Thread by @BBuchman_CNS

Onto the news. Today, the Cmte on Homeland Security meets with public health experts and the former dir. of the CDC to talk #Covid_19 and US response to pandemic threats.
Hearing starts at 10AM ET.
I will have live coverage for @CourthouseNews.

Live video feed will be available here:
c-span.org/video/?469981-…

We will be underway soon.

We have begun. Committee on Homeland Security chairman Bennie Thompson begins by offering a summary: Today we talk #COVID, what Americans can do to protect themselves, what the fed govt is doing, what more it can be doing, ETA on vaccines and more.

Today we hear from: Ngozi O. Ezike, MD, Director, Illinois Department of Public Health, a 15 year veteran of the public health sector; Tom Inglesby, MD, Director, Center for Health Security, Johns Hopkins University Bloomberg School of Public Health and ...

We will hear from Julie Louise Gerberding, MD, MPH, Co-Chair, Commission on Strengthening America’s Health Security, Center for Strategic & International Studies (former Director of the Centers for Disease Control and Prevention)

Ranking chairman on the Committee for Homeland Security, Rep. Mike Rogers says he is concerned Chinese withheld information about the virus at the start of the outbreak. He says he is concerned about preparedness at state/local level and political leaders fanning hysteria flames

Tom Inglesby, MD, Director, Center for Health Security, Johns Hopkins University Bloomberg School of Public Health, speaks first and recommends that Covid19 funding requires 2x as much or more than what was allocated for ebola because of how fast covid spreads

Routine medical care was disturbed in China due to covid, for cancer clinics, dialysis clinics etc.
Inglesby tells lawmakers we must act now to avoid the disruptions in US; testing now underway at CDC for more covid cases, so more positive diagnoses are on the horizon

It's very important for the federal government to be speaking in a single voice on covid, Inglesby says.
These updates should be like those provided in past with H1N1. There were daily announcements/status updates that kept misinformation at bay

Dr. Ngozi Ezike, dir., Illinois Department of Public Health now discussing covid cases in Illinois - the test has been "invaluable" to coordinate the effort to stop the spread from getting out of hand. But she is concerned the supply chain from CDC for the testing kits is at risk

Frmr director of CDC under former Pres Bush: Julie Louise Gerberding, MD, MPH, Co-Chair, Commission on Strengthening America’s Health Security, Center for Strategic & International Studies now speaking.

She dealt with anthrax/SARS outbreak under Bush, says many lessons were learned then that are relevant today.

Remember where we are in the outbreak. There are three main phases of outbreak response, she says.

The first is detection.

"That happened in China and was reported fairly early in the process. But we dont have full detection cus we dont have full testing."

"We still don't know if the cases we're detecting represent the tip of the iceberg and how much of the iceberg is undetected because we haven't tested or because many patients are asymptomatic, which I suspect." - Dr. Gerberding, former CDC director under Bush admin

The second phase is containment of a virus where it starts.

"In the history of the world, we haven't seen a more dramatic demonstration of that than what occurred in China and what has occurred around the world to keep viruses out of countries. It was a heroic effort."

It wasn't perfect, she acknowledges.

Where we are now is in the phase of "slowing the spread of the virus." It's here and we're doing everything we can on the front lines of public health to isolate ppl who may be exposed/incubating and manage the social system that prevents spread.

Businesses still need to run, so does med supply chain, she says. There will be a lot of local decision making, what happens on fed level she says, may look much different at state level

Trust is everything in this: "We must have credible leadership at every level, federal, state and local. We must have clear and consistent communication from trusted individuals who are knowledgeable about public health, healthcare and the science of public health interventions."

We need a spirit of collaboration not combat, Dr. Gerberding says.
#COVID

Chairman Thompson gets to this right away, says his office rec's calls regularly from people confused over covid and US response

Inglesby says there have been days where govt's different messages maybe weren't intentional but because of too many people having different information. But he adds, its crucial to say what the risk is TODAY.

Inglesby: Americans must understand what health officials believe is likely to happen going forward.

He is careful here, adds that this is not meant in an alarmist way, but so people can be informed and diminish risk.

Chairman Thompson asks Gerberding to discuss the need for a consistent voice. During her time under Pres Bush, she rcalls how difficult it is - you can't communicate enough. You have to have daily reports. Hardest thing in early phases of an outbreak is the uncertainty.

Just to acknowledge this will stop panic, she says.
People panic when they don't know who to trust or believe.

Gerberding also says it cannot be emphasized enough how important the roles of governors are in this.

Thompson bringing up the WH press briefing that was closed to cameras/audio. If you hold briefings, they should be public. Recordings should be made because it is the consistency of a msg that provides confidence.

Thompson asks Trump admin directly to allow press access

Ranking chairman asks Gerberding what is one lesson in the past? She responds: We are going to see diseases spillover from the animal kingdom for a number of reasons, for one, she advocates for rejection of "wet markets" with live animals

Ranking chairman Rogeers asks Q on quarantine. What would that look like? Dr. Ezike says first let's talk diff between quarantine sites and isolation sites.
Quarantine sites are for ppl who dont have symptoms.
Isolation sites are for those already showing.

The goal for people who are already sick is to keep them out of the hospital if they don't require ICU care.

This reduces risk to healthcare workers, public etc, Dr. Ezike says.

Rogers asks q about what an ideal isolation situation/facility would look like.
If you live alone, isolation easier but if you've got a family, Dr Ezike says it would be helpful to have facilities akin to a motel w/indiv. rooms, where air is not shared, no common lobby

Ezike also recommends having a separate processing system at hospitals potentially, keeping people who may show up sick with covid separated from those who may appear for different care, this could help maintain the spread

Ezike going through different reccs and says at the top of mind is recs for long term care facilities because the population is so high risk. Assisted living facilities must be looking at infectious control programs, reeducate staff, thinking about ways to co-house people

Dr. Ezike mentions how a patient who was being tested for covid in a IL hospital was anxious to leave w/o knowing results because w/o sick leave, he was losing money and risking his job. This is effectively counterintuitive, she argues, solutions needed at state/fed level

Gerberding emphasizes later that we also need to get a firm grasp on how covid spreads among children as states/fed govt weigh school closures etc.

In Wuhan, the estimate was that the epidemic was doubling every week. We don't know if it will be the same here, Dr. Inglesby says. But we saw prominent clustering in families or ppl who have close contact.

Inglesby: "We should presume there will be relatively rapid spread in our communities and we're beginning to take measures to change that but I think it could spread rapidly. Fortunately, many cases will exhibit mild illness but...

Inglesby: "We're going to learn a lot about what it looks like in US in coming wks. Social distancing measures should be more seriously weighed in areas where outbreak already is but at some point, those measures wont scale any further."

Inglesby continued on covid: "It will be too many people to do that. We'll have to shift strategies."

Ezike says Illinois Public Health officials are in constant contact with CDC, they have onsite support, go-teams deployed to help with outbreak investigations; guidance routinely updated and disseminated. There's a robust collaboration, CDC is listening to Illinois, she says

What else is needed to contain #COVID?

Money.

There's employee overtime, lack of housing options and more.

IL Public Health had to rent an RV because a motel wouldn't agree to take one of the people who needed to be isolated, Dr Ezike says

Rep David Joyce, R-OH, starts out his time on the dais by praising Trump's response to #COVID. He lauds the coronavirus task force (populated by a lot of people with zero medical experience or experience in infectious disease).

Rep Joyce says to Gerberding: you mentioned we have not yet completed the SARS evaluation for vaccines but that process is initiated. And SARS 2 is a coronavirus, does that put us steps ahead in vax development?

Gerberding: One optimistic view is that science has developed since that outbreak in 2012.
At a recent WHO leadership mtg on vaccines for coronavirus, there were 31 ppl talking about their approach to vax development but all of that was pre-clinical, Dr Gerberding says

"That's the positive experience but the reality check is getting a candidate vaccine is straightforward but getting it through safety testing, clinical testing, getting thru front line conditions, regulatory processes and manufacturing...
" is different ...

Gerberding on the difficulty of building out #COVID vaccine for all: Unlike SARS, "In this case, the vaccine is not just for a small # of people, but for the world... That is a daunting task."

Gerberding: "What concerns me is we are seeing some overpromising and we need not to alarm people when promises don't actually come to fruition on the timeline ppl are expecting."

(continued)

Gerberding: "We need to be straightforward about the challenge ahead: work hard, invest, support those doing the work. But this vaccine is not going to be in American arms for a long time."
cc: @realDonaldTrump

Rep Yvette Clarke, D-NY discussing the spread of coronavirus in NY. "We can expect more to come but this is not the time for fear but the time for facts... Doctors, not politicians, need to be in the driver's seat as we combat this global outbreak."

This is not a hoax or an apocalypse either, it is a public health emergency that can be addressed with funding and sound science, Rep. Clarke says.

She refers now to the Trump admin's decision in May '18 to shut down NSC global health unit.
What were the consequences of this action? Gerberding says she honestly doesn't know but she knows Dr. Ziemer and was sorry to see him go.
via @wapo washingtonpost.com/news/powerpost…

You may hear the phrase "sentinel surveillance testing" when #covid comes up.
Dr. Ezike explains: once you have ability to test, it involves testing those who dont have a direct connection to a confirmed case or have no direct travel to a virus hotbed

If they develop a flu-like illness and go to their doctor, the doc could identify 'you don't have the flu or other common respiratory viruses, maybe this is coronavirus despite you having no connection.'

This type of testing allows us to see what % of coronavirus exists and allows us to see where pockets may be flaring up in a given state

Rep Max Rose says he sees business leaders telling people not to travel internationally. He wants to know if this is taking it too far.
Gerberding says there's no decision that you cant travel period but while there's work on slowing the spread, air on the side of caution.

If we're in a situation where we cant isolate and quarantine each individual, it does make sense to think about avoiding crowds, minimizing movement, flying as well, Gerberding says.
"We're on the move when it's important, but be more comfortable using digital communication"

Inglesby says things can change in 24 hours esp. as countries begin to start testing. (See Italy)
Inglesby agrees with current CDC advice on travel given the circumstances right now.

Rose says he's concerned low-income earners won't respond to recs on quarantines. What can fed govt do to support ppl so they can respond to quarantines?
Inglesby: One thing is to make sure there are no barriers to testing or getting medical care or isolation.

Inglesby says he's seen evidence of people having a $3K bill for a covid test and that obviously deters people from being tested.

Rep. Rose asks if fed govt should expand unemployment insurance?
Inglesby says if its a way of helping low wage workers to make better public health decisions, it should be considered.

Gerberding also tells lawmakers govt must do more to speak out against the stigmatization of Asian Americans/ those of Asian/Chinese descent

Rep Green (TN) Why is it that the mortality rate in Wuhan is so high (3%) and outside of China its .7%.
Inglesby: One factor in Wuhan could be the surge in hospitals without ventilators because they ran out early on; the outsize impact of smoking on citizens etc.

We're talking about antiviral meds that worked on ebola - Rep Green wants to know if these meds could tamp down coronavirus and be produced faster than a vaccine.

Gerberding: I'm really hopeful. I want them to work. But we have to think about what we've learned about respiratory infections/antivirals so far. We have several antivirals for flu, they may mitigate but are not curative.

Some of these antivirals could potentially make respiratory inflammation much worse. Testing must take place.

"We cannot overpromise on what we may say. Hope for the best but don't be surprised if disappointed."

Public agencies have been training for infectious disease spread for quite some time, Inglesby says. There's been a lot of preparedness all around but the covid challenge is still one that will test the capacity of public health facilities and hospitals

Story coming up for @CourthouseNews

Congress has reached a deal.

$8.3B will be appropriated to deal with the coronavirus outbreak.
The House is expected to vote on it today. There will be 40 mins of debate, no amendments.
Stay tuned.
@CourthouseNews

And the text of the coronavirus funding package is released. Available here:
documentcloud.org/documents/6794…
@CourthouseNews

INBOX: @SpeakerPelosi on coronavirus emergency spending bill:
“Americans urgently need a coordinated, fully-funded, whole-of-government response to keep us safe from the widening coronavirus epidemic."
(Thread)

"We can do that now because today we reached a bipartisan, bicameral agreement on an emergency coronavirus response funding package of $8.3 billion of entirely new funds, thanks to our appropriations negotiators under Chairwoman Nita Lowey."

Pelosi: “We commit more than $3 billion to the development of treatments and a coronavirus vaccine and include an additional $300 million to ensure Americans will have access to the vaccine regardless of their ability to pay."

The bill will also protect against price-gouging, Pelosi said, by "ensuring that the federal government will only pay a fair and reasonable price for coronavirus vaccines and drugs and providing HHS the authority to ensure that they are affordable in the commercial market."

Pelosi says $2.2 billion provided in bill for public health funding for prevention, preparedness and response, including nearly $1B specifically to alleviate the immense financial strain on state, local, tribal and territorial hospitals and health systems.

Pelosi: "To protect public health, the bill will allow Medicare providers to extend telemedicine services to seniors regardless of where they live, at an estimated cost of $500 million."

Pelosi: "The bill also allows an estimated $7 billion in low-interest SBA loans to small businesses impacted by this epidemic."

STORY DEVELOPING.
courthousenews.com/house-set-to-p…
#CoronavirusOutbreak