Anthony Fauci, M.D., Director of the National Institute of Allergy and Infectious Diseases, and other key White House healthcare policy and pandemic response leaders, testified virtually and live to members of the U.S. Senate Health, Education, Labor, and Pensions (HELP) Committee on Tuesday, May 12, at a key moment in the COVID-19 pandemic saga, and responding to senators’ concerns over such issues as guidelines for economic reopening, testing capability, and other pressing issue. Dr. Fauci, as well as Robert Redfield, M.D., Director of the Centers for Disease Control and Prevention (CDC), Stephen Hahn, M.D., Director of Food and Drugs at the Food and Drug Administration (FDA), and Admiral Brett Giroir, M.D., a four-star admiral in the U.S. Public Health Service and U.S. Assistant Secretary for Health, were the other federal officials who testified via video link before members of the HELP Committee, whose chair is Lamar Alexander (R.-Tenn.), and whose ranking member is Patty Murray (D.-Wash.). Some of the senators were present physically in the hearing room in the U.S. Capitol, while others, like the federal officials testifying, were connected remotely.
In response to a question from Sen. Elizabeth Warren, who asked Dr. Fauci, “Do you think we have the pandemic contained?” he said, “If you think we have it completely under control, no.” And, asked about overeagerness to reopen the economy and U.S. society, Fauci said, “There is no doubt, even under the best of circumstances, when you pull back on mitigation you will see some cases appear.”
Later, speaking to Nicolle Wallace on MSNBC, Leana Wen, M.D., a former Health Commissioner for the City of Baltimore, said of Dr. Fauci that “It’s clear about what he’s saying, because it’s entirely based on science and evidence. Nothing about this virus has changed; we don’t have a cure, we don’t have a vaccine. What’s keeping infection rates down is social distancing. I think he said it as diplomatically as he could have; but to his point, we are going to see needless suffering and death, because we are opening too soon, and so we will see those consequences.”
As the three-and-a-half-hour-long hearing progressed, every member of the HELP Committee was given the opportunity to ask any of the witnesses questions, and to follow up with further questions.
At the outset, Sen. Alexander said, “Let’s look down the road three months. There will be about 5,000 campuses trying to welcome 20 million college students, and 100,000 public schools welcoming 20 million students.” Turning to Fauci, he asked, “What would you say about returning to school in August?”
“I would be very realistic with the chancellor and tell her that in this case, the idea of having treatments available or a vaccine, to facilitate the reentry of students into the fall term would be something of a bridge too far,” Fauci said. “The drug that has shown a degree of efficacy [Remdesivir] has been modest and has been demonstrated in hospitalized patients. So if students would like comfort in that there is a treatment probably the best hope is passive transfer of convalescent plasma. But we’re really talking about safety among students going back to school. The solution really would be a vaccine. But even at top speed, we don’t see the appearance of a vaccine in the fall semester.”
“Could I say that we’ll have adequate tests for every student to be tested in September?” Alexander asked. “Is that strategy possible in August and September?”
“The strategy really depends heavily on what the community spread is at the time, whether there’s almost no spread or high spread,” Admiral Giroir said. “But yes, we expect there to be 25-30 point-of-care tests available. We think it more likely that there will be surveillance testing in conjunction with the CDC and local health department. We know that in experimental labs, as many as 10-20 tests can be pooled, so one test could test 20 students. Or waste water from an entire dorm or segment of a campus, could be tested, the waste water. Dr. Redfield?”
“First, it’s really important to evaluate critically the role of social distancing on college campuses and not to forget the importance of what we’ve learned, and developing wellness education,” Dr. Redfield said. “We’re going to have to look at the role of testing; I think it will be important; and it will be individualized.”
“Dr. Fauci, you have warned of needless suffering and death if we push to open too soon, but the President has been sending the opposite message,” Sen. Murray said. “What is the most important message, and the consequences?”
“As I’ve said many times publicly, what we have worked out is a guideline framework of how to safely open America again,” Fauci replied. “And there are several checkpoints in that, including looking at outbreaks in particular (areas). That would really determine the pace or the speed around whether one should reopen. So I get concerned if you see an outbreak and don’t see a 14-day decrease to allow you to go to Phase 1, and then pass the checkpoints into Phase 2 and then Phase 3. And I’ve expressed the concern that if some states and communities jump over those barriers… my concern is that we will start to see little spikes that will turn into outbreaks. So… to the best extent possible, we need to go by the guidelines.”
“The consequences could be pretty dire, right?” Murray followed up. “The consequences could be really serious,” Fauci responded. “And particularly—if states, even if they’re doing it at an appropriate pace, which many of them are and will, that they have in place already the capability—there is no doubt under even the best of circumstances, when you pull back on mitigation, you’ll see some cases appear. It’s the ability to respond to those cases that will determine whether you can continue to go forward, as we try to reopen America. So it’s not only doing it at the right time and in the right place, but having the ability to respond when outbreaks occur.”
Testing issues cited
Sen. Murray spoke out strongly about the White House’s COVID-19 response overall, saying,, “This administration has been plagued by unrealistic goals… Last week, just 250,000 tests per day were performed in the U.S. And the President had the gall to claim that we had prevailed. Dr. Giroir,” she said, addressing Giroir directly, “public health experts do not think that the U.S. has prevailed. This administration has had a record of broken promises about providing tests. I wanted to ask you today, will the Administration’s forthcoming strategic plan required under the COVID-19 package passed into law by Congress, include specific numeric targets for testing capacity, supply chain capacity, and projection of shortages?”
“Yes, Senator Murray, we continue to have a work in progress as we build the testing capacity; we’ve set a goal of 12 million tests over the next four weeks,” Adm. Giroir said. “But as Dr. Fauci said, we have to be [proactive]. Yes, there will be targets, the targets will continue to change based on the evidence. But yes… and I’m pleased in May and June that we will be able to get ahead of the states.” “We will see numbers that you will reach, targeted for testing, supply chain capacity, and projection of shortages?” “Yes, Ma’am, we developed the need statements with the states and CDC, so we’ll be testing about 3.9 percent of the U.S. population,” Giroir predicted. “We need to be evidence- and data-driven, because what we see in May and June will drive what we need to do after that. We know that the testing needs will go up in May and June.”
Later in the hearing, Sen. Mike Enzi (R-Wyo.), who practiced as a physician, said, “We have to be prepared for a second wave of outbreaks as we go into the flu season, potentially stressing the healthcare system even more than it has been.” And, he went on, “I agree with Senator Murray that we need to have some specific goals. Dr. Hahn, our understanding of the clinical picture of COVID-19 continues to evolve. What first looked like a respiratory illness now seems much more comprehensive, potentially affecting the heart, brain, kidneys, and other organs. How does this potentially impact research into vaccines, etc.?”
“Thank you, Senator,” Dr. Hahn said to Enzi. “The evolving picture does in fact impact the endpoints (we’re heading towards)—to make the necessary authorizations and approvals. We’ve set up this Coronavirus treatment acceleration Program, where our top scientists have been consulting with NIH [the National Institutes of Health] and CDC. We do know that some patients with severe COVID disease have developed thrombotic issues. And obviously, that will have (an impact). So we want to adapt it to the clinical circumstances as well as to the type of therapy.”
“What has HHS done to ensure we have significant capacity to administer a vaccine?” Enzi followed up. “This is an important point, because it’s not just about a potential vaccine or vaccines that would be developed,” Hahn conceded, but also about the supply chain and the ability to administer vaccines. As a result, he said, the FDA has created a schematic to help agency leaders “look forward to the potential supply chain issues, such as syringes, etc.; so we’ve been leaning into this supply chain, to make sure that when the vaccine is ready to go, we are [prepared per] the supply chain.”
The hearing proceeded forward through a wide range of questions and responses with very little evident political partisanship, but Sen. Rand Paul (R.-Ky.) injected a strong dose of partisanship when he insisted to Dr. Fauci that the country of Sweden has done a great job in keeping its business and society open while maintaining the same death rate as neighboring countries (a factually incorrect assumption; Sweden’s death rate is now several times that of its neighbors Norway, Sweden, and Finland), and emphasizing that children have had far lower infection rates and far lower rates of extreme illness from COVID-19. Paul, who is both a physician by training and who is the one member of the Senate who has been documented with a COVID infection, from which he has since recovered, tried to compel Fauci to affirm the idea that schools and colleges should open nationwide in the fall.
“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 should be the end-all” in leading federal decision-making connected to economic policy around the pandemic, Paul said. “I don’t give advice about economic things, or anything other than public health,” Fauci responded. “Second, you said we should be humble about what we don’t know. And I think that falls under the fact that we do need to be humble, particularly around children. And we’re seeing things—right now, children presenting with COVID-19 who have a very strange inflammatory syndrome, similar to Kawasaki Syndrome. So I think we have to be careful that we don’t know, and not be cavalier. So you’re right that in general, children do much better than adults. But I am very, very humble in knowing that we don’t know everything about this disease. And that’s why I’m very cautious in making predictions.”
Some Republicans also took the administration to task around testing, including Sen. Mitt Romney (R.-Ut.), who compared the U.S. unfavorably to South Korea, in terms of early testing. Speaking of South Korean leaders, Romney noted, “By March 6, the U.S. had completed just 2,000 tests, whereas the South Koreans had completed 140,000. And they know have 256 deaths, and we have 80,000 deaths. I found our testing record to be nothing to celebrate.”
And Sen. Elizabeth Warren (D.-Mass.) spoke in strong terms later in the hearing, when she said, “In the past 16 weeks, over 1.3 million Americans have been infected with coronavirus; we know that about 80,000 people have died, and 33 million are out of work. Dr. Fauci, do we have the coronavirus contained?”
“If you think that we have it completely under control, we don’t,” Fauci told her. “We are seeing a diminution of infections and hospitalizations in some places, like New York, but we’re seeing outbreaks in other places. I think we’re going in the right direction, but that doesn’t mean we have by any means, total control of this outbreak.” “We have about 25,000 new infections a day and 2,000 deaths a day. And we could be at 200,000 new cases a day by June?” she asked. “I don’t see that. I’m hoping that we’ll be much, much better than that, by June,” he responded.
“But we are at 25,000 new infections and 2,000 deaths a day,” Warren continued. “So let me just ask: if we know that it is possible to get this virus under better control, and other countries have done it, like South Korea, but we continue to set records for new infections and deaths. You recently said that a second wave in the fall was inevitable, but if we could put all the right countermeasures in place—continued social distancing, significantly more testing and contract-tracing—we could do better. So right now, we’re about 16 weeks away from Labor Day. That’s about the same amount of time since the virus was first detected in the U.S. Do we have enough robust countermeasures in place that we don’t have to worry about the fall and winter?” “The projection is that by the time we get to the fall, we will have that in place,” Fauci replied. “
“If we don’t do enough testing, contract tracing, and social distancing, will deaths from coronavirus necessarily increase?” Warren asked. “Of course; if we do not do an adequate response, we will have the deleterious effects.,” Fauci responded. “If we do not respond in an adequate way, when the fall comes, it is without a doubt that we will have outbreaks in the community, and there will be surges.”
