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Admiral Giroir, Dr. Fauci, Dr. Redfield Testify Before Senate While In Quarantine. Aired 11:30a-12p ET
Aired May 12, 2020 - 11:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
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SEN. RAND PAUL (R-KY): I think actually, the truth is the opposite. We have no evidence that survivors of coronavirus don't have immunity, and a great deal of evidence to suggest that they do.
The question of immunity is linked to health policy in that workers who have gained immunity can be a strong part of our economic recovery. The silver lining to so many infections in the meat processing industry, is that a large portion of these workers now have immunity. Those workers should be reassured that they likely won't get it again, instead of being alarmed by media reports that there is no evidence of immunity.
You've stated publicly that you'd bet it all, that survivors of coronavirus have some form of immunity. Can you help set the record straight, that the scientific record, as it's being accumulated, is supportive that infection with coronavirus likely leads to some form of immunity, Dr. Fauci?
DR. ANTHONY FAUCI, DIRECTOR, NIAID: Yes, thank you for the question, Senator Paul.
Yes, you're correct, that I have said that, given what we know about the recovery from viruses such as coronaviruses in general -- or even any infectious disease with very few exceptions -- that when you have antibody present, it very likely indicates a degree of protection.
I think it's in the semantics of how this is expressed. When you say, Has it been formally proven by long-term natural history studies, which is the only way that you can prove, one, is it protective -- which I said and will repeat, is likely that it is -- but also, what is the degree or titer of antibody that gives you that critical level of protection, and what is the durability?
As I've often said, and I again repeat, you can make a reasonable assumption that it would be protective but natural history studies over a period of months to years will then tell you definitively if that's the case.
PAUL: And I think that's important. Because, in all likelihood -- is a good way of putting it -- the vast majority of these people will have immunity, instead of saying there is no evidence. You know, the WHO kind of fed into this by saying no evidence of immunity. And in reality, there's every evidence stacking up and, in fact, a lot of the different studies have shown that it is very unlikely that you get it again in the short term.
With regard to going back to school, one thing that was left out of that discussion is mortality. I mean, shouldn't we at least be discussing what the mortality of children is? This is for Dr. Fauci as well.
The mortality between 0 and 18 in the New York data approaches -- it's not going to be absolutely zero but it approaches zero. Between 18 and 45, the mortality in New York was 10 out of 1,000. So really, we do need to be thinking about that.
We need to observe with an open mind what went on in Sweden, where the kids kept going to school. The mortality per capita in Sweden is actually less than France, less than Italy, less than Spain, less than Belgium, less than the Netherlands, about the same as Switzerland, but basically I don't think there's anybody arguing that what happened in Sweden is an unacceptable result. I think people are intrigued by it and we should be.
I don't think any of us are certain when we do all these modelings. There have been more people wrong with modeling than right. We're opening up a lot of economies around the -- around the U.S. And I hope that people who are predicting doom and gloom and saying, oh, we can't do this, there's going to be a surge, will admit that they were wrong if there isn't a surge. Because, I think that's what's going to happen.
In rural states, we never really reached any sort of pandemic levels in Kentucky and other states. We have less deaths in Kentucky than we have in a -- in an -- in an average flu season. That's not to say this isn't deadly. But really, outside of New England, we've had a relatively benign course for this virus nationwide.
And I think the one-size-fits-all -- that we're going to have a national strategy and nobody's going to go to school -- is kind of ridiculous. We really ought to be doing it school district by school district. And the power needs to be dispersed because people make wrong predictions.
And really, the history of this when we look back will be of wrong prediction after wrong prediction after wrong prediction, starting with Ferguson in England. So I think we ought to have a little bit of humility in our belief that we know what's best for the economy.
And as much as I respect you, Dr. Fauci, I don't think you're the end all. I don't think you're the one person that gets to make a decision. We can listen to your advice, but there are people on the other side saying there's not going to be a surge and that we can safely open the economy, and the facts will bear this out.
But if we keep kids out of school for another year, what's going to happen is the poor and underprivileged kids who don't have a parent that's able to teach them at home are not going to learn for a full year. And I think we ought to look at the Swedish model and we ought to look at letting our kids get back to school. I think it's a huge mistake if we don't open the schools in the fall. Thank you.
FAUCI: Mr. Chairman, can I respond to that, even though there are only 32 seconds left?
SEN. LAMAR ALEXANDER (R-TN): Yes, and you might make it clear whether or not you suggested that we shouldn't go back to school in the fall.
FAUCI: Well, first of all, Senator Paul, thank you for your comments. I -- I have never made myself out to be the end all and only voice of this. I'm a scientist, a physician and a public health official. I give advice according to the best scientific evidence.
There are a number of other people who come into that and give advice that are more related to the things that you spoke about, about the need to get the country back open again and economically. I don't give advice about economic things. I don't give advice about anything other than public health. So I wanted to respond to that.
The second thing is that you use the word -- we should be humble about what we don't know and I think that falls under the fact that we don't know everything about this virus and we really better be careful, particularly when it comes to children, because the more and more we learn, we're seeing things about what this virus can do that we didn't see from the studies in China or in Europe.
For example, right now, children presenting with COVID-16 -- with COVID-19 who actually have a very strange inflammatory syndrome very similar to Kawasaki syndrome. I think we better be careful if we are not cavalier in thinking that children are completely immune to the deleterious effects.
So again, you're right in the numbers, that children in general do much, much better than adults and the elderly and particularly those with underlying conditions but I am very careful and hopefully humble in knowing that I don't know everything about this disease and that's why I'm very reserved in making broad predictions. Thank you.
ALEXANDER: Thank you, Senator Paul. And Senator Baldwin?
SEN. TAMMY BALDWIN (D-WI): Thank you, Mr. Chairman and Ranking Member Murray and our witnesses. I want to try to cover a lot of territory in my five minutes, so I'd certainly be appreciative of concise answers. But I want to start with Dr. Redfield.
Dr. Redfield, (inaudible) think that the current testing protocols at the White House presents a model for other essential workplaces?
DR. ROBERT REDFIELD, DIRECTOR, CENTERS FOR DISEASE CONTROL AND PREVENTION: I'm sorry, Senator, I -- I -- you broke up in the beginning of your question. If you could just say it again? I'm sorry.
BALDWIN: Yes. Dr. Redfield, do you think that the testing protocols currently in place in the White House present a model for other essential workplaces?
REDFIELD: Well I think -- thank you for the question. I think one of the important things you bring up is the essential worker guidance that CDC put out and I think it was originally modeled obviously on healthcare workers, whether it was significant healthcare shortages and individuals that were ...
BALDWIN: ... many workplaces, I'm asking you if you think that the White House protocols, testing are a model for other essential workplaces?
REDFIELD: I -- I -- I would just say that I think each workplace has to define their own approach as how to operationalize our ...
BALDWIN: ... had some considerable comment on the fact that OSHA has not stood up an enforceable, mandatory emergency temporary standard for workers in all sorts of work settings, but that aside, would you say that the PPE rules that -- and protocols in effect right now in the White House are a model for other essential workplaces?
REDFIELD: We would -- my own view -- would -- would go back to the guidelines that CDC has put out about essential workplaces for people, if they are an essential workforce that they go in public, they maintain six feet distancing and they wear face coverings.
BALDWIN: OK. Admiral Giroir, you have testified about how far you've come with regard to testing assessments. I -- I want to ask you if you believe that we already have a national testing strategy today that spans -- that spans from the nationwide testing needs assessment to the nationwide testing supply assessment and a strategy to fill that gap, to procure domestically what we need in terms of bridging that gap with testing platforms, swabs, specimen collection media and reagents and the PPE needed to conduct those tests?
ADMIRAL BRETT GIROIR, U.S. PUBLIC HEALTH SERVICE COMMISSIONED CORPS: So thank you for that. We do have a strategy that spans us at least to the -- at least to the fall and beyond.
As I -- as I mentioned, we're working individually with every state and I think Senator Paul is correct, that Kentucky, Wyoming or New Jersey, Rhode Island are different and they're -- there are vastly different testing needs -- the East Coast will have multiples of testing versus other state -- and we're working those individually ...
BALDWIN: So -- so I know you testified earlier that not only are you working with the states but you're working with every lab in every state ...
BALDWIN: ... increase capacity. What about working with those who would be the -- those who would need testing to, say, reopen their school, their university, their business? Each of them have identified what they think are their testing needs, based on, you know, guidance, not mandatory, enforceable rules, but are you in contact at that level?
Is your dashboard -- have visibility at that lowest level or are you mostly in contact with the states and with the labs?
GIROIR: So over the last few months, we've done a lot of the individual work at nursing homes, at meat-packing plants, at other -- I mean, really down to the very granular level.
GIROIR: Where we are right now, however, is we are really working with the state leadership, with the public health lab, the state epidemiologists, the shows, the state health officials because they -- they really need to understand what their sum is going to be in their state ...
BALDWIN: OK, thank you.
GIROIR: ... and then the -- and then the funding, we're asking very specifically in the CDC funding for specific plans for schools, nursing homes, underserved, et cetera.
BALDWIN: Thank you. So I have two more points that I'm going to make, don't have time for questions. One is about transparency of that needs assessment. Can the public see it, can the states see it, can the health committee members see it? Is it publicly available?
And secondly, the delivery of this supply is a critical issue and it seems to me that the logistics for getting this out, whether it's PPE, testing or medical equipment, is still extremely fragmented, leading to price gouging and many other inefficiencies. We need to stand up the full power of the Defense Production Act.
GIROIR: Would you like me to comment on that, ma'am? I'm sorry.
BALDWIN: I'm happy to have you comment, with the indulgence of the Chairman. We've gone over time and ...
ALEXANDER: ... a succinct answer to the Senator, please, Admiral Giroir?
GIROIR: Yes, ma'am and yes, sir. Particularly for things like swabs and media, there is still a very -- I would say non-mature industry within the country and that's why we've -- we've made the decisions to procure that all centrally through December and then distribute that to the state because there's just too many small companies, too many -- too many variables to control without a really heavy federal hand. That's just an example of where we really moved into that and used the DPA for swabs to help support American industry.
In more mature aspects of the industry, like some of the large test producers, we feel that by helping direct them to make sure that the states get what they need in the right distribution, that we're not procuring them directly by us, but again, we're going to be very evidence and data driven as we move on. Thank you, sir.
ALEXANDER: Thank you very much, Senator Baldwin. Senator Collins?
SEN. SUSAN COLLINS (R-ME): Thank you, Mr. Chairman.
Let me begin by first thanking each of our witnesses today for their expertise, their dedication and their hard work.
Dr. Redfield, I want to start with you. I am hearing from dentists (ph) all over the state of Maine that the fact that they cannot practice in our state, despite following very strict infection control protocols, is causing growing health problems.
Dentists tell me that teeth with cavities that could have been filled, are now going to need root canals. Teeth that could have been treated with root canals, are now going to require extractions. People with oral cancers cannot get the treatment, the cleanings that they need before beginning their treatment.
Dental health is clearly so important, and Maine's state officials as well as our dentists are seeking assistance in reaching the right decisions. Forty-seven other states either have reopened dental practices, or have a date set for them to reopen.
So my question to you is this, if dentists are following the American Dental Association guidelines, if they're instituting strict protective measures for their patients, their staffs, their hygienists, themselves, and if they're closely examining and seeing a decline in the number of COVID-19 infections in their county, are these reasonable factors for states to consider in reopening the practice of dentistry?
REDFIELD: Yes, Senator, thank you for the question. You know, we have been interacting and talking with dentists and working with the state and local public health officials (ph) to update our guidelines on reopening a variety of medical services, as you know.
And I think you raise a very important point, and I would not disagree with what you said about looking at the American Dental Associations as well as the reality of the outbreak in the area. But we are in the process of updating those guidelines, and they will include direct guidelines for dental practices.
COLLINS: Thank you very much, Doctor.
Dr. Giroir and Dr. Hahn, recently, there's been a significant demand for remdesivir -- I may be mispronouncing it -- which transitioned to receiving an Emergency Use Authorization. Last week, Maine's two largest hospital systems contacted me with questions about how this therapeutic will be allocated, going forward.
HHS finally released a statement on Saturday about allocations going to states -- interestingly, not directly to hospitals. But once again, the decision-making behind these allocations is very unclear. HHS and the assistant secretary for Preparedness and Response say that each state is expected to receive an allocation, but no timetable has been provided.
Beyond those who are being treated with this drug at Maine Medical Center through a clinical trial, I'm concerned that hospitalized patients in Maine will have little or no ability to be treated with this promising therapeutic for the foreseeable future.
As this and more therapeutics and ultimately a vaccine come on to the marketplace, how can these allocation and distribution issues be resolved so that patient care is not delayed, and so that it doesn't depend on which state you live in, whether or not you're going to get access to these treatments and ultimately a vaccine?
HAHN: Senator Collins, this -- oh, go ahead, Admiral Giroir.
GIROIR: Go ahead -- go ahead, Commissioner.
DR. STEPHEN HAHN, COMMISSIONER OF FOOD AND DRUGS, USFDA: Senator Collins, I think we completely agree with you that this has to be an evidence-based approach, getting the medical therapeutics, vaccines, remdesivir, whichever it happens to be, to the people in need.
I think we can all agree upon the fact that we've learned a lot of lessons from the remdesivir situation. And of course, as you mentioned, that's being led by HHS and ASPR.
What you see in the most recent announcement is that what the test scores did was provide guidance to HHS regarding where the most significant outbreak of hospitalizations -- outbreak occurred, and where those hospitalized patients were. This represented about a quarter of the supply of drug that we have, and more will be allocated according to methodology that gets drug to where those hospitalized patients are.
I think valuable lessons can be learned and will be learned with respect to other therapies and to vaccines in particular, and we must incorporate those into our operational plans, moving forward.
COLLINS: Thank you, Doctor.
Admiral, do you have anything to add? I'm over time, sorry. Thank you. If you have anything to add, if you'd do so for the record.
GIROIR: No, ma'am. No, ma'am, I agree with the commissioner. It's -- it's absolutely critical that it's evidence-based, based on the people who could benefit from it and also fair and just throughout our country.
ALEXANDER: Thank you...
COLLINS: Thank you.
ALEXANDER: ... Senator Collins. And Senator Murphy?
MURPHY: Thank you very much, Mr. Chairman. Thank you to you and Senator Murray for convening this.
Thank you to all of our witnesses for your service.
This is obviously an exceptional hearing today, in that three of our witnesses are in quarantine. And so I just want to start by asking a pretty simple yes-or-no question that I think I know the answer to.
Dr. Fauci, Dr. Hahn, Dr. Redfield, I'm correct that all of you are drawing a salary -- as you should -- during your period of quarantine, is that correct?
FAUCI: Senator, let me -- let me start off. I think we'd better be careful about the issue of quarantine. We are essential workers, as part of the essential infrastructure, and we are -- when needed, which is often, do our duties in (ph) our (ph) respective places at the White House. I was at the White House yesterday, and I will likely even -- perhaps even be there today, and in my office at the NIH.
So it is not really, strictly speaking, a quarantine as we know it. But it is performing our duties as critical workers, and I'd be happy to have my colleagues also respond to that.
HAHN: Senator Murphy, this is Steve Hahn. I agree with Dr. Fauci. And yes, I am drawing a salary and I had continued to work during my quarantine. And as an essential worker, will participate in meetings face-to-face when that attendance is considered critical.
SEN. PATTY MURRAY (D-WA): My point here, listen, you all should draw a salary while you are taking precautionary steps because of the contacts you have made. My point is that quarantine is relatively easy for people like you and me. We can still work and get paid, we can telework but there are millions of other Americans who work jobs that can't be performed from home or are paid by the hour.
And it's just remarkable to me that this administration has not yet developed a mechanism for states to implement and pay for a quarantine system that will work for all Americans. Your plan to reopen America requires states develop that plan and yet my state has no clue how to implement and pay for that system without help from the federal government.
Which leads me to my second question, Dr. Fauci and Dr. Redfield, you made news today by warning us appropriately of the dangers of states opening too early. But as Senator Murray mentioned this is infuriating to many of us because it comes hours after the president declared that we have prevailed over coronavirus which I'm just going to tell you is going to make it much harder on state leaders to keep social distancing restrictions in place.
It comes days after the president called on citizens to liberate their states from social distancing orders. And I think you're all noble public servants but I worry that you're trying to have it both ways. You say that states shouldn't open too early but then you don't give us the resources to succeed.
You work for a president who is frankly undermining our efforts to comply with the guidance that you've given us. And then the guidance that you have provided is criminally vague. And I want to ask my last question on this topic. Obviously, the plan to reopen America was meant to be followed by more detailed nuance guidance.
What is a downward trajectory mean? What happens if the trajectory is downward in some setting but upward in others? What happens if you reopen and then there's a spike in one location or another setting? And, of course, you knew this because you developed this guidance, this additional guidance that is site specific.
That frankly is helpful. Some of this is on the CDC website but some of it is not and we need it. My state needs it. We don't have all of the experts that you have. And so we rely on you. So reporting suggests Dr. Redfield that this guidance that was developed by you and other experts was shelved by the administration.
That is was withheld from states and the public because of a decision made by the White House. So, my specific question is why didn't this plan get released? And if it is just being reviewed when is it going to be released?
Because states are reopening right now and we need this additional guidance to make those decisions.
REDFIELD: Senator I appreciate your question. Clearly, we have generated a series of guidances as you know and as this outbreak response has evolved from a CDC to an all of government response as we work through the guidances a number of them go for interagency review and interagency input to make sure that these guidances are more broadly applicable for different parts of our society.
The guidances that you talked about have gone through that interagency review, there are comments that have come back to CDC, and I anticipate they'll go back up into the task force for final review.
MURPHY: But we're reopening in Connecticut in five days -- in 10 days. This guidance isn't going to be useful to us in two weeks. So is this week? Is it next week? When are we going to get this expertise from the federal government?
REDFIELD: The other thing I will just say is that the CDC stands by the technical assistance to your state and any state upon any requests. I do anticipate this broader guidance though to be posted on the CDC website soon.
REDFIELD: I can't tell you -- soon -- but I can tell you your state can reach out to CDC and we'll give guidance directly to anyone in your state on any circumstance that your state desires guidance from.
MURPHY: Soon isn't terribly helpful. Thank you, Mr. Chairman.
ALEXANDER: Thank you, Senator Murphy. Senator Cassidy.
SEN. BILL CASSIDY (R-LA): Gentlemen, thank you very much for your service and I will have a set of questions. So if your questions can be brief I appreciate your answer can be brief. Dr. Hahn, in your testimony you mentioned that the testing for the population and the vaccine trials now includes older Americans.
I guess my question though is what about children? Does it include children? Does is also include the obese, the diabetic, the immunocompromised, those who are at risk of having a less non-response or a mitigated response to vaccination. Can you comment on that, please?
HAHN: Yes, sir. Thank you, Senator Cassidy. When the phase two, phase three trials are in place they will include our most vulnerable populations including individuals that you described. We're working very closely ...
CASSIDY: Sir, if I can interrupt?
HAHN: Yes, sir.
CASSIDY: Phase two is normally checked for safety, you would not have to do a separate phase two in the patient who was younger? You follow what I'm saying or can you just assume the safety data from the adults apply to that of the children?
HAHN: Sir, no we would also want to assess safety, sir, as well, in children.
CASSIDY: So the current phase two trials do they include children?
HAHN: They're in phase one studies right now, sir.
CASSIDY: Well, Dr. Fauci said we have a phase two going on.
HAHN: Well I think it's about to start from the Moderna vaccine. Perhaps Dr. Fauci can answer that.
FAUCI: Yes, no Senator Cassidy, no. I did not say a phase two, I said we are in a second dose of the phase one and we will proceed when we finish with phase one to go into phase two.
CASSIDY: So ...
FAUCI: We are into phase two yet.
CASSIDY: So, I think I'm hearing that children will be included in phase two trials?
GIROIR: So, that's under discussion between FDA and NIH at this time, sir. Because we do realize that it's important ... CASSIDY: Sounds correct (ph).
GIROIR: ... for us to understand what this is in children.
CASSIDY: Dr. Redfield, the build back upon what Senator Murphy said, the published guidelines for schools opening obviously you're about to modify. But I notice as I read through them there's nothing about testing. So we speak about testing, targeting testing and how we use testing. But the guidelines for the school systems have nothing about how to integrate testing.
Will these be in those guidelines that are being released?
REDFIELD: Senator, thanks for the question. Clearly there's going to need to be as already been stated an integration of a testing strategy that is going to be different for different school settings as well as different jurisdictions whether it's (inaudible) or setting. And that is going to have to be integrated into each of those.
There's a general overarching guidelines and then as I said I do think the testing strategy, which is important, including the surveillance strategy needs to be an individualized ...
CASSIDY: Let me -- let me -- let me comment on that Dr. Redfield.
REDFIELD: ... development guidelines (ph).
CASSIDY: Dr. Redfield in all due respect, I think children whether you're rural, frontier, suburban or urban is the one setting in which there is a remarkable commonality. And I will echo what Senator Murphy said, the resources that the federal government has greatly exceeds all but the most sophisticated populous wealthy state, and even then it exceeds it by some extent.
So I do think it would good to have, OK, in a primary school setting, this is best practices, or these are three options and choose between one of these three. To say to each school district or each private or parochial or independent school, work with your state board of health, figure it out, seems a wasted effort.
I say that because children play such a role in both protection of disease, the spread of disease, etc. -- so your thoughts on that, because it really seems, that's the one setting where you can have, you know, not cookie cutter, but certainly a pattern which can be followed.