as possible.
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\11\ Serving While Sick: High Risks and Low Benefits for the
Nation's Restaurant Workforce, and Their Impact on the Consumer. New
York: Restaurant Opportunities Centers United, September 30, 2010.
http://rocunited.org/wp-content/uploads/2013/04/reports_serving-while-
sick_full.pdf.
\12\ Pichler S and Ziebarth N. The Pros and Cons of Sick Pay
Schemes: Testing for Contagious Presenteeism and Shirking Behavior.
Cambridge, MA: National Bureau of Economic Research, Working Paper
22530, August 2016. https://www.nber.org/papers/w22530.
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the covid-19 response
It is clear that the Nation has transitioned from planning phase to
response and mitigation of COVID-19. In addition to TFAH's on-going
recommendations, we recommend some steps specific to this outbreak:
Implement emergency funding as quickly as possible. We
applaud Congress for quickly approving a robust emergency
Federal funding package, with significant investments in
domestic and global public health, health care preparedness and
research and development of medical countermeasures. Federal
agencies should be preparing now to quickly distribute funds to
States and other partners, as any delay could cost more lives.
We must minimize administrative delays in getting money into
the hands of health agencies that need to move quickly to
respond.
Science is key to effective response and should drive policy
decisions. Science needs to govern the Nation's COVID-19
response, led by Federal public health experts--including
leadership at the Centers for Disease Control and Prevention
(CDC) and National Institutes of Health (NIH)--who have years
of experience in responding to infectious disease outbreaks.
Policy decisions--from the Federal to the local level--should
also be based on the best available science. Communities that
are considering school or business closures or similar measures
should consider unintended consequences and take appropriate
action steps. If closings are necessary, authorities should
assist families for whom such action is especially problematic,
such as low-income families and individuals without paid sick
leave and children who rely on school meals for adequate
nutrition. Nearly 100,000 schools and institutions serve free
and reduced meals to 29.7 million students each day.\13\ The
U.S. Department of Agriculture should be implementing
flexibility for schools to make grab-and-go meals and other
options available if schools are to close.\14\ Home-bound
individuals who need access to health care personnel,
equipment, and medications may also need additional assistance.
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\13\ National School Lunch Program. U.S. Department of Agriculture
Economic Research Service. https://www.ers.usda.gov/topics/food-
nutrition-assistance/child-nutrition-programs/national-school-lunch-
program/.
\14\ School Nutrition Association Letter to USDA, March 5, 2020.
SNA. https://schoolnutrition.org/uploadedFiles/News_and_Publications/
SNA_News_Articles/Coronavirus-Options-Letter.pdf.
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Keeping the public and partners informed will be critical. CDC and
other Federal agencies are communicating frequently with public
health departments and other sectors. We encourage elected
officials and community leaders at all levels to make policy
and communications decisions based on the best available
science and public health guidance, understanding that the
situation is evolving rapidly, and messages must change.
Respond quickly and continue to address the spectrum of
health needs in our communities. We know that people with
underlying health conditions are at higher risk for severe
health outcomes from COVID-19. Unfortunately, 6 in 10 adults in
the United States have a chronic disease, and 4 in 10 have 2 or
more.\15\ So it is vital, while Congress is supporting health
departments to respond to this outbreak, that we also pay
attention to the on-going health threats public health is
working to address--from obesity, to substance misuse and
suicide, to tobacco and vaping. We need to support the on-going
public health activities that will make our communities
healthier and reduce risk for COVID-19.
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\15\ Chronic Diseases in America. CDC National Center for Chronic
Disease Prevention and Health Promotion. https://www.cdc.gov/
chronicdisease/resources/infographic/chronic-diseases.htm.
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The full extent of the outbreak in terms of public health, health
care and economic costs remains to be seen. We do know that taking
immediate steps to mitigate the effects of the outbreak will save lives
and prevent harm. Thank you for the invitation to participate today,
and I look forward to your questions.
Mr. Payne. Thank you.
I now recognize Dr. Dobbs to summarize his statement for 5
minutes.
STATEMENT OF THOMAS DOBBS, MD, MPH, STATE HEALTH OFFICER,
MISSISSIPPI STATE DEPARTMENT OF HEALTH
Mr. Dobbs. Chairman Payne, Ranking Member King,
distinguished Members of the committee, thank you all so much
for having me.
Oh, let me get a little closer. Yes, is that better? All
right, great, thanks.
Hey, thank you all for having me. I really look forward to
the opportunity to talk a little bit about why public health is
important. Why is it different from health care? Why is it
really relevant to what we are talking about right now?
When I was in medical school back in the 1990's, I thought
I was going to be a medical scientist. I spent--in my initial
part of my career, and much of what I was doing, I was working
on HIV control and tuberculosis control, not only in the
American south, but also too in Southeast Asia and in Russia.
I learned a lot, not only about medical things, but the
value of public health. If you want to have an impact on what
goes on in a community, you can't look simply at the
individual. You have to look at the community and the
environment that surrounds that person. It is this public
health investment that allows us to do the work that we need to
do to make sure that the public, the community, and the
individual is maximally protected.
Now, switching a little bit to the coronavirus
conversation, so coronavirus is a virus. Although most people
will get over it without a lot of sequelae, it will be very
impactful, especially for older folks. As we have seen, the
mortality rate among older people infected has been really bad.
We need to make sure that we tailor our responses to those that
are going to be most affected.
We have tools in place now that public health has been
using for years to look at different things. In Mississippi,
for instance, we have these massive--well, significant flu
outbreaks in nursing homes every year. We have learned very
quickly that, if we implement those basic public health
responses like rapid identification, immediate isolation,
quarantine, restricting visitation, that we can actually
severely limit the impact on our older folks.
The things that we have learned year after year from not
only our sort-of micro outbreak responses, but also too from
these major things like H1N1--we are talking about Ebola, Zika,
chikungunya, we build up expertise, we build up capacity, we
build up tools. When we talk about Ebola virus, we scrambled,
right, because it was a new thing. What do you do? We are--you
know, the community is really scared about what is going to
happen with people in the community.
So we basically put together technology to do home
monitoring, using mobile devices. But building on that
foundation, we were then able to go on to use this for our
folks coming over for coronavirus. These historical lessons
help us work to the future.
But one of the challenges that we face is this funding up
and down, where sometimes we will get specific money to address
a specific issue like Zika, or like Ebola. But then, as that
crisis resolves, or sort of diminishes, then we are--have to
contract back to a state of acceptable, but not sufficient
readiness.
When we look at what is going on in Mississippi right now,
we have activated our agency emergency response functions, and
we are working closely with our State emergency management
agencies. Within Mississippi and other States we have a
pandemic response plan that is tailored to influenza, but we
know that the elements within that plan are well-suited to the
response for pandemic coronavirus. Pulling together different
experts within our State, especially under the--Governor Reeves
passed an executive order putting a new planning committee--we
are going to leverage that information that we got from
responding to H1N1, making sure we are prepared for that next
flu pandemic to move forward.
But we can't really make sure that we advance those efforts
unless we have some steady funding, and don't go through this
perpetual sort-of roller coaster cycle of funding for one thing
that is limited to that, don't have the flexibility then to use
it for the next thing. I really think that we could almost use
less money, if given more stably over time, and be more
effective if we were able to be prepared for the next thing.
Also, let's talk about innovation. I think innovation is
very important, making sure that we innovate not only in
technology for surveillance, because the things that we use for
public health are high-tech, data-rich environments.
We are just recently in Mississippi invested in artificial
intelligence, business analytics, trying to look at what is
going on with outbreaks in our State. These are things that are
not inexpensive, but it is not only the software, it is also
the people that you have to do that. If you want to have the
best people doing the most important job, we need to make sure
that we build up our public health work force, and have the
people there that can do what they need.
Then telehealth, I would like to really say I appreciate
the creativity of expanding telehealth options as we are
looking at this COVID response, because what is going to be
better than making sure people can be getting care of their
home, either if they are unable to get out, or if they are ill,
or if they are being monitored, but also too these older folks
who might need to be coming in for another non-medical reason
besides a viral illness. They can stay home and be cared for,
not come into the health care environment, where they are going
to be exposed to these potentially dangerous things. We are
proud in Mississippi to have a Telehealth Center of Excellence,
where we are advancing telehealth capabilities to reach people
in all sorts of areas, and the department of health has
partnered with them.
I would like to thank you for the funding coming down. We
will put it to good use, and make sure we do our best to cut
off this epidemic. Thank you.
[The prepared statement of Mr. Dobbs follows:]
Prepared Statement of Thomas Dobbs
March 10, 2020
Chairman Payne, Ranking Member King, and distinguished committee
Members, thank you for the opportunity to appear before you today to
discuss the evolving novel coronavirus (COVID-19) threat; what may well
be the pandemic of our generation. I am here today to discuss the
Nation's COVID-19 response from a State and local perspective as
experienced through the public health system in Mississippi.
COVID-19 is a virus that causes a febrile respiratory syndrome
similar to influenza. Although many have died world-wide, most cases
will have mild or even no symptoms. The vast majority of people
infected with COVID-19 will fully recover. Older adults and those with
chronic medical conditions are far more likely to experience severe
manifestations of the disease. COVID-19 is spread primarily from
person-to-person via infectious respiratory droplets, much like
influenza and other common respiratory viruses. Based on these
transmission characteristics, measures to limit the spread of the
disease will be focused on limiting contact with infectious patients
and decreasing the likelihood of the public encountering the virus in
public settings. To protect health care workers, strict adherence to
infection control practices and the use of personal protective
equipment (PPE) will be necessary. The increased utilization of
protective equipment is certain to strain the supply chain, leading to
resource gaps in certain areas. An increase in patients requiring
hospitalization and intensive care will strain bed capacity. Staffing
to care for an increased number of severe cases may be difficult,
especially if health care workers are ill and must stay home for
prolonged periods. There is currently no antiviral treatment or vaccine
for COVID-19.
In addition to strains on the health care system, the public health
system will be greatly challenged to meet the need. The public health
system plays a unique role in protecting the safety and well-being of
the public. When viewed through an historical lens, the majority of
health and longevity gains achieved in our society are attributable not
to clinical health care, but to public health activities that assure
that people have clean water, safe food, healthy environments, and that
they do not succumb to outbreaks of infectious diseases. This system,
especially at the State and local level, serves to ensure that disease
outbreaks are detected quickly and addressed promptly. These are
functions that cannot be performed by the traditional health care
system. Within each local jurisdiction, legal mandates charge public
health authorities with monitoring and responding to disease outbreaks
in a manner that is not achievable through entities such as clinics and
hospitals. At the State and local level, systems and staffing are in
place to ensure rapid detection of communicable disease. Trained staff
ensure disease cases are located, isolated, and treated; not only for
the benefit of the individual but also to the benefit of broader
society by preventing additional disease from being transmitted. These
actions are always in play at the State and local level, addressing
diseases such as tuberculosis, syphilis, HIV, and localized outbreaks.
Within the context of COVID-19, these systems have been activated in
Mississippi to track down at-risk travelers, maintain isolation and
quarantine, respond to outbreaks, and implement broader control
measures. At a level above these localized responses, coordinated
surveillance systems must be maintained and activated to support the
entire endeavor and coordinate across jurisdictions. These activities
are further coordinated with Federal partners such as the Centers for
Disease Control and Prevention. Staffing and maintaining this complex
and data-intensive infrastructure requires talent, funding, highly-
specialized skill sets, and access to sophistical information
technology.
When the public at large is threatened by pandemic illness, a
closely coordinated response with State, local, and National emergency
response systems is required. This coordination allows for a
unification of mission and the capacity to bring multiple partners into
the response framework, such that resource needs from all sectors can
be deployed for a common purpose. The key element that makes these
endeavors successful is unified command. This concept ensures that all
partners are incorporated into the larger effort, and that they are
accountable to a singular leadership that assures activities are
coordinated and effective. In Mississippi, we are fortunate that our
State public health agency is well-integrated into State and local
emergency response activities. The State department of health maintains
a constant staff presence within the State emergency operations center,
ready to fulfill our response function in concert with the Mississippi
Emergency Management Agency (MEMA). Our local Emergency Response
Coordinators maintain close connections to the county Emergency
Management Agencies, ensuring that we are ready to act quickly in the
event of a local crisis. Our State-wide essential services function
health care coalition (MEHC) incorporates State and local government
agencies with external health care organizations for the purposes of
joint planning, the rapid dissemination of information, determining
resource needs, and response coordination. (For MEHC members see
Appendix 1.) All of these close relationships are only reinforced by
our regular, joint activations for natural disasters and other events.
Mississippi sits in a state of readiness for the arrival of COVID-
19, with an expectation of community transmission in the near future.
As a component of our public health response, the Mississippi State
Department of Health has been placing all at-risk travelers on limited
quarantine. Our public health nurses have been directly monitoring
every at-risk person twice daily for symptoms of COVID-19, using our
established telehealth home monitoring platform that was initially
designed to assist in the management of patients with tuberculosis. As
of March 7, 2020, there have been no confirmed cases of COVID-19 in
Mississippi. Testing for COVID-19 in Mississippi is available through
the Mississippi State Department of Health and certain private labs. At
the present time, we have sufficient capabilities to meet testing
demand. As the lead agency for pandemic response, the Mississippi State
Department of Health is working closely with the Mississippi Emergency
Management Agency (MEMA) in anticipation of the arrival of COVID-19.
On March 4, 2020, Governor Tate Reeves signed an executive order
forming the Mississippi Pandemic COVID-19 Steering Committee. Based on
the foundation of the Mississippi Pandemic Influenza Steering
Committee, this broad team of State partners will refine the existing
pandemic plan to meet the specific needs of a COVID-19 pandemic. The
pandemic response plan is an organizational roadmap that helps
coordinate all partners, in a common mission, to meet the needs of
Mississippi citizens. Such coordination is key for a pandemic event, as
multiple components of society, businesses, schools, health care,
critical infrastructure, and government are likely to be affected. Non-
pharmaceutic interventions, activities that limit the spread of disease
in the absence of vaccine or medications, will be core activities in
the COVID-19 response. These include actions such as isolation,
quarantine, social distancing, and school closures. These
interventions, and their disruptive sequelae, require multi-agency
coordination and close collaboration with external, community partners.
The current pandemic influenza plan, which is updated annually,
contains essential elements that are relevant not only to influenza but
to any pandemic respiratory illness that is spread through similar
mechanisms. This continuous planning effort, supported throughout the
years with Federal funding, is absolutely essential to ensure
Mississippi is prepared to execute a response in a timely manner. This
existing plan includes directives for all State agencies under the
existing Essential Services Functions as defined in the State's
Comprehensive Emergency Management Plan. The 2019 Mississippi Pandemic
Flu Response Plan, an Annex to the State's Comprehensive Emergency
Management Plan, serves as the source document for our COVID-19
response. This Annex establishes a framework for the management of
State-wide operations, under a unified command, with appropriately
scaled and structured responses. It establishes policies and procedures
by which the State can coordinate local and State planning, response
and recovery efforts. This plan follows the National Incident
Management System (NIMS), a tool that ensures a consistent approach for
all levels of governments, while incorporating private sector and non-
governmental organizations, to work together in incident response,
regardless of cause, size, or complexity.
The State of Mississippi is grateful for the emergency supplemental
funding being made available through HHS to combat COVID-19. With this
funding, Mississippi will be able to augment testing capacity, fund
State response efforts, enhance disease surveillance, implement
community mitigation strategies, fill critical resource gaps such as
PPE and medical supplies, improve communications, support health care
delivery, support the critical social needs of the public, support
fatality management and maintain critical infrastructure. Recently-
enacted approaches to telehealth funding, such as permitting Medicare
patients in some areas to access the service from home rather than a
clinic setting, will greatly assist in community mitigation efforts by
improving efficiencies, permitting ill patients to stay home, and
allowing non-COVID-19 patients access to health care without coming
into physical contact with a clinical environment. The emergency
supplemental funding approved last week is a critical first step to
assist State and local health departments in their response efforts.
Recognizing that we do not yet know the extent to which this virus will
impact our health care and public health systems overall, it is
important to acknowledge additional supplemental funding might be
needed in the future.
Steady Federal support, through the CDC Epidemiology and Lab
Capacity grant, the Public Health Emergency Preparedness cooperative
agreements and the HHS ASPR Hospital Preparedness Program, are
essential mechanisms for supporting action at the State and local
levels. Without these programs, meaningful action at the community
level would be severely hampered. The COVID-19 response is but one of
many activations that I have experienced in my public health career.
Threats such as the West Nile Virus, pandemic H1N1 influenza,
Chikungunya, Zika, the opioid epidemic and Ebola give us historical
perspective of what we are likely to face in the future; a steady
stream of natural and man-made threats that will continue to undermine
our Nation's health and prosperity. Although different in nature, the
public health response infrastructure needed to address them is largely
the same. Support for these responses is often reactive and specific to
a specific disease event. Maintaining a robust and capable public
health response system takes a steady investment in time and effort.
The necessary skill sets, staffing, and technology are not readily
scalable in the event of acute need. As you consider future investments
in protecting the safety of your constituents, I would ask you to
consider steady and sustained investment in our public health
infrastructure. Stable support over time will permit us to remain in a
state of perpetual readiness rather than diverting essential resources
away from other public health issues when we must rapidly escalate a
response in the event of a crisis.
Appendix 1.--Members of Mississippi ESF-8 Health Care Coalition
Agriculture & Commerce (MDAC)
Agricultural Theft & Consumer Protection
Animal State Board (MBAH)
Assisted Living (ALFA, INHA, MHCA, MCAL)
Community College State Board (MCCB)
Coroners & Medical Examiners Association (MSCMEA)
Dental Association
Dental Examiners State Board (MSBDE)
Dental Services, State Public Health
Dialysis (Network 8)
Education (MOE)
Emergency Management (State, Local, Tribal, MEMA, MCDEMA)
Emergency Medical Services (State, Local, Tribal, MEMS)
Emergency Planning & Response (OEPR) Local and State Public
Health
Environmental Quality (MDEQ)
Field Services, Local and State Public Health
Funeral Directors & Morticians Association (MFDA)
Healthcare (MHCA) Home Health
Health Disparity, State Public Health
Health Facilities, LTC, Licensure & Certification
Home Health (MAHC)
Hospice & Palliative Care Association (LMHPCO)
Hospitals: MHA, Military, Parchman, UMMC, VA
Human Services (MOHS)
Institutions of Higher Learning (IHL)
Medicaid
Medical Licensure State Board (MSBML)
Mental Health (MDMH)
Mortuary Response Team (MMRT)
National Guard (Army NG, Air NG)
Nursing State Board (MSBN)
Pharmacy State Board (MBP)
Primary Health Care (MPHCA)
Public Health (State, Local, Tribal, MPHA)
Policy & Planning, State Public Health
Public Safety (MOPS)
Rehabilitation (& Vocational) (MDRS)
Rural Health/Primary Care
Salvation Army
State Emergency Response Team (SERT)
State Fire Academy
Transportation (MOOT)
Veterinary Medical Association
Women, Infant & Child (WIC)
Mr. Payne. Thank you. I will now recognize myself for 5
minutes of questioning.
This question would be to all the panelists. Many have
criticized the administration's outbreak response for being too
slow to realize the severity of the threat. How would you
assess the U.S. Government's response, and what aspects of the
Government's response could you--could be improved upon?
Mr. Klain.
Mr. Klain. You know, Mr. Chairman, I would say there is two
things where we are lagging quite badly.
The first is this testing issue. Again, as I said in my
statement, there is no reason why other countries--South
Korea--are so far ahead of us, 100,000-plus tests in South
Korea, less than 5,000 in the United States. I think that is a
product of some bad decisions made at the CDC, and a lack of a
real effort to accelerate testing around the country.
The second thing I think is hospital preparedness. In
various communities our hospitals are going to see an influx of
cases, and I don't think they have been prepared for dealing
with that, whether that is working with FEMA to temporarily
ramp up capacity in those hospitals, or to do things like they
are doing in Korea and Germany, with drive-through testing,
other things. We need to be creative and flexible, but really
increasing the capacity of our system to deal with the influx
of cases we are going to see.
Mr. Payne. OK, thank you.
Mr. Neuwirth.
Mr. Neuwirth. So I would agree with Mr. Klain, in that the
testing capabilities of each State are something that, you
know, needs to be addressed. Here in New Jersey, we have only
received 2 test kits to date. I am recognizing that, you know,
our 9 million residents are actively dealing with SARS-CoV-2, a
coronavirus. We would expect additional capacity in the State
of New Jersey to effectively and efficiently test everybody
that needs to be tested. To date, those 2 tests, 2 test kits,
you know, are something that needs to be addressed.
The second is that, recognizing how fast-moving the
situation was even back in January, it is important that
information be shared in a timely manner as effectively as
possible, and ensuring that decisions made at the Federal level
are effectively communicated to the State to ensure that the
States are in a position and maintaining a posture to implement
those policy decisions made at the Federal level. The greater
lead time that the States are given, the more effective and
appropriate those implementations are.
Mr. Payne. Thank you.
Ms. Gracia.
Ms. Gracia. Yes, I would emphasize the importance of the
coordination and, really, coordination across agencies, and
having senior-level coordination as we are seeing now through
the White House with the coronavirus task force.
Second, the importance of continuing to rely on the science
and the evidence to make decisions, whether it is policy
decisions, public health guidance that is being put out by the
Federal agencies, that we continue to rely upon the expertise
and the experience of the scientists, as well as the medical
and public health experts.
Mr. Payne. So we need to believe and trust the science that
is coming along. Thank you.
Dr. Dobbs.
Mr. Dobbs. Yes, thank you. You know, it has been a very
complicated and rapidly-evolving situation. I understand it is
very challenging.
By and large, CDC has been very responsive to our needs. I
can call the leadership pretty quickly. We, in Mississippi, we
are a little bit behind in the sense that we don't have much in
the way of testing. But we do have adequate testing
capabilities at this time.
I would say that, early on, if we were given some more
flexibility in who we test, I think that would have been good.
There were pretty strict guidelines at the beginning.
The other thing is, you know--and this is part of
preparedness, to begin with. I think the CDC coordination with
Border Patrol was a little bit difficult at the very first,
when we were getting our travelers in. We had a little bit of
hiccups with that. But they have been very responsive, and it
is a difficult situation. I just really do appreciate the work
of CDC and the assistance that they give us.
Mr. Payne. Thank you. In the interest of time, the Chair
will recognize the gentleman from New York, the Ranking Member,
Mr. King.
Mr. King. Thank you, Mr. Chairman. Let me just, I guess,
ask Mr. Neuwirth and Dr. Dobbs.
Again, you sort-of touched on this already, but what
improvements could be made in coordination with the Federal
Government now?
I mean allowing for whatever has gone wrong in the past,
but as of today forward--or I would say the last several days
going forward, how do you see the level of coordination, and
what improvements can be made?
Mr. Dobbs. Yes. Well, I think the coordination even among
Federal agencies would be good, because we have seen some
missed communications between those levels, which then kind-of
trickles down to us. That can be a little bit difficult. You
know, quick communications are very important. By and large, I
think that has been very good.
I think clear understanding of what funding is going to be
available, and what we can use it for.
Also, I can't say how much I support the hospital
preparedness program. I think that that has been cut some over
the years. That is really a foundational element for these
sorts of responses. We have pulled back from, I think, actually
cashing up as many supplies and PPEs we had in years past,
because that has--the priority on that has shifted a little
bit. I think that would be very important.
Mr. Payne. Mr. Neuwirth.
Mr. Neuwirth. Specifically referencing Joint Base McGuire,
Joint Base McGuire-Dix-Lakehurst, you know, this is a base used
by our Federal partners as a potential housing solution for
quarantined individuals. New Jersey has put forth a remarkable
amount of support and resources to ensuring that this housing
solution remains intact and fully functional to meet the
demands of the situation. You know, the base was operational
for an initial 2-week period, and the State, up until the
absolute deadline of Friday at 8 a.m., was unaware whether or
not that--the base would remain operational for the quarantine
for--as a quarantined housing solution.
So ensuring that, you know, New Jersey can appropriately
support, you know, this housing solution moving forward, you
know, this is one example of where understanding where the
Federal Government sits, as far as continuing this operation,
and how we can best support it is important to us.
Mr. Payne. Mr. Neuwirth, since New York and New Jersey are
so close, I have a very parochial interest in this. We have
probably tens of thousands of more commuters back and forth
every day. How--what is the level of coordination between the
States?
Also, I know Governor Cuomo has gotten approval from New
York to do its own testing. Has New Jersey applied for that
approval?
Mr. Neuwirth. So yes. So we are doing our own testing in
the State. Right now, as of today, the State's public health
and environmental laboratories is the one in New Jersey
performing the tests in-State, ensuring a rapid turnaround time
as best we can. We are in lockstep with our New York City and
New York State partners.
You know, we have, you know--historically, we have had a
phenomenal relationship with the city and the State, just
because of our close proximity, the way we manage and deal with
the risk together, how we conduct our preparedness response
activities. They are often in lockstep. So it is the historical
relationships that we have been able to leverage for this event
that has ensured the relationship has been maintained and
leveraged, so that both sides of the river are fully aware what
the other side is doing, so that we are--we remain in lockstep.
Mr. King. Thank you.
Mr. Klain, first of all, let me thank you for your efforts
in Ebola. It was outstanding. I give you full credit for that.
Governor Cuomo announced something today, and I just
wondered if this was ever contemplated, if the Ebola virus had
not been contained the way it was. He has actually ordered the
National Guard in to Westchester County and New Rochelle. It is
going to be a 1-mile containment zone. Basically, it originates
from a synagogue. That is--I think now there must be 50 to 100
cases, if not actually diagnosed, but certainly people being
tested from that area.
Was that ever something that was contemplated by you? I
know it is really--I support the Governor doing it, but I can
see, if it is carried to a larger level, it is--basically, it
is going to shut down almost any community center, house of
worship, school. It will leave certain businesses open. But did
you contemplate how that would actually be implemented?
Mr. Klain. Congressman, we did not. We never expected to
have that many cases of Ebola in the United States. We were
focused on isolating people when they came here from West
Africa, and getting them promptly into treatment.
I do think, though, that this subcommittee should look at
the issue raised by this, you know, kind-of quasi-quarantine of
New Rochelle, and what other measures could be effective.
I also think thinking about the National Guard or FEMA to
help increase hospital capacity, tent hospitals, or rapid
treatment centers, I think, you know, we are going to need
person power to help respond. At a time when our health care
system--you know, we see doctors and nurses drop out because
they are sick. They are going to get the virus, too. So I
think, you know, thinking creatively about who can really help
power this response is an important thing.
Mr. King. So as far as--oh, I am sorry. My time is--I yield
back. Thank you.
Thank you very much.
Mr. Payne. Thank you. The Chair now recognizes the
gentlelady from New York, Ms. Clarke.
Ms. Clarke. Thank you very much, Mr. Chairman. I thank our
Ranking Member and our expert panelists for coming in to share
your expertise with us today.
We know that America needs a fully-funded, whole-of-
Government response to stay safe against the coronavirus. In my
home State and city of New York, we are in the midst of an
unprecedented health crisis. Leaders should not minimize or
exaggerate the scale of the task before us. We can beat the
coronavirus, but the administration needs to set politics aside
and put scientists in the driver's seat.
Having said that, Mr. Klain, after weeks of stating that
enough resources were available to fight the coronavirus, the
Trump administration finally announced that it was seeking an
emergency supplemental to make additional resources available.
This request was made more than a month after the first
recorded case of coronavirus was discovered in the United
States.
How would a timelier response--or how would a timelier
request, excuse me, have helped the United States respond
better?
Mr. Klain. Congresswoman, I think that is a good question.
I testified before the Foreign Affairs Subcommittee about a
month ago, and said that the request should already be here,
and Congress should be acting on it. I do think that more
funding might have accelerated this testing situation, might be
helping States more quickly.
I think it is important to know, again, Congress deserves
great credit for passing this funding quickly. But the real
question is how quickly does it go from Washington out to the
States. The gentlemen and ladies to my left here, you know,
they are going to have to actually make this work on the
ground, and they can't unless the money moves from Washington
to them. I think that is really where we should be focused on
now, is once Congress did this incredible thing of, in 2 weeks,
writing and passing a bill, is the money really getting out
there to ramp up testing, to ramp up health care systems, to
help the people who are going to need the help.
Ms. Clarke. Very well. So this question is for both you and
Dr. Gracia.
I think many of us in Congress were shocked and
disappointed that the administration's initial proposed amount
for the emergency supplemental was only $2.5 billion. Luckily,
Congress passed an $8.3 billion supplemental that was
significantly more robust than the administration's request.
What more can the Government do to ensure that there is
enough funding to support State and local outbreak response
efforts?
I would add to that, leaving an infrastructure in place so
that we are not rebuilding the infrastructure time and time
again as these outbreaks occur, because certainly there will be
others.
Mr. Klain. You know, Congressman, I agree with that so
strongly, and I kind-of agree with what Dr. Dobbs said earlier.
The issue sometimes is the amount of money, and the other issue
is the consistency of the funding.
We today are in the middle of an epidemic. That is what we
are focused on, as we should be. But we are only 3 years away
from the next one, and 3 years from the one after that, and 3
years from the one after that. It is these boom-and-bust cycles
in funding that really undermine our preparedness.
I think--I hope that what Congress will take out of this is
great job on the emergency supplemental, but what are we doing
to prepare for the big threat that is out there in the future?
Ms. Gracia. Thank you, Congresswoman. You raise a very
important point and question. One is a recognition that I think
you certainly have, that public health departments at the State
and local level, they are truly our first line of defense as it
relates to these types of outbreaks, to other natural disasters
where there are public health consequences. What we have seen,
however, is that there really has been a longer-term
underfunding of public health, and that there have been cuts
that have really impacted public health departments at the
State, local, Tribal, territorial levels.
We look at, for example, the Public Health Emergency
Preparedness Grant that is administered by the CDC, that that
has experienced cuts over the years, 20 percent, more than 20
percent over the past decade; where the hospital preparedness
program, which has been cut in half since 2003. These are
important funds to really be able to support public health over
time, to be able to continue to have the type of emergency
preparedness response infrastructure for surveillance for the
work force. It is very difficult to hire individuals for the
short term, and be able to guarantee that they are going to be
able to stay on board, and really build that training and
capacity within the public health departments.
There also is a need for more funding as it relates to the
core capabilities in public health, things like pandemic
preparedness, but also communications expertise, epidemiology,
and surveillance expertise, the ability to bring together
coalitions. These types of areas are truly fundamental for core
public health.
Ms. Clarke. The Trump administration has repeatedly
attempted to cut funding to public health. Could you describe
how chronic underfunding of public health makes the United
States more vulnerable to outbreaks?
Yes, I am sorry, Ms. Gracia.
Ms. Gracia. Certainly. So I think one is to recognize that
we have made, actually, important progress, in particular over
the past 2 decades, as we look at public health's level of
preparedness, in particular since the September 11 attacks.
That--there was a recognition that public health really is part
of the National health security enterprise, and that we needed
to really bolster that infrastructure, which is inclusive of
laboratory capacity, the work force, being able to have the
surveillance systems in place, and communication systems in
place, as well as looking at coalitions that can be built
between public health and health care.
But as I noted earlier, what we need to do is really build
on the expertise from these previous outbreaks and other types
of public health threats. You know, these are the individuals
who have been through these types of outbreaks and other public
health emergencies in the past. Recognizing that--the need to
have stability in that funding so that it is not at risk.
We have seen, for example, over the past decade, the budget
to the Centers for Disease Control and Prevention has declined
by 10 percent, and a large percentage of CDC's budget----
Mr. Payne. Please----
Ms. Gracia [continuing]. Goes to State and local health
departments.
Ms. Clarke. Thank you, Mr. Chairman. I yield back.
Mr. Payne. Thank you. I recognize the gentleman from
Mississippi, Mr. Guest.
Mr. Guest. Thank you, Mr. Chairman.
Dr. Dobbs, you and I had a chance to visit earlier, before
your testimony. You and I discussed about the fact that we
currently in Mississippi have both the ability and the capacity
to test for COVID-19 in our home State. Can you talk just a
little bit about that, please?
Mr. Dobbs. Thank you, sir. Part of it may be that the
timing was advantageous, but we were able to bring up the COVID
testing pretty quickly. Our public health lab, within a week of
getting the reagents and the guidance, was able to get the
testing activated.
So far we haven't done a ton of tests. We have done about
50, but they are all negative. We have got many coming in every
day. We think we have sufficient capacity to meet demand for
the near future, but also foreseeing now, with private lab
capacity coming on-line, like Lab Corps and others, that will
help with the clinical environment.
I am looking forward to the opportunity where public health
can fulfill a different role, which is mostly going to be
surveillance, so we can have a better understanding of what is
going on in different communities, and also maybe acute
testing. You know, we can run it in about 4 hours after we get
a specimen. So if there is something that needs to happen right
away, we can execute that.
Mr. Guest. Can you talk a little bit about your response
that you have received so far from CDC?
Mr. Dobbs. In response to the testing, it has been good.
The information that they have been giving us has been very
helpful. Their guidance has been very good, especially their
guidance documents for clinical scenarios.
I will say their website is kind-of cumbersome. I needed to
talk to them about that. It doesn't come as fast as you would
want it, honestly. I mean, we were always sitting on go for the
next thing. But the quality of the work has been good, from our
perspective.
Mr. Guest. Dr. Dobbs, you have talked in your opening
statement, and some of your questioning, and then in your
written statement about the use of telehealth, and you say here
that telehealth will greatly assist in community mitigation
efforts by improving efficiencies, permitting ill patients to
stay home, and allowing non-COVID-19 patients access to health
care without coming into physical contact with a clinical
environment.
Could you explain that very briefly again?
Mr. Dobbs. You bet. If you think about who is at risk for
bad outcomes from COVID-19, it is going to be older folks,
primarily, people with chronic medical conditions. These are
people that are going to access the health care system quite
frequently. A lot of it is going to be non-urgent, things that
can be done through a telehealth platform.
So we have really been pushing hard with our partners at
UMC. Actually, I was talking with some of the other big health
systems today, meeting with Blue Cross, trying to help them set
up systems where they will fund communications with people from
their home so that you don't have to right now, you know--or at
least previously, you have to go to another clinic setting
around a bunch of other people. It is so much more convenient.
This is not only an opportunity for us to help with COVID-19,
but maybe even sort-of catapult the future of health care by
thinking about what telehealth could look like.
Mr. Guest. Is it conceivable that telehealth could be used
to help screen individuals as they are coming into the country
through ports of entry?
Mr. Dobbs. In a place like Mississippi, especially, where
we don't have a lot of medical providers, and we have a pretty
rural geography, if we could leverage telehealth for that
function, or any other function that requires medical
intervention, it really does expand our reach remarkably.
Mr. Guest. Now, Dr. Dobbs, you talked about the importance
of the Hospital Preparedness Program. Could you expand on that
just a little bit?
Mr. Dobbs. If we think about who is the boots on the
ground, who are the people who are going to respond locally
when something goes awry, it is going to be those local
community folks. It is going to be the local emergency
management folks. It is going to be the hospitals, it is going
to be the clinic. It is going to be the people who are in that
area. The Hospital Preparedness Fund helps--lets us organize
these health care coalitions so that we can have a reach into
the communities and respond, but also to make sure that
hospitals are ready, not only in supplies, but also planning,
because they are going to be at the front line.
The thing that worries me more about this than anything is
going to be resource utilization within our hospitals and
intensive care units. Even now, if we have a bad flu year, we
run out of intensive care unit beds. So having that core
infrastructure to make sure that we are ready when something
above and beyond happens is going to be very important.
Mr. Guest. So that helps you and your department with the
logistics as you are trying to find placement for individuals
who are ill, whether it be with coronavirus or some other
illness that they would be battling.
Mr. Dobbs. Yes, absolutely.
Then also, even within the HPP program, there are some
flexibilities that might help. Like for instance, we have a
warehouse of PPE that we sit--that we keep. We have about
200,000 masks that we can distribute immediately if we need to.
So we are ready to go. But based on some of the structure of
that HPP program, we only can use 10 percent of over--of it for
overhead administration, but they count rent for the warehouse
as overhead, administration. So we would welcome flexibility in
funding for HPP, as well.
Mr. Guest. Dr. Dobbs, very briefly, just for the people
back in Mississippi, can you talk a little bit about the
emergency supplemental funding, and what that will be used--and
how that will be used to fight coronavirus back home?
Mr. Dobbs. Yes. We have got a laundry list of things we
want to do. We want to expand surveillance, we want to increase
lab capacity. We want to expand on our informatics. We have
already started doing some advanced analytics, using Biosense
to figure out where cases are going to be. We want to make sure
that we have resource allocated for, like, PPE or other things
to support hospitals. We want to--I have already brought on 3
doctors. I don't know how I am going to pay for them. I guess
this is how. Then--and nurses, boots on the ground, to get the
work done, and then advancing technology and equipment and
other PPE needs.
Mr. Guest. Thank you, Dr. Dobbs.
Mr. Chairman I yield back.
Mr. Payne. Thank you. The Chair now recognizes the
gentlewoman from Illinois, Ms. Underwood.
Ms. Underwood. Thank you, Mr. Chairman. Thank you to all of
our witnesses for being here today.
It is a pleasure to see my former colleagues from the Obama
administration here today as we chart a path for Congress to
lead the response to the coronavirus.
Mr. Klain, what essential leadership functions must our
Federal Government fill when it comes to helping the public,
State, and local public health departments, employers, and our
health care system navigate this public health crisis?
Mr. Klain. Congresswoman, I think it is a question of both
competence and confidence.
So I think, on the competence side, the Government has to
provide the leadership and the funding to deliver this
response. This is going to be a giant project, to manage these
cases, to roll out testing, as the panel has discussed, to help
our health care system get prepared for the influx of cases,
and to deal with all the other things, the contact tracing the
State and local public health departments are going to do as we
move toward containment, and all these other things.
So the Government, the Federal Government is going to have
to provide expertise in the form of the CDC and people at ASPR,
and BARDA, and other agencies. It has to provide funding, it
has to provide leadership. But it also has to provide
confidence. I think we need to see from Washington clear
direction and messaging so the American people can panic less,
and can understand that there is a plan in place, and a way of
attacking it, and so on and so forth.
I think both those things, you know, we just have not hit
the mark on that yet. We need to do better on both those
fronts.
Ms. Underwood. Thank you.
Dr. Gracia, you recently published a report evaluating
States' ability to respond to public health emergencies like
the coronavirus. What did you learn from publishing that report
about the actions the Federal Government must be taking to
support State and local public health departments, in addition
to providing supplemental funding?
Ms. Gracia. Thank you for that question, Congresswoman
Underwood.
So indeed, we published this report, which, as I noted
earlier, demonstrates and documents the progress we have made
overall, with regards to our National health security and
public health preparedness, but that there are areas for
improvement, one being this issue with regards to funding for
States and localities to be able to really respond in a way
that meets these increasing number and frequency of public
health threats.
We also recognize, too, that this is an important area that
not only involves the public health sector. Often we think
about these health threats as isolated to public health
departments. Yet these are issues that really require a multi-
sectoral approach, and one in which we engage various sectors,
from the business sector to the education sector, the health
care sectors, and others that are really involved and have a
seat the table, as well as the community in really driving
preparedness and response.
So when we think about what the Federal Government can be
doing, it is really helping to support that capacity for State
and local health departments, ensuring that there is that
stability of funding. So that that type of coordination, that
expertise, and that capacity can continue to be built in States
and localities to do exactly as, for example, Dr. Dobbs has
spoken about, is having the work force that is trained, having
the laboratory capacity, the surveillance that is needed.
Ms. Underwood. Awesome. In your written testimony, Dr.
Gracia, you also touched on how the flu vaccination is a proxy
measure for our ability to vaccinate a large population once
the coronavirus becomes the--coronavirus vaccine becomes
available. Can you expand on that?
Ms. Gracia. Yes. You know, the flu and what we see, for
example, with seasonal flu outbreaks demonstrates a couple of
points.
One, it shows how public health departments often are
having to deal with multiple types of crises at the same time,
and so how they can be stretched with regards to really being
able to respond to the needs of the public.
But second, because with the flu vaccine it is a vaccine
that is recommended for almost a majority of the population--it
is recommended by the CDC for individuals who are 6 months and
older--it also demonstrates what our vaccine infrastructure
looks like, in particular with regards to if we were in need of
doing a mass vaccination campaign, for example, for adults.
With children, children are seeing their physicians and other
health care providers more frequently. With adults that may be
more difficult.
So, in looking at how we are actually doing with seasonal
flu, which, as a Nation, the average--National average for
seasonal flu vaccination is 49 percent, whereas the actual
recommendation from the Department of Health and Human Services
in the Healthy People 2020 is to reach 70 percent----
Ms. Underwood. Yes.
Ms. Gracia [continuing]. We recognize that there are
shortcomings and gaps with regards to that infrastructure that
entails public health departments, health care, commercial
entities, as well to ensure that the population is vaccinated.
Ms. Underwood. Do you want to speak about why flu
vaccination is such an important part of our response to this
threat?
Ms. Gracia. So, in particular, we are currently in the
midst of, you know, the flu season, and we still have high
activity across States. You know, it is important that we know
that the best way in particular to prevent the flu is through
flu vaccination, and that many of the preventive measures that
we also talk about with regards to hygiene and hand-washing and
staying home when sick, that those are similar types of
preventive measures and guidance that we are providing as it
relates to COVID-19 and the novel coronavirus.
So, as we think about what may be needed down the line with
regards to the types of interventions, really building the
capacity to respond to outbreaks such as the flu is important
as we think about outbreaks such as COVID-19. We saw one of the
deadliest flu seasons in the 2017 and 2018 flu season in nearly
4 decades. So that really lends to how we, as a Nation, are
prepared----
Mr. Payne. Thank you.
Ms. Gracia [continuing]. For these types of outbreaks.
Ms. Underwood. Well, thank you all so much for being here
and for your testimony today. I yield back.
Mr. Payne. Thank you. The Chair recognizes the gentlemen
from Texas. All right, the Longhorn State.
Mr. Crenshaw.
Mr. Crenshaw. Thank you, Mr. Chairman. Thank you all for
being here on this important topic.
This question goes to the gentleman from New Jersey and the
gentleman from Mississippi. I just want to get your take on the
proper roles at the State level and the Federal level. We hear
we are unprepared. We hear we are way unprepared, or we hear we
are doing pretty well. It is all relative in the end, how well-
prepared we are. So I want to get an idea from you at the State
level.
What does preparedness look like at a reasonable and--a
reasonable standard?
What is the different function of a local county public
health center, versus the State level, versus the Federal
level, what is the best way to interact?
Mr. Neuwirth. So first and foremost, preparedness looks
like having the funding and resources needed at all levels of
government to adequately respond to what we are seeing day to
day, and that, you know, requires our acute care facilities,
our hospitals, our long-term care facilities, our health
departments having whatever they need immediately to conduct
their job, continue providing high-quality clinical care to
those that are ill, allow the resources and staffing and
information needed at the local health departments to ensure
appropriate case management, contact tracing, and overall
management of, you know, the pathogen in the communities as
needed.
Coordination and communication at all levels of government
is incredibly important to ensure that the States have a
unified, coherent strategy on mobilizing all of the
preparedness activities and resources that they have available
to them. Without timely information from the top about
important policy decisions that are being made----
Mr. Crenshaw. Look, can we get an example? I kind-of want
to dig into the preparedness, because you basically just said
when everything is really perfect, that is prepared. But that
is not reasonable. I asked for a reasonable standard.
You know, so, I mean, like, how much better can we be,
reasonably? I mean, I want to have reasonable conversations
here. Of course I could--we could quadruple your funding, and
then you would be more and more prepared, and you will come
back next time and ask for even more money. I know how this
goes. That is all fine. Of course we want to keep getting
better.
But within reason, within a reasonable construct, you know,
what does prepared look like? How many masks? How many pieces
of equipment are reasonable to ask for, and that we should have
had ready prior? What is--what exactly are we not--is the
Federal Government not communicating to you effectively?
Mr. Neuwirth. What has been said moments ago, that
continued funding over, you know, the past several years to
continue to maintain what we have built upon from previous
outbreaks such as Ebola, Zika, the opioid crisis. There has
been a lot of work that has been maintained, but the increases
and decreases of funding year over year degrades the
preparedness activities that we have put into place.
So ensuring that, again, that the resources are available
to the States----
Mr. Crenshaw. That the Federal--that is the Federal
Government's job, to make sure the States have the resources.
But--so at what--where is the State's role in that, and why
can't you be ready to the standard that you have set yourself--
set for yourself?
Mr. Neuwirth. We are ready to the standard we have set for
ourselves. It is a matter of maintaining that level of
preparedness year over year. Because in between those years,
the States are managing disasters, public health, natural
disasters, technological, that we use those resources and those
preparedness activities to respond to.
So it requires tight coordination and support from the
Federal Government to ensure that, you know, year over year, as
the States prepare for and respond to various disasters, that
that capability is rebuilt and, you know, exercised, and ready
for the next disaster.
Mr. Crenshaw. Sure. I am just trying to get more details,
because I am trying to get examples on exactly what--where did
we fall short, and then what exactly was it, and how can we do
better the next time. I understand that we always need to do
more coordination, and that we can talk in vague terms and say
more funding and more coordination and all of that. We are
really trying to get into some specifics here.
Maybe the gentleman from Mississippi could give us some
insight from Mississippi.
Mr. Dobbs. Thank you for your question. I think one of the
things that is important to think about from a State
perspective--and I have been doing this for a long time--is
that State budgets are--and county budgets, especially--are
very susceptible to the business cycle. When they contract,
they just--they cut indiscriminately. So the stability that we
see primarily is going to be, for better or worse, there is a
lot more stability from the Federal funding sources. So those--
that can be kind of the bedrock of public health.
The other thing that has happened, I think almost
philosophically, as we have worked to expand the insurance
coverage to people, which is important, and I think people need
health care, but there has been an assumption that public
health and health care are the same thing. They are not at all
the same. I have about half the nurses I had 4 years ago. So
how do you respond to a crisis when I can't pull nurses to go
to houses and check on people?
So I think this sort-of communication about health care
versus public health has distracted a little bit from some of
our core needs.
Then the other thing, I think relationships is so
important. So sometimes some places have great relationships
with the local folks and the counties and stuff. We have those
relationships pre-built, it is not just a money thing, it is a
slow investment so that, when things do go bad, we just call
Joe and say, ``Hey, we got this going on,'' and we know what to
do together. Again, I think that gets to the stability and the
steadiness of how much better it is just to have a slow and
steady approach, than having a more reactive approach.
Mr. Crenshaw. I am out of time. Thank you, Mr. Chairman.
Mr. Payne. Thank you. The Chair now recognizes the
gentleman from Louisiana, Mr. Richmond.
Mr. Richmond. Thank you, Mr. Chairman. I will pick up where
my colleague left off, talking about specific examples. Mr.
Klain, I will ask you.
But not having enough tests is--explain to me. Was that
necessary? Was that incompetence? Was it just oversight? Tell
me how it is that Korea has more tests than the United States.
Mr. Klain. Congressman, I think this is, as I said in my
statement, a singular failure of U.S. policy and execution. The
President imposed travel restrictions on people coming here
from China. Those travel restrictions, though uneven and not
complete, slowed the pace of the disease. It bought us time.
Buying time works, if you use the time productively.
We knew in December and early January we were going to need
millions of tests. I have said we should test 30 million people
in the United States: Seniors, people who have access to
seniors, people in nursing homes. Doing surveillance, as
several members have said, not just waiting for people to raise
their hands and say, ``Test me.'' We knew we needed that in
January.
The CDC pursued building its own tests that turned out to
be flawed. It didn't adopt the WHO test.
We don't really know what significance there was in the
messages that the President sent, that this wasn't a big deal.
He said as recently as 15 days ago there are only 15 cases, and
it is almost resolved. So you had a series of management
failures, bureaucratic failures, execution failures that leave
us so far behind other countries.
This isn't a scientific problem. If they can test 150,000
people in South Korea, America can test people, too. They don't
have any wisdom that we don't have here. So that is a failure
of execution in this country.
Mr. Richmond. Thank you.
Dr. Dobbs, let me ask you, as the lead State health
official in Mississippi, I want to engage in a conversation
about the collateral consequences and challenges that you face.
So let's take Gulfport, Mississippi. I am a casino worker that
gets paid by the hour. Biloxi and Gulfport survive a little bit
on tourism. How--if I am feeling down, how do we get that
person to take those days off that is necessary, or self-
quarantine for 14 days, and still pay their bills at the end of
the month?
Mr. Dobbs. Thank you for the question. That is an enormous
challenge. We have been engaging with business communities,
especially businesses that have a lot of hourly workers, and
not that we have a resolution to this at all, but it is a big
challenge because people who work hourly and get paid, and
don't have sick leave are not going to do it.
At the State level, State government, you actually have to
take a vacation day before you can take a sick day. So people
are not going to want to take their vacation day. So we are
looking at--as part of any emergency declaration, to actually
do away with that. So with government, there are, I think,
opportunities to address those inequities.
But in the business community it is a real challenge. I
think we, as a country and as a State, are--really need to look
at options we can do to make sure people can have paid sick
leave.
Then, the other thing to think about, and this is--there is
not an easy answer to this either--is when people have to go
home, and are out without a job for 2 weeks, who is going to
pay the power bill? You know, we are working with nonprofits,
and I know there is some capabilities to do that, but it could
be a big issue, and might cost a lot of money.
Mr. Richmond. Let me ask you a question, then. I am
completely thinking out of the box, but in New Orleans we are
accustomed to natural disasters, whether it is hurricanes,
whether it is BP, whether it is, you know, levees. That is
where FEMA steps in with either individual assistance or public
assistance, and they start off with a certain amount, and then
you have to go and prove your need, and all of the other
things.
Is FEMA the agency that we could task with providing either
individual assistance, public assistance, if needed, improve--
somebody out there--if we want to be responsible with this,
somebody out there is going to have to provide some assistance.
So could FEMA do that under the individual assistance program?
Mr. Dobbs. Technically speaking, I am not quite sure the
best mechanism. But conceptually, it sounds like a very good
fit to me. I mean, if we align this with a disaster response,
it seems like it makes a lot of sense.
Mr. Richmond. Right.
Mr. Klain. Congressman, I could.
Mr. Richmond. Mr. Klain.
Mr. Klain. Five years ago I wrote a piece where I said that
Congress should amend the Stafford Act to add epidemics as a
disaster for the purpose of the Stafford Act. Right now FEMA
could do as you suggested if you saw another hurricane in your
State, or an earthquake, or a fire. But epidemics are not a
natural disaster under the Stafford Act.
To go back to a question Congressman Crenshaw asked, I
think that is a zero cost--I mean not ultimately zero cost, as
you draw down on it, but the kind of thing that we should be
doing to get prepared. Because whether it is this one or
another one, some day we are going to face an epidemic that
really is a FEMA-triggering disaster. The Stafford Act should
catch up with that.
Mr. Richmond. Thank you. To--the former Chairman when I got
here, Mr. King from New York, one of the last recommendations
that we still have not adapted from the 9/11 Commission is to
put all of the jurisdictions to responding to natural disasters
and others, and putting the Stafford Act back under Homeland so
that we could coordinate. I think now may be the time for us to
raise that issue in a bipartisan manner to get Homeland the
jurisdiction that----
Mr. King. I agree, absolutely.
Mr. Richmond [continuing]. It should have.
Mr. King. That is long overdue, and I appreciate the
gentleman raising that issue again. Thank you.
Mr. Richmond. Thank you. I yield back.
Mr. Payne. Thank you. Let's see. Mr. Neuwirth and, I
believe, Mr. Klain. Oh, I am sorry. I have done that once
before, too.
The Chair recognizes the gentleman from Texas, Mr. Green.
Mr. Green. Thank you, Mr. Chairman. I thank the Ranking
Member, as well. I thank the witnesses for appearing.
There are times when we are not as alert as we should be. I
do confess that, as I listened, I was not as alert as I should
have been, because I seem to believe that I heard Dr. Dobbs
indicate that in Mississippi you have to take a vacation day
before you can take a sick day. I am confident that I was not
as alert as I should be. I should be more alert. I should hear,
I should listen.
Dr. Dobbs, tell me that I did not hear you properly, that I
misunderstood, please.
Mr. Dobbs. No, sir. You are absolutely correct. That is
just for State government workers, though. That is not
everybody----
Mr. Green. Well----
Mr. Dobbs [continuing]. But, I mean, it----
Mr. Green. But, you know, they eat the same way everybody
else eats.
Mr. Dobbs. Yes.
Mr. Green. You was telling me that, in Mississippi, if you
are sick, before you can have a sick--day of sick leave, you
have to take a vacation day?
Mr. Dobbs. Yes, sir.
Mr. Green. Do you know of any other State in the United
States where this is prevalent?
Mr. Dobbs. You know, I didn't know that that wasn't
prevalent. I didn't know any better.
Mr. Green. So it is--well, maybe I don't know better,
either. Staff, somebody, please help me. I want to know,
because I--that shocks my conscience, to be very honest. It
does. Sickness and vacation are totally antithetical. I mean,
they are not the same. They are not in the same class of time
and leave. But you have given me reason to pause and think.
Now, back to why I am here today. Much of what we hear and
learn when we experience these circumstances is counter-
intuitive. Wearing some sort of gear on your face, the public
believes that that is beneficial. People go out and buy as much
gear as they can for their faces, because they assume that it
will protect them.
The staff has provided me with some intelligence that I
would like to share with you, and I would like to find out what
your thoughts are. It reads, ``Many countries''--actually, it
is ``many others,'' but I will say countries--``Many countries
have implemented travel bans, restrictions, and border closures
against China and other affected nations. Notably, the World
Health Organization, WHO, opposes the use of travel bans, and
public health experts have expressed skepticism of the
effectiveness of a travel ban.''
Now, I am a layperson. I read this. I see travel bans in
place. Would somebody kindly give me your thoughts on what the
World Health Organization has indicated, in terms of its
opposition to the use of travel bans, and the skepticism of the
effectiveness?
Mr. Klain. I will try to start, Congressman.
Mr. Green. OK.
Mr. Klain. I think the issue is that almost--there has been
numerous studies of travel bans through the year, and what they
have--years. What they find is that they can delay the
introduction of a disease, but not stop it. We are living
through that right now. The Trump administration imposed a ban
on some travel from China, and yet coronavirus is here, and
spreading rapidly. It did delay, I think, the spread. But it
didn't stop it.
Now, why? In part because, by the time the ban was spread,
200,000 or 300,000 people from China had come here. Now the
disease also is coming from Italy. It is coming from all kinds
of other countries around the world. We can't stop the spread
of that. The travel bans never prevented Americans from
traveling back home to our country, as it should not. But
Americans can bring this disease to our country as much as non-
U.S. nationals can.
Even the--Trump's travel ban with regard to China exempted
crews of planes and ships. Now why? Because our health care
system needs imports from China. We can't have the kind of
things these other people are talking about--PPE, drugs in the
health care system--unless they are coming right now in our
supply chain from China. So boats from China bring those things
here. Those boats are driven by men and women who are Chinese.
So that was exempted from the Trump travel restrictions.
So my point is we live in an interconnected world. Travel
restrictions are always going to be incomplete, and imperfect,
often too late. That doesn't mean that an effort to slow the
spread of disease wasn't smart. I think it was smart in some
respects. But obviously, we are living the reality that it did
not keep this virus out of this country.
Mr. Green. Thank you, Mr. Chairman. I will yield back.
Mr. Payne. Thank you, sir.
I please ask for unanimous consent for Representative
Jackson Lee to sit on the panel and ask questions.
The Chair will recognize the gentlelady from Texas, Ms.
Jackson Lee.
Ms. Jackson Lee. I thank the Chair for his courtesies, and
the Ranking Member, as well. Thank you for holding this
enormously important hearing.
I am going to ask unanimous consent to submit into the
record a coronavirus plan of action that I introduced about 2
months ago, ask unanimous consent.
Mr. Payne. Without objection.
[The information referred to follows:]
CORONAVIRUS PLAN OF ACTION FROM CONGRESSWOMAN SHEILA JACKSON LEE
ENHANCED PRODUCTION OF N-95 MASKS
INFORMING STATE HEALTH AGENCIES AND ALL FEDERALLY QUALIFIED
HEALTH CLINICS TO TEST ALL PATIENTS PRESENTING WITH FLU-LIKE
SIMPTOMS FOR THE CORONAVIRUS
INCREASE THE SUPPLY OF FLU VACCINE AND USE PUBLIC SERVICE
ANNOUNCEMENTS TO PROMOTE GETTING A FLU SHOT TO REDUCE THE
NUMBER OF PERSONS WITH FLU-LIKE SYMPTOMS
TASK FORCE MUST NAME A SINGLE CORONAVIRUS AUTHORITATIVE
SOURCE FOR ALL FEDERAL INFORMATION ON THE VIRUS AND ESTABLISH
CLEAR COMMUNICATION LINKS TO K-12 AND POST-SECONDARY SCHOOLS,
THE MEDIA, AND THE PUBLIC
ESTABLISH A REQUIREMENT THAT THE NATION'S AIRPORTS, TRAIN,
AND MASS TRANSIT SYSTEMS BOTH SMALL AND LARGE, NEED TO HAVE
RESPONSE TEAMS AS NECESSARY TO DEAL WITH AND TREAT THE
TRAVELING PUBLIC
MAKE SURE THE FEDERAL ADVISORY TASK FORCE MAKES PUBLIC
REPORTS ON THE STATUS OF THE SPREAD OF THE CORONAVIRUS
INCLUDING THROUGH THE DEVELOPMENT OF AN APP THAT PROVIDES UP-
TO-DATE TRAVEL ADVISORIES REGARDING CERTAIN COUNTRIES AND BASIC
INFORMATION ON THE VIRUS
Prepared by the Office of Congresswoman Sheila Jackson Lee
Ms. Jackson Lee. Thank you. Let me thank all of the
witnesses that are here. It is my intention to try to ask quick
yes-or-no answers. I may focus--not painfully, Ron, Mr. Klain--
on you, not painfully, but because you have the Federal
experience, and that is where we are now. To the health
nonprofits and State agencies, I want to make sure that we are
being as helpful to you as we possibly can.
So we may have just the straight yes-or-no answers, but I
do want to say--is that, with the leadership of the House, we
passed an $8.3 billion plan--excuse me, funding that includes,
through the emphasis of Members of this committee and others,
funding to State and local health agencies. We hope that you
will see that money for purposes that you need to see them. So
my line of questioning will be along those lines, and then I
will spend some time with Ron Klain.
So, Mr. Commissioner Neuwirth, do you have test kits in
your possession in the State of New Jersey?
Mr. Neuwirth. I have two test kits in possession in New
Jersey.
Ms. Jackson Lee. It is that entire State, or do you think
your local agencies have test kits, as well?
Mr. Neuwirth. The State of New Jersey has 2 test kits, each
with 500 tests in them. We can test a maximum of 432
individuals with 2 test kits.
Ms. Jackson Lee. So even though they have--you said 500
apiece, or 500 total?
Mr. Neuwirth. Five hundred apiece, of which 432, total,
between the 2.
Ms. Jackson Lee. OK. Even with me adding and saying, oh,
you have 1,000, you are saying you can test 432?
Mr. Neuwirth. Correct. Each individual requires more than
one----
Ms. Jackson Lee. Yes.
Mr. Neuwirth [continuing]. Test.
Ms. Jackson Lee. Do you mind me saying--and this is only a
news report--that your Port Authority director--recent news
reports is indicating that your--the port, I guess, of New York
New Jersey has--is now infected with the coronavirus. Is that
something you can affirm?
Mr. Neuwirth. I, too, have seen that in the media.
Ms. Jackson Lee. All right. Let me then--Mr. Dobbs is with
Mississippi State. Thank you very much.
How many test kits do you have, sir?
Mr. Dobbs. We have the capacity to run about 700 tests.
Ms. Jackson Lee. OK. So in that--can you say what--how many
test kits you have? I know that you do several out of that.
Mr. Dobbs. We just got a shipment of that additional kit,
and each kit will run a bunch of tests, obviously. So we have
some left from the previous one, and then a new one that we
just got in this week.
Ms. Jackson Lee. OK. So you wouldn't--700 tests, does that
mean on 1 individual----
Mr. Dobbs. No, that would be 2 tests for each person, yes.
Ms. Jackson Lee. Right.
Mr. Dobbs. So about----
Ms. Jackson Lee. So you are down to 350 persons that you
could test.
Mr. Dobbs. Yes, ma'am.
Ms. Jackson Lee. OK. I am not familiar with, I am sorry,
the Trust for America's Health. Is this a----
Ms. Gracia. Yes, Congressman, we are a nonprofit,
nonpartisan public health advocacy, policy, and research
organization. One of our priorities is public health, emergency
preparedness. We produce an annual report called ``Ready or
Not'' on the Nation's readiness.
Ms. Jackson Lee. Yes. Let me just quickly ask you. There is
a debate about the contagious nature of coronavirus. Would you
say that it has a high level of contagiousness, if you will?
Ms. Gracia. Well, we are seeing that it is a coronavirus
that has easy transmissibility. So the way in which we are
talking about taking preventive measures and precautions is
similar to what we would do for other types of respiratory----
Ms. Jackson Lee. But does it have a higher level of
contagious factors?
Mr. Payne. Oh, yes.
Ms. Gracia. So we are still learning a lot about the
disease. I think, one, we recognize enough that, yes, there is
person-to-person transmission. We are seeing community spread
in certain parts of the country.
Ms. Jackson Lee. Right.
Ms. Gracia. So, because of that, we are taking these types
of precautions----
Ms. Jackson Lee. I think, to a high degree, maybe than some
others--people are not confusing it, but comparing it to the
flu. I don't pretend to be a professional, but I would venture
to say that the flu does not equate in its contagious factors
to now the coronavirus.
So I am going to go to--I was almost going to call you Ron,
Dr. Klain, but let me move forward. My premise is that we have
not been effective as a Federal Government, starting with the
administration. Ebola, under the administration of President
Obama and Biden, and one of the strongest--or one of the more
difficult cases was in a hospital in Dallas, in the State of
Texas, where medical providers, nurses, and others--someone
took off for a wedding, someone else took off for vacation.
But let me ask this. We--I think we had knowledge of this
in December 2019. What would have been the roadmap?
Preventative equipment for our health providers? Storing up our
test kits so that they could be appropriately distributed? The
appropriate documentation to inform people about washing hands
and otherwise? Coming out with an immediate statement, say,
right after the first of the year, talking about preparedness
and not panic?
Can I yield to you on the response that you have seen so
far?
Mr. Klain. Thank you, Congresswoman. I would say there are
3 things that should have happened in January that didn't
happen.
First, a real focus on getting this test capacity problem
solved, either by adopting the WHO testing approach, or by some
other solution. We are just way behind. As a result of being
behind, we can't really have an effective containment strategy
for identifying where the disease is. It is in a lot of places
in this country. We don't know where it is. That is a problem.
That is a failure on testing.
Second, I think getting our medical facilities preparedness
for a surge of cases. Particular hospitals, particular
communities, community health centers are going to see an
influx of cases, and not really have the capacity to deal with
that. I think that is really a problem.
The third is, I think, crisper communications about warning
people that this was coming. I understand we don't want to
panic people. We don't want to be hyperbolic about it. But we
have really known since January that we would see a ramp of
cases that would have effects across the country. What we are
going through right now is a kind-of a little bit of public
panic, because it is coming on suddenly, it is unexpectedly. We
haven't really prepared for that, and I think those are the 3
things that we missed by a slow response here.
Ms. Jackson Lee. Let me just----
Mr. Payne. Thank you.
Ms. Jackson Lee. Let me just thank you very much, and----
Mr. Payne. Yes, the----
Ms. Jackson Lee. Ron, I will try to follow up with you.
Excuse me for that, Mr. Klain. I will try and follow up with
you. Thank you.
Mr. Payne. Thank you. The gentlelady's time----
Ms. Jackson Lee. Thank you, Mr. Chairman.
Mr. Payne [continuing]. Has expired. Let's see now.
I have a unanimous consent request for the gentleman from
Louisiana.
Mr. Richmond. I ask unanimous consent to put in the record
an article by Ron Klain, ``A Success Not to be Repeated.''
Mr. Payne. Without objection.
[The information follows:]
Article Submitted by Honorable Cedric L. Richmond
A Success Not to Be Repeated
Ronald A. Klain, External Advisor to the Skoll Global Threats Fund and
Former White House Ebola Response Coordinator. September 29,
2016.
In October 2014--after the first death from Ebola on U.S. soil, the
first transmission of the disease here, and in the wake of a rapidly
escalating epidemic in West Africa--President Obama asked me to become
the White House Ebola Response Coordinator, or Ebola czar. We got a
late start, and had some shaky moments at first, but in the end, we
helped save hundreds of thousands of lives in West Africa, protected
the American people, and increased our health care system's readiness
for a future epidemic. Now, with the AAMC's help, we can try to make
sure we don't have to undertake such an effort again.
Make no mistake: The Ebola response effort delivered critical
results, and the AAMC and its member institutions were major
contributors to that work. We accelerated Ebola response efforts,
learned from early missteps, and assembled resources to battle the
disease at home and abroad. Academic medical centers like Emory
University, the University of Nebraska Medical Center, and Bellevue
Hospital Center were prepared and equipped to treat Ebola patients in
the United States and to keep the virus contained, while many others
led local preparedness efforts and continue to help advance medical
research on Ebola. These facilities and the AAMC provided valuable
advice in our strategy to prepare American medical facilities to screen
suspected Ebola cases, and treat those with the disease safely and
effectively. The association was among the earliest supporters of
President Obama's emergency Ebola response funding package on Capitol
Hill, which won prompt bipartisan support and was signed into law only
6 weeks after it was sent to Congress. As a result, the United States
was able to provide generous help to the global response effort in West
Africa, and make much needed investments in our preparations to combat
infectious disease at home.
Now, our challenge is to make sure that this is a success we never
need to repeat.
``A preparedness strategy that only takes us from crisis to
crisis--often with unreliable funding--is not ideal, and maintaining
readiness for both expected and emerging threats is a long-term and
expensive endeavor.''
We can't prevent the threat of other dangerous infectious diseases:
Far from it. Indeed, with the increased interaction between humans and
animals through habitat incursion, the impact of globalization and
expanded global travel, and the consequences of climate change, the
world is entering a phase of accelerated emergence and re-emergence of
dangerous infectious diseases. Middle East Respiratory Syndrome in
2012, Ebola in 2014, and now Zika in 2016--with Yellow Fever on the
horizon--show how serious and frequent these sorts of epidemics are
becoming.
It is precisely because such epidemics are increasing in frequency
and spread that we need to change the way the U.S. Government responds
to them. Yes, we had an Ebola czar, but we should not need a Zika czar,
a Yellow Fever czar, or some future pandemic flu czar. And yes, we got
emergency funding through Congress to fight Ebola--but the package to
fight Zika has been stalled for months, and future epidemics will move
faster than Congress can in assembling a response.
Medical schools and teaching hospitals are frequently on the front
lines of these epidemics, and the public has come to count on these
institutions to partner with the broader public health community to
scale up rapidly for the highly specialized expertise in research,
education, and clinical care needed to combat such challenges. A
preparedness strategy that only takes us from crisis to crisis--often
with unreliable funding--is not ideal, and maintaining readiness for
both expected and emerging threats is a long-term and expensive
endeavor.
As a result, the AAMC's help is needed to make two critical changes
in how the United States responds to these threats in the future.
First, instead of appointing ad hoc czars after an epidemic breaks
out, the next President should create a Pandemic Prevention and
Response Directorate in the National Security Council, much like those
that already exist to fight terrorism and climate change. This team
would have the responsibility of developing epidemic prevention and
response strategies, funding proposals, and working with private
partners--before the next outbreak. The directorate would be
responsible for both naturally occurring epidemics as well as potential
bioterrorist threats. This permanent effort should be led by a senior
White House official, a deputy assistant to the President who would
report directly to the National security advisor and have access to the
President. The AAMC should continue its engagement with the broader
public health community and support the creation of a new, permanent
White House effort to coordinate epidemic prevention and response.
This change in how the Government manages epidemics should be at
the top of the list for the next President and should be in place on
Inauguration Day 2017.
Second, when a tornado, earthquake, or hurricane strikes, the
President does not need to wait for Congress to act to send help--the
President has authority under the Stafford Act to send immediate
assistance. But as we learned with Ebola, and now with Zika, the same
is not true for epidemics. These natural disasters are not covered by
the Stafford Act, and the President must plead with Congress to provide
funding for prevention and response efforts. In the face of a public
health emergency, however, the time that such wrangling consumes can
put us further behind the epidemic, render our counter measures less
effective, and even cost lives.
The bipartisan group--led by Sen. Brian Schatz (D-Hawaii) and Sen.
Bill Cassidy (R-La.), and Rep. Rosa DeLauro (D-Conn.)--has proposed a
solution: A Public Health Emergency Fund that would make immediate
assistance available for epidemic response when the Secretary of Health
and Human Services declares a public health emergency. When a public
health threat requires an emergency response, either at home or abroad,
such a fund would ensure that lack of immediate access to funds does
not prevent necessary action. Backing from the AAMC for this type of
emergency fund would help move this proposal closer to reality.
The AAMC played a major role in America's response to the Ebola
epidemic of 2014-15, and as a result, lives were saved in Africa and a
health crisis was prevented here in the United States. Now, its
leadership can make a major difference in making sure we have the
direction and resources in place to combat the next such challenge--
before it becomes a public health crisis.
Ms. Jackson Lee. Mr. Chairman, may I add something to the
record?
This is dated March 3, 2020. ``The U.S. has only a fraction
of the medical supplies it needs to combat the coronavirus.''
This is in the National Geographic.
Mr. Payne. Thank you.
Ms. Jackson Lee. I ask unanimous consent----
Mr. Payne. Without objection.
[The information follows:]
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.
Ms. Jackson Lee. Thank you.
Mr. Payne. Mr. Neuwirth, we have heard the--that the
Federal Government has been ineffectively communicating, and
providing contradictory guidance to the local and State
governments during this outbreak. What has your experience
been, and how can communication with the State and locals be
improved?
Mr. Neuwirth. So our experience has been one of--you know,
there have been challenges up until this point ensuring that we
are able to effectively implement the policy decisions of the
Federal Government in a timely and consistent matter.
We are in lockstep with our regional Federal
representatives at the U.S. Department of Health and Human
Services and the CDC, of course. But there--you know, there
have been, since the beginning of this in January, instances
where, you know, additional lead time on information coming
from the Feds would have provided the State of New Jersey
additional time to prepare and respond in an even more
efficient manner.
Up until this point we have been very proactive in our
implementation of the crisis management team and the
coronavirus task force, so we have been prepared to respond on
a moment's notice. But additional lead time of information
coming from the Feds on important decisions such as screening
at the airports, the joint base, and the testing kits would be
tremendously valuable.
Mr. Payne. Yesterday we learned that the CDC has delayed
confirming presumptive coronavirus cases in New Jersey. Has
this issue been resolved?
Mr. Neuwirth. This issue has not been resolved. To date the
CDC has not confirmed any presumptive positive case in New
Jersey.
Mr. Payne. Thank you. To Mr. Klain and Mr. Neuwirth also,
the roll out of the testing kits has been flawed, obviously; we
have 2 in New Jersey. What could the Government have done
better to ensure that local and State laboratories could test
Americans for coronavirus?
Mr. Klain, you want to start?
Mr. Klain. You know, Mr. Chairman, as I said a minute ago,
I think that we could have made a decision to adopt the testing
protocols and kits used in other countries that have allowed
them to ramp up very quickly. We made a different decision here
that didn't work out.
We also could have made it a higher priority to really
focus on that. I just think we lost time. We are behind.
I think the decision to bring in private labs is a positive
decision. It certainly increases the capacity, but that is only
going to deal with people who are in a diagnostic or clinical
setting. Your doctor sends you and says, ``Go get a lab,'' and
we really need to be doing surveillance. We need to be going
out in the community and finding the cases, finding the cases
in nursing homes, and community centers, and where older people
congregate. I think that is really a weakness of relying on
private labs as the principal solution for testing.
Mr. Neuwirth. I concur with Mr. Klain. It is important to
recognize that the State public health environmental
laboratories, of which--there is a network of them across the
country--are--primarily serve as surveillance laboratories, not
clinical diagnostic laboratories. We do not, as State labs,
have the clinical throughput that these third-party commercial
labs have.
So it is important to bring on-board and bring on-line
these third-party commercial laboratories for the clinical
diagnostic piece that they can test tens of thousands of
individuals at any given time, and allow the State's public
health and environmental laboratories to conduct a very
progressive and very, you know, comprehensive surveillance
activities across the State to ensure we remain ahead of where
these cases are.
Mr. Payne. Thank you. In the interest of time, votes have
been called, and I will recognize the gentleman from New York
for a question and a closing.
Mr. King. Thank you, Mr. Chairman.
I have a question, Mr. Klain, and let me just state for the
record up front that there were, obviously--the whole issue
with the test kits was wrong. They should have been out. So I
am asking this in not a rhetorical way, but planning toward the
future with what we learned from the past.
To me, the CDC, the fact that they did not accept the WHO,
was there a reason for that?
Second, is there partisan influence in the CDC, or was this
an honest mistake made by scientists in the CDC, or doctors at
the CDC when the test kits came out and they were obviously
inadequate and they were flawed?
So what I am getting at is there can be policy mistakes,
and there can be just the luck of the draw, that they did their
best, and it went wrong.
So, again, any thoughts that you have on that, based on
your experience?
Mr. Klain. Congressman, you know, I think we don't know the
answers to that question. We don't know the answers to some of
those questions. You would have to ask CDC why they made the
choices they made, and then why the approach they took didn't
work. I don't know the answer to that.
I think--I don't think this is a partisan thing. I don't
think this is some conspiracy, or some political decision to go
this way. But I do think--and so I don't want to overstate my
criticism of the administration, but I also don't want to
understate it, which is I think the signs were flashing yellow
early on that the CDC approach was not going to work.
I think stronger coordination and leadership from the top,
from the White House, would have said, ``Hey, you know what? We
have got a mess here.'' No one chose to make this mess. It was
an accident. But we need to do something quickly to turn this
around and to get this fixed.
So, you know, I don't blame anyone for the initial mistakes
and the consequences. But then, you know, that is what
leadership is. Leadership is saying, ``Hey, this isn't working.
We need to get on top of this. We need to catch up.'' I think
that is, I think, where, you know, again, without being
partisan or political, I think that is where the policy
decisions came, which was, once the lights were flashing
yellow, what did we do to accelerate a response to that.
Mr. King. I guess the only question I would add to that--
and again, I don't have the answer, so I am not trying to make
this a partisan debate--is if they had done that, would they
have said this was politicians interfering with the scientists?
I mean, if CDC thought this was the right way to go, and
the President or the Vice President or some Republican Member
of Congress said, ``Hey, you have got to speed this up,'' and
then they did speed it up, and it didn't work, they would say
it was politicians interfering with science.
I mean, again, I am trying to----
Mr. Klain. Yes. No, Congressman, I think that is----
Mr. King. But, I mean, the people at the top, you have to--
--
Mr. Klain. No, Congressman----
Mr. King. They are going to take the blame, I realize that.
Mr. Klain. That is a--look, I think, Congressman, that is a
fair question. What I would say is that the role of political
leadership, whether that was President Obama in the Ebola
response, or President Trump and Vice President Pence now, is
to ask the scientists, ``How is it going? What is going on
here? Why is it that I am waking up and I see that Korea has
tested 50,000 people and we have tested 500?''
Mr. King. I am asking the same question.
Mr. Klain. You know, like--so I don't think there is
anything politicizing about science to ask your scientists,
``How come I am seeing this on the news, and how come I am not
seeing this here?''
Ultimately, the medical decisions, the scientific decisions
should be made by them. But, you know, the Government should
hold people accountable for results.
Mr. King. Again, if I could make a semi-partisan point,
maybe that is why it is important to have you and the Vice
President running these things finally.
I mean, again, maybe if Mike Pence had been there from the
start, they would have gotten a faster result. The bureaucrats
sometimes only respond if you know that----
Mr. Klain. Congressman, I absolutely agree with that. I
think that some kind of White House coordinator was needed. It
was one of my early criticisms of the administration. I am glad
they have done it.
My only criticism of the current coordination would be I
think someone really needs to be on this full-time. I think,
obviously, the Vice President has a lot of other
responsibilities, as he should. That is not a criticism, it is
just a reality. I think they brought in Ambassador Birx, who I
have a great deal of respect for, to work with the Vice
President. She is still doing her other job, as well, kind-of
running PEPFAR. I think, whether it is her or someone, this
should be a full-time job. This is a big problem for our
country. Leading the response shouldn't be your side gig.
Mr. King. I just hope, when this is all over, we have a
good after-action report. Thank you for your service.
Mr. Payne. I thank the gentleman. I--you know, and I
absolutely am a believer, in a time of crisis, we should tend
to lean on people that have had some experience in the past,
the near past, such as yourself, involved in these things. So
thank you for your service.
I would like to thank all the witnesses for their valuable
testimony, and the Members for their questions.
The Members of the subcommittee may have additional
questions for witnesses, and we ask that you respond
expeditiously in writing to those questions.
Pursuant to committee rule VII(D), the hearing record will
be open for 10 days, without objection.
Hearing no further business, the subcommittee stands
adjourned, and we are 389 not voted. Thank you.
[Whereupon, at 3:38 p.m., the subcommittee was adjourned.]
[all]