Published by The Lawfare Institute
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On Feb. 26, the House Foreign Affairs Subcommittee on Asia, the Pacific, and Nonproliferation held a hearing in which lawmakers questioned officials responsible for the U.S. response to the coronavirus (COVID-19) outbreak.
The hearing occured only a day after the announcement of possible community spread of infection in California and the Trump administration’s appointment of a policy czar-like figure, Amb. Deborah Birx, the State Department’s global AIDS coordinator, who will be overseen by Vice President Pence.
Chairman Ami Bera set the tone of the hearing: The U.S. needs to be prepared for the worst but hope for the best. In his opening remarks, Bera specified that politics have no place in this issue. Ranking member Ted Yoho reiterated this call and emphasized that we are all on “Team America,” as a virus knows no borders or political party. Both representatives highlighted a concern over misinformation, but Yoho praised the ongoing U.S. government response as more rational and collaborative than past epidemic responses.
The subcommittee heard testimony from three officials from the State Department: Jonathan Fritz, the deputy assistant secretary for China, Mongolia, and Taiwan Coordination; Ian Brownlee, the principal deputy assistant secretary for consular affairs; and William Walters, the executive director and managing director for operational medicine in the Bureau of Medical Services. The subcommittee also heard from Centers for Disease Control and Prevention (CDC) Director Robert Redfield.
In opening statements, the officials emphasized past and ongoing efforts by their respective departments to contain the virus and safeguard the health of U.S. citizens, at home and abroad. The current U.S. policy toward COVID-19 is aggressive containment.
Bera voiced concerns over a new case with unknown origin in his district in California. News reports indicate that the patient presented with symptoms but was not tested for COVID-19 during the first days of hospitalization. Bera directed initial questions to Redfield, asking why the CDC denied testing of this individual for five days and what criteria are used to determine who is tested.
Redfield explained that, when the outbreak began in Wuhan, China, those infected were directly linked to the fish market and all cases had some link to Hubei province. Because it is also the height of cold and flu season, the public health sector is unable to test every individual presenting with flu-like symptoms, which are similar to those of mild COVID-19 infection. Until this week, CDC guidelines indicated that only those with a direct link to China should be tested. The new reported case in California is the first case without a direct link. As a result, the CDC revised its guidelines to eliminate the geographic distinction on Feb. 26 and released said guidelines on the day of the hearing. Redfield clarified that the new guidelines recommend that, when a clinician or public health official suspects coronavirus infection, the patient should be tested.
Bera expressed fears about sufficient speed and availability of tests in the United States. Redfield not only defended existing testing capabilities but also argued that it is an accomplishment for a test to be developed in a single week. He lamented that one issue facing speed of testing ability is bureaucratic: While other countries appear to be able to develop a test and send it directly to health care providers immediately, the CDC director said, the U.S. regulatory process significantly slows the release of critical testing capabilities due to efficacy testing requirements. Yoho responded positively to Redfield’s complaint and offered assistance in speeding up provisional approvals for tests. The CDC, with the help of a private contractor, expects to send out a new round of testing kits by the end of February. At this stage, 40 CDC jurisdictions have testing capabilities.Yoho stressed that, across the private sector, it is essential to ensure there are no variations in sensitivity or specificity in tests.
Rep. Ted Lieu directed criticisms of the CDC toward Redfield, referring to recent headlines regarding an allegedly faulty CDC COVID-19 test. Redfield explained that the CDC faced an initial setback due to a manufacturing error that led some diagnostic kits to produce inconclusive results, but he assured lawmakers that the existing CDC test is effective.
Several members expressed interest in containment procedures. Rep. Abigail Spanberger asked Redfield to expand on comments made about surveillance. Redfield explained that the CDC maintains a nationwide surveillance system for influenza, tracking both diagnosed cases and the spread of the virus, while helping develop containment plans. The CDC is in the process of creating a surveillance system for COVID-19. This system will be implemented over the next four to eight weeks. Redfield indicated that the influenza surveillance system is an effective tool for flu containment and expressed confidence in its use for COVID-19.
The CDC director also noted that a policy of aggressive containment buys U.S. public health officials more time to develop a vaccine, and Redfield was confident that an effective vaccine for COVID-19 is scientifically feasible. The National Institutes of Health is in charge of development and has partnered with a private-sector company. The vaccine development will move into Phase 1, in which small numbers of people recieve the trial vaccine, in the upcoming weeks.
Cooperation With China
Representatives maintained skepticism over the forthrightness of the Chinese government. Yet the State Department. officials tasked with U.S. management of COVID-19 indicated good levels of cooperation with the Chinese. Rep. Brad Sherman emphasized that the Chinese government hid the outbreak initially. Officials responded that there is no evidence of lack of candor between the Chinese and U.S. personnel at this time. Deputy Assistant Secretary Fritz maintained that the evacuation of personnel and U.S. citizens from Wuhan on five chartered flights was achieved through a high level of coordination with Chinese counterparts.
The Chinese CDC has a 30-year relationship with the United States. Redfield said he has been in contact with the head of the Chinese counterpart since New Year’s Eve, with very open dialogue. The CDC director expressed concern over reports that approximately 1,700 Chinese health officials have been infected, but he emphasized that there are no reported COVID-19 cases among U.S. health workers at this time.
Divergent Statements and Misinformation
Rep. Andy Levin expressed frustration with the differing statements from public officials during the week leading up to the hearing. He read the statement from the national director of immunization, which indicated that coronavirus spread in the U.S. is a question of when, not if. Levin called attention to the difference in tone and prediction from that of National Economic Director Larry Kudlow and President Trump, who both indicated that the virus is under control. Levin implored Redfield to clarify the message from the Trump administration. Redfield responded by assuring lawmakers that the risk to the American public is low and that the current approach of containment is working.
Redfield indicated that the countries with rapid rates of virus spread are Italy, Iran and Korea. Countries such as Singapore and Hong Kong have had better success in containing the virus. Redfield repeated a theme during the hearing: The key is early recognition and containment. These tactics are meant to give the U.S. time to better prepare a response.
Despite the low risk, the CDC is likely to identify more cases of community spread in the coming days and weeks. The director recommended acceleration of flu-avoidance strategies, such as hand washing and avoiding public spaces when feeling ill. No one needs to stock up on medication or cleaning supplies, he said. For further guidance, Redfield directed viewers to CDC.gov. Notably, he emphatically advised against purchasing masks, which need to be available for doctors and health care providers; there is no role for medical masks in the community, and they should be prioritized for those directly affected. Contrary to Trump’s claim at a New Hampshire campaign rally, there is no evidence that the spread of the virus will end with the winter season, nor is there evidence that drugs such as Theraflu or vaccines for other viruses will be useful in combating the disease.
Following a call from Levin to denounce xenophobic treatment, particularly of individuals of Asian descent, during the COVID-19 outbreak, Redfield emphasized that stigma is the enemy of public health,
What Is Still Unknown
Rep. Brian Mast probed officials on the current knowns and unknowns. Redfield stressed that there is a lot we don’t know, which is one of the most concerning aspects of the disease. COVID-19 can present as asymptomatic in some patients, which complicates the disease as a public health crisis. For example, aboard the Diamond Princess cruise ship, more than 50 percent of those diagnosed with COVID-19 lacked symptoms but were able to transmit the virus. The symptoms can range from a dry cough or scratchy throat, to much more serious cases. Thus far, 5 percent of cases are critical and 10-15 percent require intensive care. Mast delved further into factors that facilitate recovery, noting that of the 80,000 diagnosed cases in China, 33,000 of those cases have recovered. The CDC director explained that the two main indicators of the virus’s severity are age and comorbidity, or simultaneous presence of more than one disease in a patient. Additionally, the health care system’s effectiveness is a significant factor in recovery. In Wuhan, where the mortality rate is more than 4 percent, the hospital system has scaled from 120 beds to 70,000 beds, which is compromising the integrity of the health system. Redfield contrasted that rate with other parts of China with more effective health care infrastructure, which have a mortality rate closer to 0.5 percent. Given this discrepancy, the CDC is particularly concerned about countries like Afghanistan and Pakistan. The U.S., by contrast, is in a great position because of the effectiveness of its health care systems.
The capability of COVID-19 to be transmitted through fomites—objects or materials that can carry infection—remains a mystery. The CDC is aware that COVID-19 currently has a life of about two hours on metals such as copper or steel; the virus may live longer on other fomites, including cardboard.
How the epidemic might affect the U.S. supply chain is also unknown. When members of Congress expressed concern about this potential problem, Deputy Assistant Secretary Fritz emphasized that the administration is monitoring the problem and has a dedicated interagency process that is examining the matter. The Food and Drug Administration is taking the lead, while the State Department is looking at the impact of the outbreak on domestic supply chains.
International Support and Funding
Officials made reference to the $100 million in foreign assistance that the U.S. has committed to global partners for combating COVID-19. Historically, the U.S. has focused on building up foreign health care systems to be resilient to disease outbreak. Officials speculated that the foreign state of affairs would likely be worse without that foreign assistance.
Fritz alerted Congress to concerns over reports of China not allowing Taiwanese individuals to leave China. Rep. Steve Chabot stated a desire to see Taiwan elevated to a fully recognized member of the World Health Organization (WHO) with observer status. China’s refusal to allow Taiwan’s participation is particularly harmful during an outbreak as serious as COVID-19 due to Taiwan’s excellent medical institutions. Taiwan’s lack of involvement creates a knowledge gap in the existing response. Fritz agreed with Chabot’s characterization of Taiwan’s exclusion from the WHO. Taiwan currently is facing 37 reported cases of COVID-19.
Rep. Sherman criticized the administration’s decision to take COVID-19 funding from existing funds earmarked for the Ebola response. Redfield acknowledged the ongoing Ebola outbreak in the Congo, but explained that, while there is no guarantee that there will be no additional Ebola outbreaks in the coming years, health officials are winning the current battle.
Protection of U.S. Personnel
During the hearing, the Washington Post broke a story about a Health and Human Services (HHS) whistleblower who flagged a lack of training and personal protective equipment for staff who greeted Wuhan evacuees. While no HHS officials were present at the hearing, State Department officials stated that, in their experience, all proper protocols and precautions have been followed.
Yoho asked officials what the State Department is doing to protect American personnel. Walters, from the State Department’s Bureau of Medical Services, indicated that the department believes there has been adequate training and preparedness to protect U.S. personnel across 220 offices, with 75,000 workers spread out across the globe.
Editor’s Note: Additional confirmed cases of COVID-19, without a direct link to China, have been announced in the days following this hearing.