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Dr. Anthony Fauci And Top Health Officials Testify Before Senate; Dr. Fauci: We Feel That Number of Deaths Are Likely Higher Than 80,000. Aired 11-11:30a ET
Aired May 12, 2020 - 11:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
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SEN. PATTY MURRAY (D-WA): And yesterday, President Trump had the gall to declare the U.S. had, quote, "prevailed on testing," in a press conference that was filled with misinformation and distortions.
Dr. Giroir, public health experts do not think the U.S. has prevailed. I'm glad you've finally committed that states -- including my home state of Washington -- will receive enough tests to meet their goals for May and June, but this administration has had a record of giving us broken promises that more tests and supplies are coming, and they don't. And we know, by the way, that testing is going to -- needs will persist long past June, long (inaudible).
So I wanted to ask you, today, will the administration's forthcoming strategic plan, that is now required under the COVID package that was just passed and signed into law, will that strategic plan on testing include specific numeric targets for testing capacity, supply chain capacity and projection of shortages?
ADMIRAL BRETT GIROIR, U.S. PUBLIC HEALTH SERVICE COMMISSIONED CORPS: Thank you for that question and statement, Senator Murray.
Yes, we are, as I've stated, we continue to have a work in -- in progress as we build the testing capacity. We have established the targets with the states, of over 12 million tests over the next four weeks. We think those targets are going to be good in May and June. But as Dr. Fauci said, we really have to be evidence-based.
We expect those targets to go up, as we progressively open, as communities go through phase one and then into phase two. And certainly, those numbers will need to go up significantly again in the fall, when we potentially have influenza circulating with -- with COVID.
So, yes, there will be targets. The targets will need to change, based on the evidence that we see, but we are highly committed to securing the supply chain. We work daily with every manufacturer, and I'm just pleased we're, in May and June, able to get ahead of the states so that we can supply them what they need so they have those assurances.
GIROIR: So there's not going to be any doubts about that. MURRAY: But (ph) my question (ph) to you is, when you put out that specific plan that you were required to do, we will see numbers that you are going to tell us that you will reach, targeted for testing and supply chain capacity and production (ph) (inaudible). Instead of just saying, We hope to have a million this week, next week, some -- you will give us the specific targets, correct?
GIROIR: We know specifically -- I'll say yes, ma'am, we know the specific -- we know the specific amounts of tests we have over the -- over the summer, where...
MURRAY: Not have, how many we need.
GIROIR: So, yes, ma'am. We developed the need statements by working with the states individually, with epidemiologists, with the CDC so that overall in May, we'll be testing about 3.9 percent of the overall U.S....
GIROIR: ... population.
MURRAY: Fine (ph), but what I'm -- I'm telling you that...
SEN. LAMAR ALEXANDER (R-TN): Well, over time, Senator Murray.
MURRAY: ... how many we have, but how many we will need, not just for May, but in the coming months, so that we can be prepared to have them.
GIROIR: Yes, ma'am. And not to be repetitive, but we need to be evidence and data-driven. Because what we may see in May or June will drive differences in the amount of test goals we have. So we -- we really just need to be very humble about this, we need to look at the data.
We know that the testing needs will go up over May and June, as we progressively open, and we will do our best to predict that, but you have to understand, we have to see what the data and the evidence show at that time.
MURRAY: OK, I appreciate that.
And Mr. Chairman, again, what our strategic plan requires is what is the goal. Not how many we have, but how many we need. And that's what we'll be looking for. Thank you.
ALEXANDER: Thank you, Senator Murray.
SEN. MIKE ENZI (R-WY): Thank you, Mr. Chairman. And I particularly appreciated your opening statement, where you had a very succinct list of preparations we need to learn from this pandemic for the next one. Not only should we be working on this and preparing, but we need to look at the future too. And I think we've learned a lot. We're fighting a virus at the same time that scientists are learning about it, so we need to be nimble. We also need to ensure that we are prepared for a second wave of outbreaks that could (ph) coincide with the start of the flu season, potentially stressing our health care system even more than it already has been.
Admiral Giroir, I thank you for your comments. I think they've been comforting about what has been done and what can be done. I agree with Senator Murray that we need to have some specific goals. As an accountant, that's always one of the things that I'm looking for.
For questions, Dr. Hahn, our understanding of the clinical picture of COVID-19 continues to evolve.
What first looked like a respiratory illness now seems much more comprehensive, potentially affecting the heart, the brain, the kidneys and other organs. How does this evolving picture impact the ability to evaluate the appropriate clinical or surrogate endpoints for review of vaccines and treatment?
DR. STEPHEN HAHN, COMMISSIONER OF FOOD AND DRUGS, USFDA: Thank you, Senator, for that question. The -- the evolving clinical picture -- and obviously, the way this is manifesting around the country clinically -- does in fact inform the end points that we will work with developers of therapies on, so that we can get the absolute most efficient, but also the most accurate information and appropriate endpoints to make the necessary authorizations and approvals.
We have set up this program called the Coronavirus Treatment Acceleration Program, where our top scientists and clinicians have been at the table, consulting with our colleagues at NIH and CDC to actually address those questions.
What are the appropriate endpoints? I'll give you an example. We do know that in some circumstances, patients who had several COVID disease have developed thrombotic or clotting-type episodes. And so we've prioritized a review of agents that we think might be beneficial.
And obviously, the clinical endpoints for those trials will be different than an agent that's an antiviral like remdesivir where, as Dr. Fauci mentioned, we're looking at time to recovery. So we want to adapt it to the clinical circumstance, as well as to the type of therapy that's put before us.
ENZI: Thank you.
Another question to Dr. Hahn. We have made a lot of progress in vaccine development already, but BARDA has identified that domestic manufacturing of needles and syringes in a significant gap in pandemic preparedness. What has HHS done in advance of a potential national vaccination campaign to ensure that we have sufficient capacity to administer a vaccine? HAHN: Senator Enzi, thank you for that question.
This is a really important point, because as you mentioned, it's not just about the vaccine or hopefully vaccines that are developed, it's all about -- it's also about the supplies that are needed as well as an operational plan for administering the vaccine.
HAHN: So this is an all-of-government approach. There is a program that's been set up called Operation Warp Speed that includes Dr. Collins, Dr. Fauci, his colleagues at NIH, the Department of Defense as well as other members of HHS and FDA.
Dr. Peter Marks from our Center for Biological Evaluation and Research has been helping coordinate that, is working very closely with Dr. Fauci and his team, and we have created what is called a Gantt chart to look forward, what are the necessary supply chain issues syringes, needles, et cetera depending on the various vaccines that are being developed, how many times they have to administer it and the route of administration.
So we've been leaning in on this supply chain to ensure that when a vaccine is ready to go we will have the necessary supplies to actually administer it and operationalize the vaccination.
ENZI: Thank you. I have a couple of more questions, but again the clock's not visible there so I expect I've used up my time. I'll submit those in writing.
ALEXANDER: Thank you, Senator Enzi. Senator Sanders.
SEN. BERNIE SANDERS (I-VT): Thank you very much, Mr. Chairman. And let me thank all of the panelists for the hard work they're doing, and for being with us today. It is sad to say that we have a president of the United States, the leader of our country who, from day one downplayed the dangers facing this country from the pandemic who told us that the crisis would be over in a few months, that we did not have to worry.
Who fired those members of the government who wanted to act aggressively, and among other things the time when we need international cooperation, cut funding for the World Health Organization.
But let me also say that I think we understand that facts are terribly important, not everybody that we don't fully understand, all of the ramifications of the COVID-19 epidemic. But let me ask Dr. Fauci a few questions, if I might.
For a start, the official statistic, Dr. Fauci is that 80,000 Americans have died from the pandemic. There are some epidemiologists who suggest the number may be 50 percent higher than that, what do you think?
ANTHONY FAUCI, DIRECTOR, NIAID: I'm not sure, Senator Sanders, if it's going to be 50 percent higher, but most of us feel that the number of deaths are likely higher than that number because given the situation, particularly in New York City, when they were really strapped with a very serious challenge to their health care system that there may have been people who died at home who did have COVID, who were not counted as COVID because they never really got to the hospital.
So in direct answer to your question, I think you are correct that the number is likely higher. I don't know exactly what percent higher...
FAUCI: ... but almost certainly it's higher.
SANDERS: Dr. Fauci, let me ask you this, in the terrible pandemic of 1918 the virus exploded in the fall, it came back with a vengeance. Are we fearful that if we don't get our act together, as bad as the situation is now, it could become worse in the fall or winter?
FAUCI: Well, Senator, thank you for that question, it's a frequently asked question. And I think that possibility does exist, however -- and the reason I say that is that when you talk about will this virus just disappear?
And as I've said publicly many times, that is just not going to happen because it's such a highly transmissible virus, and even if we get better control over the months it is likely that there will be virus somewhere in this -- on this planet that will eventually get back to us.
So my approach towards the possibility of a rebound and a second wave in the fall is that A, it's entirely conceivable and possible that it would happen, but B, I would hope that between now and then, given the capability of doing the testing that you've heard from Admiral Giroir, and the ability of us to stock up on personal protective equipment, and the workforce that the CDC under Dr. Redfield will be putting forth to be able to identify, isolate, and contact trace.
I hope that if we do have the threat of a second wave, we will be able to deal with it very effectively to prevent it from becoming an outbreak not only worse than now, but much, much less.
SANDERS: OK. Well, let me ask -- we have heard a lot of discussion about vaccines, obviously everybody in Congress and in this country wants a vaccine, we want it as quickly as possible, as effective as possible.
Let me ask the honorable FDA Commissioner, sir, if God willing a vaccine is developed, and if we're able to produce it as quickly as we all hope we can, I would imagine that that vaccine would be distributed to all people free of charge, or make sure at least that everybody in America who needs that vaccine will get it, regardless of their income, is that a fair assumption?
HAHN: Senator, I certainly hope so. FDA is very committed to making sure that all populations in the United States, including those most vulnerable, are included in the clinical trials, and... SANDERS: Well, that -- sir, that's not what I'm asking. What I'm asking is if and when the vaccine comes, it won't do somebody any good if they don't get it. And if they have to pay a sum of money for it in order to profit the drug companies, that will not be helpful. Are you guaranteeing the American people today that that vaccine will be available to all people regardless of their income?
HAHN: Sir, the payment of vaccines is not a responsibility of FDA, but I'm glad to take this back to the task force. I share your concern that this needs to be made available to every American.
SANDERS: Does anybody else want to comment on that?
Mr. Giroir, do you think we should make that vaccine when, hopefully it is created, available to all regardless of income? Or do you think that poor people and working people should be last in line for the vaccine?
GIROIR: I'm sorry, Senator, were you asking me...
SANDERS: Yes, I was, sir. Yes, I was.
GIROIR: No, I -- my office is one of the offices committed to serving the underserved, and we need to be absolutely certain that if a vaccine, or an effective therapeutic or preventive is available that it reaches all segments of society regardless of their ability to pay or any other social determinants of health that there may be.
SANDERS: Good. So when you're telling the American people today that regardless of income, every American will be able to gain access to that vaccine when it comes?
GIROIR: They shouldn't (ph) gain access to it. I don't control -- you know...
SANDERS: Well, you represent -- you represent an administration that makes that decision.
GIROIR: I will certainly advocate that everyone is able to receive the vaccine regardless of income or any other circumstance...
SANDERS: Let me just switch gears...
ALEXANDER: You're over time, Senator Sanders...
SANDERS: All right, I'm sorry. All right, thank you, Mr. Chairman.
ALEXANDER: Those are important questions. I don't want to cut senators off, and it's hard to see the time clock, but if we could stay as close as possible to five minutes then all senators can get their questions in.
Thank you, Senator Sanders.
SEN. RICHARD BURR (R-NC): Thank you, Mr. Chairman.
And thank our witnesses today for what you've done for the people in this country and their safety and people around the globe. Let me ask you, Dr. Fauci, because you have been in the task force and at a majority of the press conferences.
Has anybody in this administration ever asked you or any member to take the foot off the gas of trying to find a cure or any type of counter measure?
FAUCI: No, Senator, not -- not at all. As a matter of fact, we at NIH, as you know, have been right from the very beginning. Put out foot right on that accelerator in every aspect, including the development of vaccines and therapeutics.
And as I've described my opening statement, we actually started that in January, literally days after the virus was known and its sequence was published. So no, I have never been told by anyone to pull back on the development of any counter measure or any basic and research project that we've been involved in.
BURR: Thank you, Dr. Fauci. This question is for Dr. Redfield. Dr. Redfield, we have authorized in this committee and appropriated out of Congress multiple times over the last few decades, money for virus surveillance and you talked about it.
In the past four years from F.Y. '16 to F.Y. '20, it's been $23 million a year and with the CARES Act it's over a billion dollars in biosurveillance. We've seen the private sector go out and use data available to track the progress and spread of -- of coronavirus around the world.
Why has CDC not contracted with private sector technology companies to try to use their tools for biosurveillance.
DR. ROBERT REDFIELD, DIRECTOR, CENTERS FOR DISEASE CONTROL AND PREVENTION: Senator, thank you for the question. This is a critical issue as you know and also come into one of the core capabilities. I talked about data analytics and data modernization, which we're appreciative of the additional funding Congress has given.
I can tell you that this is under critical review now. We do have contracts with some of the private sector groups now to try to make the type of availability of data that we've seen with Florida in all of our jurisdictions across the country in the process of making that happen.
BURR: Dr. Redfield, in April of last year -- June of last year, we reauthorized the pandemic and all hazards legislation, which authorized at that time 30 new billings, 30 new employees that CDC specifically in surveillance.
Now I asked Dr. Schuchat in March, how many of those 30 had been filled. She said zero. As of mid-April zero of those 30 bill its have been filled. How many of those 30 employees that this committee authorized CDC to bring on and biosurveillance had been filled today.
REDFIELD: Sir, again, thank you for the question. I know our staffs have been in discussion since Dr. Schuchat's testimony and I know we're in the process of continuing to try to figure out how to move that forward, sir. I can get back to you on it as I discuss what progress has been made since we had that discussion post her hearing with you when you brought that to light.
BURR: Well, I brought it to light the first of March. And now we're in mid-May. So I'm hopeful that we won't just talk about surveillance we'll actually execute it and we'll focus the unbelievable amounts of money that we've provided for you that they will show some -- some benefit to the American people.
Dr. Fauci, let me come back to you. This is one of the fastest development timelines we've ever seen for vaccines. And the American people and hopefully people around the world will be the beneficiary of what you -- what you find and the eventual licensure of that product.
What are the biggest unknowns with this particular virus that can affect the development process? And Dr. Hahn, if you've got anything to add after that to this, please do. Dr. Fauci.
FAUCI: Yes. Thank you very much, Senator Burr. Well, there are a couple things that I think are inherent in all vaccine development.
First of all, there's no guarantee that the vaccine is actually going to be effective as you well know because we've discussed this many times in the pass.
And you can have everything you think that's in place and you don't induce the kind of immune response that turns out to be protective and durably protected. So one, the big unknown is it will be effective.
Given the way the body responds to viruses of this type, I'm cautiously optimistic. And we will, with one of the candidates, get an efficacy signal. The other things that's an unknown that's of concern but we'll be able to get around that by doing the test properly is that do you get an enhancement effect.
Namely, there have been a number of vaccines, two in particular; (inaudible) and respiratory sensitual virus. When the vaccine induces a suboptimal response and when a person gets exposed, they actually have an enhanced pathogenesis for the disease, which is always worrisome. So we want to make sure that that doesn't happen.
Those are the two major unknowns. Putting all those things together, Senator Burr, I still feel cautiously optimistic that we will have a candidate that will give some degree of efficacy. Hopefully a percentage enough that will induce the kind of herd immunity that would give a protection to the population at home.
BURR: Dr. Hahn, anything to add to that? HAHN: Yes, sir. Thank you for the question. The obstacles from a regulatory point of view I think are being met by the approaches being taken out of HHS and led by Peter Marks and that is a common pre- clinical development pathway so that we can appropriately assess one vaccine against the other.
And then a massive protocol that allows for a common control group and an assessment of very common end points that'll let us be as efficient as possible for the development of vaccine. We will evaluate approximately 10 candidates pre-clinically and then in the phase one and phase two studies and then take four to five into phase three studies in this HHS effort.
So I think those at the obstacles that can be broken down to speed the development but also allow us to ensure safety and effectiveness.
BURR: Mr. Chairman, yesterday the state of North Carolina started to publicize the recovered numbers, those individuals who had coronavirus but have recovered. It's my hope that nationally we will start reporting the recovered numbers. I think that's important for the American people to hear.
ALEXANDER: Thank you, Senator Burr. Senator Casey.
SEN. BOB CASEY (D-PA): Mr. Chairman, thank you for the hearing as well as the ranking member, Murray.
Mr. Chairman, I wanted to start today with a question regarding nursing homes, in particular across the state line (inaudible). We've had, as you might know, a high number of cases in Pennsylvania, and at last count over 57,000 cases. The number of deaths have gone about 3,700 and of course a lot of those deaths are in nursing homes. We're told that nationally more than a third as high as 35 percent of all deaths have been in nursing homes, either the death of a resident of a nursing home or worker.
CASEY: So I'm going to start with today with a question for Dr. Redfield.
Doctor, when we consider this challenge in our -- in our long term facilities, when we look at the number of deaths in nursing homes, I think a lot of families want basic transparency. And that's one of the reasons why Senator Wyden and I sent you a letter, dated April the 2nd. It was directed to you, as well as the administrator of the Centers on Medicare and Medicaid Services, Seema Verma.
And in that letter, we asked for basic information about what the administration was doing to track the outbreaks in nursing homes, to provide information -- basic information -- to families and their -- and residents, the families of residents in nursing homes. Certainly to the workers, as well as to the community and public health professionals.
Now, it took you over -- about a month to respond to that. But in your response, you didn't give us any information about the timeline. These (ph) families need this information. And now, we're told by the CMS administrator, after pressing her as Senator Wyden and I did, that this information may not be available until the end of May.
I need to hear from you today, why has there been a delay, a three- month delay, in basic information that families and people within a community need, about the outbreaks in nursing homes, the number of cases, what is happening in nursing homes?
Tell us when we're going to see that information.
REDFIELD: Well, thank you very much, Senator. And you've highlighted one of the great tragedies that we've all experienced together. Clearly, the long-term care facilities have been particularly hard-hit by this pandemic.
Several things. I know that, again, the CMS, who has oversight, several things have been done, and I can get back to you in terms of where they're at in terms of activation. But clearly (ph), all nursing homes now are required to report cases in either their individuals that are patients there, or staff, to the CDC.
Secondly, (inaudible) Verma has put a policy in place at all nursing homes, that are (ph) required to notify the members of that nursing home, of the existence of COVID in that nursing home, to include family members. (inaudible) verify in terms of when that's -- if that's operational as of (ph) today or last week, but I will get back to you with that.
One of the most important (inaudible) we have decided is, we talk about key in reopening, as Tony mentioned, we need (inaudible) symptomatic cases, we need to be able to do contact (ph) tracing. But the other thing that we really need to do, is to do surveillance. Because this virus does appear to have a high propensity for asymptomatic infection, which means our traditional ways of identifying cases is going to be blunted.
And so we're developing a national surveillance system. And first and most importantly (ph) (inaudible) is to do comprehensive surveillance in all the nursing homes (ph) (inaudible) United States. CDC will -- will be doing that, in partnership with the state and local, territorial health departments.
I think HRSA (ph) is going to have the responsibility to do it within the inner city clinics that are selected, and the Indian Health Service for the Indian health service clinics. But this is critical, we get in front of this and do comprehensive surveillance of everybody in these nursing homes.
We've also done, you know, aggressive outreach in all of them and in enhancing infection control procedures, et cetera. CDC's been out -- helped (ph) these nursing homes with that, and to the (ph) guidance, along with the CMS.
But I'll get back to you in terms of time -- I'm pretty confident they're already -- it's already operational, but I need to double check, just to make sure, because I know Seema has announced that they're all reporting to CDC now, any infection in workers or patients, and that they are required now to notify other members in the nursing home as well as family members of (inaudible) when COVID is in one of those homes.
CASEY: Mr. Chairman, I just have one question for Dr. Fauci.
Doctor, I wanted to ask you, in your testimony earlier in response to a question by Senator Murray, you outlined a basic concern you have with regard to states reopening. Can you restate that for us?
FAUCI: Yes. Thank you, Senator Casey, yes.
My concern is that if states or cities or regions attempt (ph) -- understandable -- to get back to some form of normality, disregard to a great or less degree (ph), the checkpoints that we've put in our guidelines about when it is safe to proceed in pulling back on mitigation.
Because I feel if that occurs, there is a real risk that you will trigger an outbreak that you may not be able to control, which, in (ph) fact, paradoxically, will set you back, not only leading to some suffering and death that could be avoided, but could even set you back on the road to trying to get economic recovery. It (ph) would almost turn the clock back, rather than going forward.
That is my major concern, Senator.
ALEXANDER: Thank you.
CASEY: Thank you, Doctor.
Thank you, MR. Chairman.
ALEXANDER: Thank you, Senator Casey.
SEN. RAND PAUL (R-KY): Dr. Fauci, scientists have shown that rhesus monkeys that are infected with COVID-19 cannot be re-infected. Several studies have also shown that plasma from recently infected coronavirus patients neutralizes the virus in lab experiments. In addition, infusion of convalescent plasma is based on the idea that recovering coronavirus patients are developing immunity, and that it can be beneficial as donated.
Studies show that the recovering COVID-19 patients, from the asymptomatic to the very sick, are showing significant antibody response. Studies show that SARS and MERS, also coronaviruses, induce immunity for at least two to three years.
And yet the media continues to report that we have no evidence that patients who survive coronavirus have immunity. I think actually, the truth is the opposite.