Thread by @BBuchman_CNS

Today, Dr. Anthony Fauci will testify before the Senate and he is prepared to warn lawmakers that 'reopening' America too fast
"will not only result in needless suffering and death, but would actually set us back on our quest to return to normal."
Live-tweeting starts at 10AM.

A stream of today's hearing hosted by the Senate Health, Education, Labor and Pensions Committee will be available here ⬇️
help.senate.gov/hearings/covid…
@CourthouseNews

The panel that will testify today:

INBOX: The very first public briefing of the Select Subcmte on the Coronavirus Crisis will be held tomorrow, Wednesday, May 13 at 3PM ET. I'll have the coverage for @CourthouseNews.
This is the committee chaired by Rep Jim Clyburn and we will hear testimony from:

For more background on the select committee, check out my story here:
courthousenews.com/south-carolina…

"The bottom line is it is going to get worse." - Dr. Anthony Fauci

He said this to the House on March 11 and argued that the pandemic would likely worsen in America with the continued delayed response and/or inadequate testing.

Background: courthousenews.com/infectious-dis…

"That is a failing. It’s a failing. Let’s admit that.” - Dr. Anthony Fauci

He said this to the House on March 12 as he discussed how the U.S. just simply did not have the capacity required to conduct widespread testing from the jump.

Background: courthousenews.com/us-failing-on-…

And while you wait, why not read this excellent piece by my colleague in Italy @cainburdeau:

https://twitter.com/cainburdeau/status/1260162489758646274?s=19

Another reliable link to watch today's stream - forever and always - @cspan: c-span.org/video/?471837-…

Today social distancing restrictions will be observed for the Senate committee hearing in what is described as a one-time exception.

Those present will be six-feet apart but the chairman, Senator Lamar Alexander, R-TN, will be video-conferenced in along with witnesses.

Brief biographies for each of our witnesses today provided to the committee.

First up, Dr. Anthony Fauci:
documentcloud.org/documents/6888…

Next, we have a bio for commissioner of the Food and Drug Administration Stephen Hahn:
documentcloud.org/documents/6888…

A short biography for CDC director Robert Redfield available here:
documentcloud.org/documents/6888…

And finally, a brief bio for Admiral Brett Giroir, assistant secy for Health and Human Services
documentcloud.org/documents/6888…

My colleague @JackRodgersCNS is on the Hill today and is outside of the hearing room where lawmakers will hear remote testimony from Dr. Fauci and Redfield re: admin's plans to return Americans to work, school and "business as usual."
File under: Surreal.

Away we go.
The Senate Health, Education, Labor and Pensions Committee has begun today's hearing.
I will live-tweet for @CourthouseNews and will have a full report for you later.

Sen. Alexander begins today's hearing with Fauci, Redfield, Hahn and Giroir by commending the "impressive" nature of testing in America under Trump. He defines that success by the 9M Americans who have been tested already.

"Anyone who is sick or who is a first responder or health care worker can get tested," Alexander says.

Anyone in Tennessee who needs a test can get one, he adds.

The state has so far tested 4% of its population and he says the guv there is on track to test up to 7% soon.

FDA authorized an in home saliva test last week plus its first antigen test, (swabbing the nose, results in a few minutes).
Another proposal not yet approved by the FDA is a "sort of lollipop sponge" Senator Alexander says.

The GOP senator notes: "Anyone testing negative one day can test positive the next, but widespread screening will help identify those who are sick, trace down those who are exposed and that in turn should persuade the rest of us to go back to work."

In addition to more testing, Senator Alexander expects Fauci will discuss additional treatments to "reduce the risk of death and the admin's plan to start manufacturing a vaccine before it actually has been proven to work in order to speed up the result in case it does work."

Alexander says before we get into fingerpointing, he says "everyone underestimated" how especially deadly Covid-19 would be and how contagious it would be.

A view from @cspan of how business is being conducted in the Senate committee, 70+ days since the pandemic gripped the US

Even the experts underestimated Covid-19, this hearing is about how we improve our response to this virus as well as the next one, Sen. Alexander says.

He also wants to focus on the next pandemic "which we know is coming."
How can we keep hospitals afloat/production lines etc

Sen. Alexander says that Congress was "preoccupied with impeachment" before the pandemic but now that "feels like ancient Roman history."

Today's hearing will wrap around 12:30 PM ET, according to the chairman.

Ranking Senate HELP committee member Patty Murray is now delivering remarks via video conference.
"Families across the country are counting on us for the truth about the Covid-19 pandemic, especially since it is not clear that they will get it from President Trump."

If the president isn't telling the truth, we must. And our witnesses must. And we're counting on you today, Murray says to Fauci, Redfield, Hahn and Giroir.

"We must dig into the facts about where things did go wrong because the Trump administration's response to this emergency so far has been a disaster all on its own," Senator Patty Murray says.
"Delays, missteps have put us way behind where we need to be on diagnostic tests."

Corruption and political interference have interrupted attempts for states to get desperately needed equipment, Sen. Murray notes. And experts at CDC spent weeks developing a guide on how to reopen, but the Trump admin tossed it in the trash bin for being "too prescriptive."

The administration continues to silence experts (paging Dr. Bright) and Murray says, Trump is more focused on fighting against the truth than fighting the virus and Americans have sadly paid the price.

courthousenews.com/virus-vaccine-…

Murray continues, "When I say a plan, I don't mean a PR plan. We need a plan with specific goals on testing, distribution... on disparities and building out the public health system and makes clears to states, tribes and employers on what they can expect from the administration"

Testing alone will not be enough, Sen. Murray underlines.

We need far more PPE than has been available to healthcare workers on the frontlines and we'll need far more for other workers as we reopen.

The administration must step up and get equipment to states, she says.

On the CARES Act relief packages and the need to extend assistance:

What good is a bridge that only gets you to the middle of the river? We don't need to wait around and see if people need more help. We know they do. - Sen. @PattyMurray

@CourthouseNews

Each witness will be able to give their opening remarks for 5 minutes - this is standard procedure for opening statements.
Dr. Fauci, director of NIAID, speaks first.
Dr. Robert Redfield, director of CDC goes next.
Admiral Brett Giroir follows.
Then FDA commish Stephen Hahn

Dr. Fauci begins.
With regard to diagnostics: the NIH has developed rapid acceleration of diagnostic programs and half a billion $ will go toward development of Covid-19 diagnostics,.
It's a "shark tank-like" selection process to get to success or failure rapidly, he says.

On therapeutics, he will discuss Remdesivir success but he wants to emphasize that there are many antivirals in stages of testing.
Convalescent plasma from recovered Covid-19 patients is being considered broadly.

Repurposed drugs and immune-based therapies are also under review.
Re: remdesivir placebo control trial at sites throughout the world - it was in hospitalized patients with lung disease. The result was significant but modest, he says.

"And we must remember it was only a modest result showing the drug made recovery time 31% faster. We hope to build on this modest success with combinations of drugs and better drugs," Fauci says.

On vaccines: there are 8 candidates for vaccines in clinical development. NIH has been collaborating with pharma. companies to get them rolling, Fauci said.

In January, Fauci said it would take 1 year to 18 mos. "if we were successful" in developing a vaccine. The NIH trial moved quickly, he notes. By Jan 10 the sequence was known. By Jan 11 the team met to develop a plan and within a week, development got underway.

Sixty days later, two prospective doses are enrolled in trials. There will be animal safety tests, Fauci says and he expects phase two or three to begin in summer.

"There are multiple candidates out there. This is good for global availability if we have more than one successful candidate," Fauci says of vaccine trials in the works.

Dr. Robert Redfield, dir. of the CDC is delivering remarks now and says that the agency will be at the ready to assist states with testing and tracing and to help local governments how to better understand infection and spread, esp. with asymptomatic carriers

Redfield says it "is important to emphasize we are not out of the woods yet."
We need to remain vigilant with social distancing, he adds.

Admiral Giroir is now delivering his opening remarks and is extolling what he describes as significant successes in building out U.S. testing capacity. He displays this graphic below depicting how from March 8 to May 10, just under 9M tests were conducted.

"We anticipate marked increases in current tests and dramatic expansion of new point of care tests, Giroir says noting Quidel's antigen test.
Quidel predicts 300K tests per day in just a few weeks, Giroir says. Notably, Trump said yesterday that ramp up would be next week.

FDA commissioner Stephen Hahn is now speaking (featuring this fun background blur)
Since Day 1 of the pandemic, the 18k employees at FDA have taken an active role in the "all of government response" to the pandemic.

250 labs are testing under regulatory flexibilities outlined in March by the FDA. Rolling reviews are also being conducted for tests. FDA Commissioner Hahn says they are "working to provide more clarity around what tests are working and those that are not."

Sen. Alexander asks how to persuade parents and students to return to school in August. He asks Fauci to discuss treatments and vaccines first, leaving testing q's to Giroir.

Fauci on reopening schools: "I'd be very realistic, in this case, the idea that having treatments available or a vaccine to facilitate the reentry of students into the fall term would be something that would be a bit of a bridge too far."

"The drug that has shown some degree of efficacy was modest and in hospitalized patients," Fauci says. It is not yet or maybe ever ready to be used as prophylaxis or for treatment.

"If the issue is the young individuals going back to school want to have some comfort that there is a treatment, probably the thing that will be closest then is the passive transfer of convalescent plasma serum," Fauci says.

But we're not talking about treating a student , we're talking about how they will feel safe going back to school, Fauci notes.

"If we had a vaccine, that would be the end of the issue but even at the top speed we are going, we don't see a vaccine playing into individuals' ability to get back to school in this term," Fauci says.

Admiral Giroir says the testing strategy deployed depends on what the community spread looks like in the fall.
Ideally, we'd have the ability for schools to test. But says that 25M point of care tests will be available per month by that point.

All students could be tested potentially, Giroir says. Ssome students may be tested at different times and that testing with schools could be done in conjunction with CDC and local health departments.

Fauci says if locales not seeing a decrease in cases after the initial checkpoint in phase one of the federal guidelines are passed, you have to consider this.

Fauci: "If some cities or states jump over those various checkpoints and prematurely open up without having the capability of opening up to respond efficiently and effectively, we could see little spikes that turn into outbreaks."
@CourthouseNews

Sen. Patty Murray to Fauci: If a state doesn't by those guidelines, the consequences could be pretty dire?
Fauci: The consequences could be really serious.

Fauci continues: "There is no doubt even under the best of circumstances when you pull back on mitigation, you will see some cases appear. It's the ability and capability to respond to those cases with good identification, isolation... that determines whether...

"...you continue to go forward in trying to reopen America. It is not just about having the appropriate time and constraints in place but having the pieces in place to respond when inevitable infections occur."

Sen. Bernie Sanders begins with Qs to Fauci. Sanders notes how there are 80K Americans dead and how some studies have predicted that number is actually quite higher, even twice that.

Fauci says it is possible that the existing numbers are not totally accurate.
"Many people may have died at home who had Covid-19 but were not counted," Fauci says. "I think you are correct. The % higher but almost certainly it is higher."

Fauci says the possibility of a rebound/second wave in the fall: "It is entirely conceivable and possible it will happen."
But he hopes between now and then, given increased testing capability and our ability to stock up on PPE + workforce CDC will put forth to ID/isolate/trace..

Fauci: "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 worse than now, but much much less."

Q from Sen. Burr to Fauci. Has anyone ever asked Fauci or anyone else at the NIH to take their foot off the gas on developing a vaccine for the virus?
Fauci says "no one told to pull back on the development of any countermeasure or research measure involved"

Fauci tells Senator Casey if the U.S. jumps ahead of the checkpoints for social distancing prematurely: "It would turn the clock back rather than going forward."

Sen. Rand Paul asks about immunity and blames WHO for suggesting verdict was still out immunity.
Fauci says given what we know about most infectious disease, when you have antibody present, it very likely indicates a degree of protection but its a degree of semantics too he says

Fauci: "When you say has it been formally proven by long term history studies you ask: Is it protective?
It is likely that it is, but also, Fauci says, what is the degree or type of antibody that gives you that level of protection and what is the durability?

Fauci continues on building up immunity: "You can make a reasonable assumption that it would be protective but natural history studies over months or years would tell you definitively if that is the case."

Sen. Rand Paul says he respects Fauci but doesn't think he is the "end all. This prompts Fauci to say:

"I've never made myself out to be the end-all. I give advice according to the best scientific evidence."

Fauci continues his response to Sen Paul:
"There are a number of other people that come into this and give advice about the need to reopen the country or the economy. I don't give advice about the economy. I give advice about public health."

Fauci uses Paul's own words to respond about the need to "be humble" about what we don't know.
Fauci: "You said we should be humble about what we don't know. We don't know everything about this virus and we better be careful, especially with children."

Fauci notes how we are now seeing "more and more" issues like kids presenting w/Covid who also have something that looks like the inflammatory condition known as Kawasaki disease.
"We better not be cavalier thinking children are immune to the deleterious effects," Fauci says.

Fauci continues to Senator Rand Paul: "Yes, children do better than particularly, the elderly or those with underlying conditions. But I am very careful and hopeful that I don't know everything about this disease and that is why I am reserved in making broad predictions."

Sen. Susan Collins is up and started remarks discussing how state restrictions have hurt dentists and inhibited access to people who need dental care, esp. urgent dental care.

If dentists are following the American Dental Assoc. guidelines and are instituting strict protective measures for their patients and staff, if closely examining and seeing a decline in Covid-19 infections in their county, are these reasonable factors to reconsider reopening?

Redfield says the CDC is in "in the process" of updating its guidelines for dentists.

Sen. Chris Murphy, D-Connecticut, asks Fauci, Redfield and Hahn: all of you are drawing a salary during quarantine, correct?
They are.
Murphy notes how they, himself included, get paid, telework while millions of Americans can't and are paid by the hour.

"It's remarkable that this administration has not yet developed a mechanism for states to implement and pay for a quarantine system that will pay for all Americans," Murphy says.

The Trump admin plan to reopen suggests this, but they have given no specific guidance on how to lead this in their states.

Sen. Murphy calls the Trump admin reopening guidance "criminally vague."

@CourthouseNews

The guidance from CDC, developed by Redfield and others that was reported as shelved and withheld from the White House.

Why didn't this plan get released? When will it be released? States are opening now. We need this additional guidance.

Connecticut is reopening in less than 2 weeks.
Redfield says the information is under review and coming.
The CDC stands by the technical assistance it has provided to Sen. Murphy's states and others, Redfield adds before also noting the guidance will be published "soon."

Sen. Cassidy asks FDA head Hahn about safety of treatment protocols currently being developed for both children & adults.
Hahn and Fauci confirm children not to be considered in testing for Phase II treatment trials.
Hahn says talks underway between FDA/NIH on how to navigate.

Fauci emphasizes to senators that the response for reopening states amid the pandemic is not going to be "homogenous" and we will have to tweak as we go and pay attention to infection trends etc.

Fauci in response to a Q from @ewarren about whether we have Covid-19 "under control" :

"Do I think we have it totally under control? No... I think we are going in the right direction but going in the right direction does not mean total control over the situation."

.@ewarren: We are 3 months into the pandemic and we continue to set records with the # of people who die.
What other countermeasures we can take beyond social distancing, wider spread testing?
We're 16 wks from Labor Day, the same length of time since virus first detected in US

Sen Warren: Do we have enough robust countermeasures in place not to worry about a bad fall?
Fauci: Right now, the prediction as you heard from Giroir in regard to testing, that by the time we get to the end of summer early fall we will have [more testing] in place.

Warren: If we don't do better on testing or contact tracing or social distancing, will deaths from Covid-19 increase?
Fauci: Of course, if you don't do an adequate response, we will have a deleterious experience of more deaths.
He continues:

Fauci: "If we do not respond in an adequate way when the fall comes, there will be without a doubt, infections and resurgence. I would hope by that point we would have more than enough to respond adequately but if we don't there will be problems."
@CourthouseNews

Giroir fields a Q about how factory workers in Kansas, where the economy is driven by meatpacking, are impacted.
Giroir points to rapid testing that already exists at public and CDC labs in Kansas.
Sen Roberts: "If it takes an hour to get a test, I don't knowhow that is rapid."

STORY DEVELOPING.
Eighty thousand Americans have died from Covid-19 in just over 70 days, but things will only get worse, Dr. Anthony #Fauci said Tuesday in remarks to the Senate, if the country rushes its return to normalcy.
courthousenews.com/rushing-back-w…
@CourthouseNews

Sen. Lisa Murkowski, R-Alaska: Alaska is doing OK from a numbers perspective and we'd like to keep it that way.
Facilities there are limited, geography is challenging.
"We don't want to be a hotspot in Alaska"

Cordova is getting ready to open a salmon fishery in 2 days, Murkowski notes, referencing this:
adn.com/alaska-news/20…
Keeping vigilant, providing tests is vital. Murkowski wants to know what else can be done for communities who are not yet hotspots safe?

Travel restrictions are keeping COVID out of Alaska but it is also "devastating" Alaskan tourism/local economy, Murkowski says.
Giroir commends entry isolation tactics for those who come into the state; but acknowledges the difficulty in providing tests to remote locations.

Giroir says feds have given Alaska 50k tests.
Murkowski says their plans for contact tracing in Alaska are still not efficient.
What more needs to be done to make sure once you've been tested positive you know what happens after that? Who else needs to be brought in?

Sen. Lisa Murkowski, R-Alaska says: "I am not convinced we're focusing enough on how we move to reopening if we haven't done contact tracing."

CDC dir. Redfield says agency is working with Alaska's state department, labs & even state census bureaus to coordinate on building out contact tracing.
Redfield: It will be state by state but it will probably need to be augmented and it needs to get in place before September.

Sen. Maggie Hassan, D-New Hampshire wants to know how the CDC will use facts, evidence and guidance to create safe, sustainable plans to reopen.
"Testing capacity has to be flexible enough to meet our needs,' she says.

Hassan: Should nursing homes implement a mandatory testing system?
Fauci says there should be system but testing everyone at each facility every day may not be practical. But...

there should be "strict regulations and guidelines about who is allowed to go into nursing homes." And Fauci encourages staff be monitored w/ intermittent testing to make sure there isn't introduction into nursing homes of infected individuals.

Fauci's response continued on question about testing in nursing home facilities:
"Testing every day would not be feasible but something that is much more aggressive than it has been in the past must be done."

Sen Tina Smith, D-Minn. commends Fauci and starts by just asking him:

How are you doing?

Fauci: I'm doing fine and I enjoy very much working with your senators and governors. It's at the local level that we will make this thing work.

Sen Smith notes how meatpacking plant employers are getting sick and she relays a story about an immigrant woman who sanitizes the machines that grind meat.
She felt sick on April 11, and within 10 days she asked to go home. She paid $115 for a test and was confirmed positive.

She's at home and not getting paid and doesn't have health insurance.
Two weeks ago Trump deployed DPA to keep plants open but skimped on guidance of how to keep these workers safe.
What do we do, Smith asks Fauci

Fauci says you have to provide these workers with the protection they need if you are going to keep these facilities open and not grind things to a halt.
Those who are performing essential services, Fauci says, it's "almost a moral obligation" to provide protection for them

Fauci was careful to make this point about it being a moral obligation as his personal, human opinion and not the official proclamation.

We now hear from Senator @MittRomney
"I understand politicians are going to frame data that helps them politically, I wouldn't expect that from admirals," he says to Admiral Giroir, effectively slamming Giroir for his claim that U.S. testing record is worth celebrating.

Romney, pointedly: Is Obama responsible for not having a vaccine now?
Fauci: No not at all. Not Obama nor President Trump are responsible for us not having a vaccine. We moved rather rapidly from knowing what the virus was to a phase 1 trial as fast we have done.

Romney: How is it possible that CDC has not established a realtime system to get data? What can Congress do to rectify that so we never have to deal with this again?
Redfield says Congress has added $ for data monitoring and they're in the process of updating an "archaic" system

Sen. Doug Jones, D-Alabama asks a Q about where we're going with contact tracing.
Using that data in terms of quarantine plans is crucial for everything from child care facilities to hotels that could be used for isolation. How is the plan being developed by CDC?

And how will these programs be paid for?
Redfield: To be prepared for the fall and winter, CDC is working individually with leadership at state and local health departments to help CDC understand what their capacity needs are.

CDC has over 500 people sent to states to assist plus additional state by state personnel.
Each group will construct a contact tracing piece based on what they think their needs are.

I need to pull off live-tweeting to finish my report for @CourthouseNews but stay tuned!

Story developing here: courthousenews.com/rushing-back-w…

Fauci tells senators that at no point has he felt any untoward pressure from Trump to skew information or not give sound advice.

Fauci, Redfield, Giroir and Hahn all agree they have never had a "confrontational relationship" with POTUS.

"I don’t give advice about the economy. I give advice about public health.” - Dr. Anthony Fauci to U.S. Senators today

Updated story available here: courthousenews.com/rushing-back-w…

And my many thanks to my colleague @JackRodgersCNS for the contribution and assist today.