CD211: Coronavirus (COVID-19)

Coronavirus. A lot of people are scared - and money is being made off of our fear. In this episode, let's take a calm look at the facts presented under oath by health professionals in Congress and in official press conferences. What is happening? How does this virus work? How is it transmitted? Why are we all being told to stay home? By the end of this episode, you will have those answers and (hopefully) be better prepared to handle the bad news that’s soon to come.

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Bills

H.R.6201 - Families First Coronavirus Response Act, Congress.gov

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Articles/Documents

• Article: Who Is Dr. Deborah Birx? All About the Health Official Fighting Coronavirus by DeAnna Jones, Oprah Magazine, March 17, 2020
• Article: House may not return to session until third coronavirus response bill is ready by Lindsey McPherson, Roll Call, March 16, 2020
• Article: What Went Wrong with Coronavirus Testing in the U.S. by Robert P. Baird, The New Yorker, March 16, 2020
• Article: Senate Leadership Is Pushing Through a Dangerous Surveillance Bill as Americans Are Focused on Covid-19 by Sandra Fulton, Common Dreams, March 16, 2020
• Article: Biden falsely says Trump administration rejected WHO coronavirus test kits (that were never offered) by Jon Greenberg and Victoria Knight, Politifact, March 16, 2020
• Article: Central banks, the virus, and inequality By Nomi Prins, Asia Times, March 14, 2020
• Article: Oscar Launches First Testing Center Locator for COVID-19, Oscar, March 13, 2020
• Article: Cleveland Clinic-Oscar Health partnership shows success in concierge medicine by Mary Vanac, Modern Healthcare, March 9, 2020
• Article: 5 U.S. cities to start testing patients with flu-like symptoms for coronavirus by Erika Edwards, NBC News, February 14, 2020

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Additional Resources

• Vote Results: FINAL VOTE RESULTS FOR ROLL CALL 102, Families First Coronavirus Response Act, March 14, 2020
• Vote Results: FINAL VOTE RESULTS FOR ROLL CALL 98, USA FREEDOM Reauthorization Act, March 12, 2020
• State Advisory: COVID-19 Sentinel Surveillance, Disease Outbreak Control Division, State of Hawaii, Department of Health Disease Outbreak Control Division
• Event Update March 6, 2020: City of Austin Cancels SXSW March Events, SXSW
• Homepage Thrive Capitol

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Sound Clip Sources

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Interview: The coronavirus could kill millions of Americans: ‘Do the math,’ immunization specialist says by William Feuer, CNBC, March 19, 2020

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Interview: Failure to identify, isolate coronavirus infections puts U.S. on dark path, MSNBC, March 18, 2020

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Interview: Bill Ackman's plea to President Donald Trump to save U.S. from coronavirus' economic destruction, CNBC, March 18, 2020

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Briefing: Coronavirus Task Force Briefing, White House, March 18, 2020

Speakers

• Deborah Birx: White House Coronavirus Task Force Coordinator ** Was the AIDS Ambassador during the Obama administration

Transcript:

35:00 Deborah Birx:So the test kits that we put out last week through the approval, the rapid movement of that meeting that President Trump called less than two weeks ago, that has resulted in bringing our private sector to the table, because the tests and the platform that was out there could only run between four and 12 tests per platform per day. We've now moved into platforms that can run basically 10's of thousands of tests per day. So the reason I'm grateful for your question, because it allows me to point out that of course then there was a backlog. There were individuals who had been tested, who hadn't had their specimen run because of the slow throughput. It's now in a high speed platform. So we will see the number of people diagnosed dramatically increase over the next four to five days. I know some of you will use that to raise an alarm that we are worse than Italy because of our slope of our curve. To every American out there, it will be five to six days worth of tests being run in 24 to 48 hours, so our curves will not be stable until sometime next week.

36:25 The reason I talked about Thermo Fisher yesterday is because their platform is in 2,000 laboratories. They're the ones that are putting out the million tests this week that will solve the issue that Atlanta and others have brought up.

41:30 When you look at China and South Korea data and you look what China and South Korea did, you can see that their curves are not only blunted outside of Wu Han. So the Chinese areas outside of Wu Han blunted curve and South Korea blunted curve, if you look at their curve today, there are ready on the far end of their epidemic curve. Of course, none of those countries are fully back to work. And so that's what we worry about, too.

42:30 Don't expose yourself to surfaces that could have had the virus on it, for which on hard surfaces, I know we had the cardboard issue about shipping, hard surfaces not shown, in fabric as much or in cardboard, but hard surface transmission.

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Video: Chris Cuomo: Coronavirus scares me as a parent, Cuomo Prime Time, CNN, March 17, 2020

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Video: NBC Nightly News Broadcast (Full) - March 17th, 2020, NBC Nightly News, NBC, March 17, 2020

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Briefing: Coronavirus Task Force Briefing, White House, March 17, 2020

Transcript:

58:50 Anthony Fauci: Now you could see the virus going up and up and your effect your work, what you're trying to do, may actually be having an effect, but you may not see it because it'll still be going up. And as you're trying to implement your interference with the virus, you may not realize that you're actually interfering and you'll say, wait a minute, it's still going up. What's going on? You've done nothing. But you don't know whether it would do this versus that. So the answer to your question, it probably would be several weeks and maybe longer before we know whether we're having an effect. It may be at the end of the day, we'll see a curve that would have been way way up. But I wouldn't like put us to task every few days. Well, wait a minute, it's going up. Is it working or not? That would be really misleading if we do that.

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News Conference: World Health Organization Coronavirus News Conference, World Health Organization, March 16, 2020

Watch on Youtube

Speakers:

• Tedros Adhanom Ghebreyesus: Director General of the World Health Organization

Transcript:

Tedros Adhanom Ghebreyesus: But the most effective way to prevent infections and save lives is breaking the chains of transmission. And to do that, you must test and isolate. You cannot fight a fire blindfolded and we cannot stop this pandemic if we don't know who is infected. We have a simple message for all countries. Test, test, test. Test every suspected case, and if they test positive, isolate them and find out who they have been in close contact with up to two days before they developed symptoms and test those people too.

Tedros Adhanom Ghebreyesus: WHO advises that all confirmed cases, even mild cases, should it be isolated in health facilities to prevent transmission and provide adequate care. But we recognize that many countries have already exceeded their capacity to care for mild cases in dedicated health facilities. In that situation, countries should prioritize all their patients and those with underlying conditions. Some countries have expanded their capacity by using stadiums and gyms to care for mild cases with C-Vid and critical cases cared for in hospitals. Another option is for patients with mild disease to be isolated and cared for at home.

Tedros Adhanom Ghebreyesus: Both the patient and their caregivers should wear a medical mask when they are together in the same room. The patient should sleep in a separate bedroom, two others, and use a different bathroom. Assign one person to care for the patient. Ideally, someone who is in good health and has no underlying conditions. The caregiver should wash their hands after any contact with their patient or their immediate environment. People infected with Covid-19 can still infect others after they stop feeling sick. So this measures should continue for at least two weeks after symptoms disappear. Visitors should not be allowed until the end of this period.

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Interview: Dr. Fauci: 'Possible' that millions could die in US, CNN, March 15, 2020

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Video: Former CDC director: Potential coronavirus death toll could be over 1 million, Fox News, Mach 13, 2020

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Hearing: Coronavirus Preparedness and Response, United States House Committee on Oversight and Reform, March 12, 2020

Watch on Youtube

Witnesses:

• Dr. Anthony Fauci: Director of the National Institute of Allergy and Infectious Disease at the National Institutes of Health
• Dr. Robert Redfield: Director of the Centers for Disease Control and Prevention
• Dr. Robert Kadlec: Assistant Secretary for Preparedness and Response at the Department of Health and Human Services

Transcript:

17:30 Robert Kadlec: You're correct that there is a great demand for personal protective equipment, particularly respirators, N-95 respirators. There we have a limited supply in our Strategic National Stockpile. Annually, about 350 million respirators are used. Only a small percentage of that is used by the healthcare industry about 35 million. And we believe that the demand for that could be several hundred million to up to a billion in a six month period. So it's a very high demand item. There has been a strategy to basically, and CDC has provided guidance on reuse, how can we use them longer. We've got the manufacturers and how they can surge more and many of them are doing that. And domestically even though some of their sources for product, finished product is from overseas like China. And then the third thing is is what can we do to basically use masks that haven't been used for the medical area, non medical N-95s could be used in that fashion. And FDA is basically certified through an Emergency Use Authorization that N-95s respirators used in manufacturing and in mining and in construction could be used in healthcare settings. They are very similar but not the same, but could be used that way. And the only thing that's keeping a lot of manufacturers from selling those masks to the broader healthcare population is because of liability provisions or lack of liability protections. There is the Public Readiness Emergency Preparedness Act that was passed in 2005. That basically indemnifies manufacturers, distributors and users of these masks, or pardon me, of users of products that are defined as a device or as a covered countermeasure. When we saw - I happened to be on the staff that did that legislation in 2005. We did not consider a situation like this today. We thought about vaccines. We thought about therapeutics, we never thought about respirators of being our first and only line of defense for healthcare workers. So we think that's a very important capacity and capability to include language or modify the Prep Act to include language, to include respiratory protective devices for that purpose, and that's a significant critical pass now item.

20:25 Robert Redfield: There's also clinical medicine, the practice of clinical medicine, the private sector, that actually tries to provide diagnostics so we can diagnose diabetes or anemia, lots of different diseases. And it's really the engagement of the private sector to get these tests into clinical medicine, which is it's a partnership between the private sector. CDC usually develops the test first, gets it out into the health departments to do surveillance. And then the private sector comes in to provide the clinical tools we need to basically diagnose patients, not the surveillance of the community.

23:53 Rep. Debbie Wasserman-Shultz (FL): We need to have someone in charge of making sure that as many people as possible across this country have access to getting tested as soon as possible. Who is that person? Is it you? Is it the vice president? Can you give us the name of who can guarantee that anyone, but especially healthcare workers who need to be tested can be. Robert Redfield: As I tried to explain to Congressman Green, from the CDC perspective... Rep. Debbie Wasserman-Shultz (FL): Okay, I'm asking for a name. Who is in charge of making sure that people who need to get tested, who are indicated to be tested can get a test? Who? Robert Redfield: Yeah, I was trying to say that the responsibility that I have at CDC is make sure all the public health labs have it and they can make the judgment on how they want to use it. Rep. Debbie Wasserman-Shultz (FL): But they're referencing people who have been advised to be tested to you and they've been turned down. So is it you? Robert Redfield: As I said, I'm going to look into the specifics of that. Rep. Debbie Wasserman-Shultz (FL): So basically, you're saying - I'm claiming my time - basically, you seem to be saying because you can't name any one specifically, that there's no one specifically in charge that we can count on to make sure that people who need to be tested healthcare workers or anyone else, there's not one person that can ensure that these tests can be administered yes or no. Anthony Fauci: My colleague is looking at me to answer. Here we go. Okay. All right. So the system does not, is not really geared to what we need right now. What you are asking for, that is a failing. Rep. Debbie Wasserman-Shultz (FL): A failing. Anthony Fauci: Yeah, it is a failing. Let's admit it. The fact is the way the system was set up, is that the public health component, that doctor that Dr. Redfield was talking about was a system where you put it out there in the public and a physician asks for it and you get it. The idea of anybody getting it easily, the way people in other countries are doing it, we're not set up for that. Do I think we should be? Yes, but we're not. Rep. Debbie Wasserman-Shultz (FL): Okay. That's really disturbing and I appreciate the information.

30:25 Rep. Ralph Norman (SC): I just met with a company, a Fortune 500 company, who is looking at testing their employees as they come in the door. And yet they're concern was one, frivolous lawsuits, class action suits by trial lawyers, HIPAA violations, health violations. You know, you just can't take temperatures of people without our type getting into all types of issues. The question I was asked by this employer do I give do I take the risk of when you walk in that door, no symptoms, you just see what, whether it's a temporary or whether it's asking questions, they're petrified of the outcome if they do that. They're also petrified of somebody having the virus when they walk in the door and then being held liable if they in fact, and this company has 500 employees that do shifts, work in three shifts.

32:00 Anthony Fauci: There are two types of situations. Dr. Redfield described. One, which was the classic tried and true CDC based situation where it's based on the doctor-patient interaction. Where a doctor, as a patient who wants to get tested for cause they're sick, they've been exposed or what have you. That works well. The system right now as it exists, of doing a much broader capability of determining what the penetrance is in society right now, is not operational at all for us. And what the CDC is doing now is that they're taking various cities, they started with six, and then they're going to expand it, where they're not going to wait for somebody to ask to get tested. They're going to get people who walk into an emergency room or a clinic with an influenza like illness and test them for coronavirus. You You do that on a broader scale throughout the country, you'll start to get a feel for what the penetrance is. And that's a different process. Unfortunately, our system from the beginning was not set up to do that. And that's the reason why we're not able to answer the broader questions of how many people in the country are infected right now. We hope to get there reasonably soon. But we're not there now.

36:30 Anthony Fauci: In the spirit of staying ahead of the game, right now, we should be doing things that separate us as best as possible from people who might be infected. And there are ways to do that. You know, we use the word social distancing, but most people don't know what that means, for example, crowds. We just heard that they're going to limit access to the capital. That's a really, really good idea to do. I know you like to meet and press the flesh with your constituencies. I think not now, I think you need I need I think you need to really cool it for a while because we should we should be practicing mitigation, even in areas that don't have a dramatic increase. I mean, everyone looks to Washington State. They look to California, they're having an obvious serious problem. But their problem now may be our problem tomorrow.

40:30 Anthony Fauci: Yeah, I would put the social distancing and other issues of preventing infection ahead of the testing but the testing is very important.

43:30 Anthony Fauci: When we were looking at the pure public health aspect of it, we found that 70% of the new infections were coming from the - new infections in the world, were coming from Europe, that cluster of countries. And of the 35 states 30 out of 35 of them, who were more recently getting infections, were getting them from them. That was predominantly from Italy, and from France and from Germany. So when the discussion was, why don't we just start off and say, banned from Italy, we were told by the State Department and others that in fact, you really can't do that because it's sort of like one country, the whole European thing. And the reason I believe that that the UK was left out, was because there is a difference between ease of translate of transportation between the European countries. Rep. Peter Welch (VT): Okay, that's Brexit. Thank you.

47:40 Rep. Chip Roy (TX): Last night, I spoke on the phone with Dr. Shuren at the FDA and got some updates on some of the testing information because I've wanted to talk to somebody at the FDA. And my understanding and response from them. And he's not here to testify. So I want to validate this was that he talked about upwards of 2 million tests. Those aren't individual test kits, but the ability to test 2 million times. We're coming to availability this week, 3 million more in the next week, and that we've got a rather large and robust testing ability coming to market shortly that we've got private enterprises producing these tests. We've got universities, state public officials that have the ability to test and that we are now getting to the place of scalability to ramp up and have a fairly sizable large amount of testing ability in our robust federal system. Would you agree Dr. Redfield that that is the trajectory of where we're headed. Robert Redfield: Since March 2, there's been, I've been told over 4 million tests now have entered the market. But what I want to say the test isn't whole answer. You need people to do the test laboratory equipment to do the test. You need some of the reagents that actually now are in short supply. To prepare the test. You need the swabs to take the test so we're working very hard with the FDA to make sure all these different pieces, you know right now the actual test to do this coronavirus test. I think we have the test in the marketplace. The question is how to how to actually operationalize them and I think that's what Tony and I are saying is the big challenge right now.

53:30 Robert Redfield: We need to use our efforts right now to really continue to try to contain this outbreak with the cases we have and let the public health system focus on that around those clusters, do aggressive mitigation. But if we continue to have individuals coming in to seed new communities, all through the country, it will be very hard for us to get control of this.

55:45 Robert Redfield: If someone's in self-isolation or self-quarantine at home. They're being monitored for symptoms, if they, if they do become symptomatic, they get a comprehensive medical evaluation and then obviously, either returned to home isolation if it's that that's the medical appropriate decision for them, that it's just a sore throat. Or if they look like they need medical attention, they're going to get hospitalized and managed in isolation. Rep. Robin Kelly (IL):And then how those costs covered for a private hospital, the CDC cover their out of pocket cost or how does that work? Robert Redfield: Well, the department has the authority to reimburse those. Okay, CDC has the authority The department has authority, we're working now to determine the best way to accomplish that.

58:40 Robert Redfield: We really are in a mode that this is time for big events like March Madness, big events like these big sports arena things to take a pause for the next four to six to eight weeks while we see what happens with this outbreak in this nation.

1:17:30 Rep. Mark Green (TN): On the South Korean test, we've had a lot of comparisons of how they've done testing much faster than us. I have a letter from the FDA that says the South Korean test, I want to make sure this is on the record, the South Korean test is not adequate. A vendor wanted to purchase it and sell it and use it in the United States. And the FDA said I'm sorry, we will not even do an Emergency Use Authorization for that test. So I have that letter if anybody wants to see it.

1:21:00 Anthony Fauci: So, the Chinese didn't have to send us the virus. They just published the sequence on a public database. We knew the gene that would code for the protein that we wanted to make a vaccine. So all we did was pulled the information right out of the database. We made it synthesize that very easily, overnight, stuck it in to a platform and started making it. And we said at that point that it would take, I would say, two to three months to have it in the first human. I think we're going to do better than that. And I would hope within a few weeks, we may be able to make an announcement to you all, that we've given the first shot to the first person. Having said that, I want to make sure people understand that I say that over and over and over again. That doesn't mean we have a vaccine that we could use. I mean, it's record time to get a tested. It's going to take a year to a year and a half to really know if it works.

1:22:57 Rep. Rashida Talib (MI): You know, earlier this week Congress's attending fish's physician told the Senate that he expects between 70 to 150 million people to eventually contract the coronavirus in the United States. Dr. Croce is is he wrong? Anthony Fauci: Yeah, I think we really need to be careful with those kinds of predictions because that's based on a model. So what the model is, all models are as good as the assumptions that you put into the model. So if you say that this is going to be the likely percent of individuals. Rep. Rashida Talib (MI): So what can we do to define it, is it testing? Anthony Fauci: No, no, it's unpredictable. So testing now is not going to tell you how many cases you're going to have. What will tell you what you're going to have will be how you respond to it with containment and mitigation.

1:24:00 Anthony Fauci: When people do model they say, 'This is the lower level. This is the higher level.' And what the press picks up is the higher level and they'll say you could have as many as...

1:24:15 Anthony Fauci: Remember, the model during the Ebola outbreak said you could have as many as a million. We didn't have a million.

1:28:35 Rep. Katie Porter (CA): Anthony Fauci: Dr. Kadlec, for someone without insurance, do you know the out of pocket cost of a complete blood count test? Robert Kadlec: No, ma'am not not immediately. Rep. Katie Porter (CA): Do you have a ballpark? Robert Kadlec: No, with a copay, no ma'am? Rep. Katie Porter (CA): No, the out of pocket, just the typical cost. Robert Kadlec: I do not ma'am. Rep. Katie Porter (CA): Okay. A CBC typically costs about $36. What about the out of pocket costs for a complete metabolic panel? Robert Kadlec: That would have to pass on that as well. Rep. Katie Porter (CA): You have any idea? You wanna take a ballpark? Robert Kadlec: I would say $75. Okay. Rep. Katie Porter (CA): 58. Robert Kadlec: Getting closer. Rep. Katie Porter (CA): How about flu A, the flu A test? Robert Kadlec: Again, I'll take a guess at about maybe 50? Rep. Katie Porter (CA): 43. Flu... This is like the prices right? Flu B? Robert Kadlec: Too high again, I would probably say 44. Rep. Katie Porter (CA): That's good. How about the cost of an ER visit for someone identified as high severity and threat? Robert Kadlec: I'm sorry, ma'am, what was the question here? Rep. Katie Porter (CA): How about the cost of an ER visit for somebody identified as having high severity or high threat? Robert Kadlec: That's probably about three to $5,000. Rep. Katie Porter (CA): Okay, that is $1,151. It this all totals up to $1,331. That's assuming they aren't kept in isolation. Isolation can add up for one family already $4,000, and fear of these costs are going to keep people from being tested, from getting the care they need and from keeping their community safe. We live in a world where 40% of Americans cannot even afford a $400 unexpected expense. We live in a world where 33% of Americans put off medical treatment last year. And we have a $1,331 expense, conservatively, just for testing for the coronavirus. Doctor Dr. Redfield, do you want to know who has the corona virus and who doesn't? Robert Redfield: Yes. Rep. Katie Porter (CA): Not just rich people, but everybody who might have a virus. Robert Redfield: All of America. Rep. Katie Porter (CA): Dr. Redfield, are you familiar with 42 CFR 71.3130? Excuse me? 42 CFR 71.30. The Code of Federal Regulations that applies to the CDC. 42 CFR 71.30. Robert Redfield: I think if you could frame that what it talks about that would help ma'am that would really... Rep. Katie Porter (CA): Dr. Redfield I'm I'm pretty well known as a questioner on the Hill from for not tipping my hand. I literally communicated to your office last night and received confirmation that I was going to be asking you about 42.7, 42 CFR 71.30. This provides 'Director may authorize payment for the care and treatment of individuals subject to medical exam quarantine isolation and conditional release.' Robert Redfield: That I know about. And my office did tell me that I just didn't know the numbers, ma'am, Congressman. Rep. Katie Porter (CA): Great. So you're familiar, Dr. Redfield, will you commit to the CDC right now, using that existing authority to pay for diagnostic testing free to every American regardless of insurance? Robert Redfield: Well, I can say that we're gonna do everything to make sure everybody can get the care they need. Rep. Katie Porter (CA): No, not good enough. We're claiming my time. Dr. Redfield, you have the existing authority. Will you commit right now to using the authority that you have, vested in you, under law, that provides a public health emergency for testing, treatment, exam, isolation, without cost, yes or no? Robert Redfield: What I'm going to say is I'm going to review it in detail with... Rep. Katie Porter (CA): No, I'm claiming my time, Doctor Redfield respectfully. I wrote you this letter along with my colleagues, Rosa Delora. And Lauren Underwood, Congressman Underwood and Congressman Delora. We wrote you this letter one week ago. We quoted that existing authority to you and we laid out this problem. We asked for a response yesterday, the deadline and the time for delay has passed. Will you commit to invoking your existing authority under 42 CFR 71.30 to provide for coronavirus testing for every American regardless of insurance coverage. Robert Redfield: What I was trying to say is that CDC is working with HHS now to see how we operationalize that. Rep. Katie Porter (CA): Dr. Redfield. I hope that that answer weighs heavily on you, because it is going to weigh very heavily on me and on every American family. Robert Redfield: Our intent is to make sure every American gets the care and treatment they need at this time with this major epidemic and I'm currently working with HHS to see how to best operationalize it. Rep. Katie Porter (CA): Dr. Redfield, you don't need to do any work to operationalize. You need to make a commitment to the American people. So they come in to get tested. You could operationalize the payment structure tomorrow. Robert Redfield: I think you're an excellent questioner. So my answer is yes. Rep. Katie Porter (CA): Excellent. Everybody in America hear that. You are eligible to go get tested for Coronavirus and have that covered regardless of insurance. Please, if you believe you have the illness, follow precautions, call first. Do everything the CDC and - Dr. Fauci, God bless you for guiding Americans in this time. But do not let a lack of insurance worsen this crisis.

1:42:30 Rep. John Sarbanes (MD): If somebody got the virus, three, four weeks ago, just thought they had the flu or a bad cold or something recovered from it. They're now essentially immune from getting the virus again. Is that correct? Anthony Fauci: We haven't formally proved it, but it is strongly likely that that's the case.

1:43:00 Anthony Fauci: If you do an antibody test, if you wait weeks and months after you've recovered, the antibody tests will tell you whether that person was formerly infected with Corona virus.

1:43:50 Anthony Fauci: So let's say I get infected. And whether I get sick or not, I clear the infection from my body. I do two tests 24 hours apart, which is the standard to say, I'm no longer infected. A month and a half from now you do an antibody test, and that test is positive. I am not transmitting to anybody, because my body has already cleared the virus. So even though my antibody test says you were infected a month or two ago, right now, if there's no virus in me, I am not going to be able to transmit it to anyone.

1:45:30 Rep. Jimmy Gomez (CA): Will a travel ban like this have significant impact on reducing the community spread of the coronavirus. That is cases that are already in the United States. Anthony Fauci: Yes, that is the the answer is a firm yes. And that was the reason, the rationale, the public health rationale why that recommendation was made. Because if you look at the numbers, it's very clear that 70% of the new infections in the world are coming from that region from Europe, seeding other countries. First thing, second thing of the 35 or more states that have infections, 30 of them now and most recently have gotten them from a travel related case in that region. So it was pretty compelling that we needed to turn off the source from that region.

2:02:10 Robert Redfield: CDC did manufacture the original CDC tests that we used - the CDC. And we also manufactured the initial test we sent out to the states, it's an IDT manufactured kits after that.

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Hearing: Coronavirus Preparedness and Response, United States House Committee on Oversight and Reform, March 11, 2020

Watch on Youtube

Witnesses:

• Dr. Anthony Fauci: Director of the National Institute of Allergy and Infectious Disease at the National Institutes of Health
• Dr. Robert Redfield: Director of the Centers for Disease Control and Prevention
• Dr. Robert Kadlec: Assistant Secretary for Preparedness and Response at the Department of Health and Human Services

Transcript:

28:20 Anthony Fauci: In the next, I would say four weeks or so, we will go into what is called a phase one clinical trial to determine if one of the candidates, and there are more than one candidate. There are probably at least 10 or so that are at various stages of development. The one that we've been talking about is one that involves a platform called messenger RNA, but it really serves as a prototype for other types of vaccines that are simultaneously being developed. Getting it into phase one in a matter of months is the quickest that anyone has ever done, literally in the history of vaccinology. However, the process of developing a vaccine is one that is not that quick. So we go into phase one, it'll take about three months to determine if it's safe. That'll bring us three or four months down the pike. And then you go into an important phase called phase two to determine if it works. Since this is a vaccine, you don't want to give it to normal healthy people with the possibility that A, it will hurt them and B, that it will not work. So the phase of determining if it works is critical. That will take at least another eight months or so. So when you've heard me say we would not have a vaccine that would even be ready to start a deploy for a year to a year and a half, that is the timeframe. Now, anyone who thinks they're going to go more quickly than that, I believe will be cutting corners. That would be detrimental.

30:10 Anthony Fauci: The timeline for therapy is a little bit different. The reason it is different is that you're giving this candidate therapy to someone who was already ill. So the idea of risks and how quickly you determine if and when it works is much more quickly than giving a lot of vaccine to normal people and determine if you protect them. There are a couple of candidates that are now already in clinical trial, some of them in China and some of them right here in the United States, particularly in some of the trials that'd be done in some of our clinical centers, including the University of Nebraska. It is likely that we will know if they work in the next several months.

48:22 Rep. Carolyn Maloney (NY): Is that is the worst yet to come, Dr. Fauci? Anthony Fauci: Yes, it is. Rep. Carolyn Maloney (NY): Can you elaborate? Anthony Fauci: Well, whenever you have an outbreak that you can start seeing community spread, which means by definition that you don't know what the index cases and the way you can approach it is by contact tracing. When you have enough of that, then it becomes a situation where you're not going to be able to effectively and efficiently contain it. Whenever you look at the history of outbreaks, what you see now in an uncontained way, and although we are containing it in some respects, we keep getting people coming in from the country that are travel related. We've seen that in many of the States that are now involved. And then when you get community spread, it makes the challenge much greater. So I can say we will see more cases and things will get worse than they are right now. How much worse we'll get will depend on our ability to do two things, to contain the influx of people who are infected, coming from the outside and the ability to contain and mitigate within our own country.

49:45 Anthony Fauci: Looking forward right now, as commercial entities get involved in making a large amount of tests getting variable. When you do two aspects of testing, one, a person comes in to a physician and ask for a test because they have symptoms or a circumstance which suggests they may be infected. The other way to do testing is to do surveillance where you go out into the community and not wait for someone to come in and ask for a task, but you actively pro get proactively get a test. We are pushing for that and as Bob will, Dr. Redfield will tell you that the CDC has already started that in six Sentinel cities and we'll expand that in many more cities. But you're absolutely correct. We need to know how many people to the best of our ability are infected. As we say, under the radar screen.

51:20 Robert Redfield: CDCs role in this was we very rapidly, within almost seven to 10 days, developed a test from an unknown pathogen once we had the sequence. And we did that because we wanted to get eyes on at CDC so the health departments across this nation can send samples to us and we would test them. Secondly, we rapidly tried to expand that and scale it up with a contractor so each public health lab in this country would have that test. During that process of quality control, we found out one of the reagents wasn't working appropriately and we had to modify that with the FDA. That took several weeks to get that completed, but the test was always available in Atlanta if you sent the sample to us. So there never was a time when a health department could not get a test. They had to send it to Atlanta. Now our health departments have 75,000 tests. Most health departments now over 75 health departments have the test, but the other side. Rep. Carolyn Maloney (NY): How many tests are we planning to produce in the United States? Robert Redfield: Well from a public health point of view, we've put out 75,000 the other side, as Dr. Fauci said, which is really not what CDC does traditionally, is to get the medical private sector to have testing for patients. And when the Vice President brought all the testing companies to the White House last week, we got enormous cooperation for the mall to work together. And as we sit here today, Quest and Lab Corp are now offering this test in their doctor's offices throughout this country. But it's not for an individual just to take a test. They need to go see a healthcare professional having an assessment determine whether a test is indicated and then get that test.

1:08:00 Robert Redfield: The other side of the mission is the clinical mission. And I think that's the concern of most American citizens. How do I get evaluated? And again, that really has been worked through the private sector. It wasn't really the public health lead for CDC to get a laboratory test, but I will say that the test we did develop, we published and let everybody use it. They could redevelop it. There was regulatory release. So any CLIA certified lab, according to the FDA was given relief. They could develop the test just like we did and they could use it. And some universities have done that. We also were, was released to IDT, the manufacturer that made our tests for public health purposes. They were given the regulatory relief to actually make that test and sell it to hospitals. And that's the 1 million, 3 million tests that people referred to that are rolling out for that side.

1:17:00 Robert Kadlec: I'm looking at particularly the things that we need for this outbreak right now and I just want to highlight the issues around personal protective equipment. Much of it is sourced from overseas, some of it is domestically manufactured and yes, we could have spot shortages. We're working with different companies in different sectors to see, to enhance both their increased capacity here domestically, as well as obtaining supplies overseas, from overseas unaffected areas to meet the demand. The most important demand is with healthcare workers, ensuring they have the respiratory protection and barrier protection so they can see and treat patients without the risk of getting infected and being lost to their, to the cause.

1:29:55 Robert Redfield: Yeah. So for the coronavirus right now, for example, in Italy, the average age of death is over the age of 80. Most of the deaths that we've seen are over the age of 70.

1:36:20 Robert Redfield: The CDC developed this test for the United States public health system. We did not develop this test for all of clinical medicine. The test for clinical medicine we count on the private sector to work together with the FDA to bring those tests to bear.

1:40:25 Anthony Fauci: At least from my experience, social media can often be as detrimental as it is helpful. That's the reason why, sir. I think the first question that you asked would be the one to go to the source of the data CDC, and I'm not CDC, but I'm saying CDC is a data-driven organization, and if you really want the facts and the data, I would just go to cdc.gov.

1:43:15 Rep. Jamie Raskin (MD): I want to quickly clear up a few things that have been said over the course of this process. One was by the President, in early February when he said, 'it looks like by April, you know, in theory when it gets a little warmer, it miraculously goes away.' Is there any scientific reason to believe that? Anthony Fauci: The basis for any surmising that that might happen is based on what we see every year with influenza, which actually as you get to March and April and May, it actually goes way down and other non novel coronavirus but common cold coronaviruses often do that. So for someone to at least consider that that might happen is reasonable, but, underline, but we do not know what this virus is going to do. We would hope that as we get to warmer weather, it would go down, but we can't proceed under that assumption. We've got to assume that it's going to get worse and worse and worse. Rep. Jamie Raskin (MD): Okay.

1:47:30 Rep. Jamie Raskin (MD): I hear from constituents who are having flu like symptoms, they want to know what should they do, what should they do? Robert Redfield: Well, it's Dr. Fauci said, the first thing I would do is to tell them to contact their healthcare provider or their emergency room and tell them they're concerned. They may have Coronavirus infection and then follow their instructions to where to get the test right. And then proceed with getting the appropriate clinical evaluation. Rep. Jamie Raskin (MD): Okay. So they should call someone before they go in anywhere. Robert Redfield: Well, we'd like to do that because if you really think you're infected, we're trying to avoid someone to walk into a 200 person, a hundred person emergency room. First is just to call in advance, and then they'll arrange exactly how they're going to get to test, how they're going to see the patient. They're going to be prepared when that patient comes to the emergency room, that they're going to be able to isolate them, get them tested, get them properly evaluated.

1:57:20 Rep. Harley Rouda (CA): Without test kits, is it possible that those that have been susceptible to influenza might have been miscategorized as to what they actually had? That it's quite possible that they actually had a covid-19. Robert Redfield: The standard practice is the first thing you do is test for influenza. So if they had influenza, they would be positive. Rep. Harley Rouda (CA): But only if they were tested. So if they weren't tested, we don't know what they had. Robert Redfield: Correct. Rep. Harley Rouda (CA): Okay. And if somebody dies from influence, are we doing post-mortem testing to see whether it was influenza or whether it was Covid-19? Robert Redfield: There is a surveillance system of death from pneumonia that the CDC has. It's not in every city, every state, every hospital. Rep. Harley Rouda (CA): So we could have people in the United States dying for what appears to be influenza, when in fact it could be the Coronavirus or Covid-19. Robert Redfield: Some cases have been actually diagnosed that way in the United States today.

2:00:10 Anthony Fauci: If you look at the curves of outbreaks historically that assembled it to this, the curve looks like this and then it goes up exponentially and that's the reason why it depends on how you respond now. So if we wait till we have many, many more cases, we will be multiple weeks behind. You know, I use the analogy at the press conference yesterday and I'll use it today. It's the old metaphor that the Wayne Gretzky approach, you know you skate not to where the puck is. but to where the puck is going to be. If we don't do very serious mitigation now, that what's going to happen is that we're going to be weeks behind and the horse is going to be out of the barn. And that's the reason why we've been saying even in areas of the country where there are no or few cases, we've got to change our behavior. We have to essentially assume that we are going to get hit. And that's why we talk about making mitigation and containment in a much more vigorous way. People ask, why would you want to make any mitigation? We don't have any cases. That's when you do it because we want this curve to be this and it's not going to do that unless we act now.

2:06:00 Rep. Bob Gibbs (OH) Robert Redfield: But also I see in the reports worldwide, we have a better than a 50% recovery rates. That true. Right. Robert Redfield: Right now, we'd say it's probably about 85%, sir.

2:06:45 Anthony Fauci: The end of the day. If you look at historically, for example, the experience we've had with China, about 80% of them have disease that makes people sick, but they ultimately recover without substantial medical intervention.

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Transcript & Video: Transcript & Video: President Donald Trump Addresses The Nation On The Coronavirus Pandemic, By Colorado Public Radio Staff and The Associated Press, March 11, 2020

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Cover Art

Design by Only Child Imaginations

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Music Presented in This Episode

Intro & Exit: Tired of Being Lied To by David Ippolito (found on Music Alley by mevio)