Top U.S. health officials testified before the U.S. Senate Health, Education, Labor, and Pensions Committee on Tuesday, discussing the potential for future response to the COVID-19 pandemic, the need for and capabilities of testing, and the dangers of reopening workplaces and schools too soon.
Health officials cautioned that the crisis that has resulted in more than 80,000 deaths in the United States could potentially worsen if certain areas were to ignore health guidelines for reopening their economies.
“What I’ve expressed then and again is my concern that if some areas, cities, states, what have you, jump prematurely over those checkpoints and prematurely open up without having the capability of being able to respond effectively and efficiently, my concern is that we’ll start to see little spikes that might turn into outbreaks,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told the Senate panel.
The full committee hearing was unusual in that many of the senators and witnesses delivered testimony and questions from their offices or homes, rather than the Senate chamber itself. Also giving testimony were Dr. Robert Redfield, director of the Centers for Disease Control and Prevention; Adm. Brett Giroir, assistant secretary for health; and Dr. Stephen Hahn, commissioner of the U.S. Food and Drug Administration.
All agreed: scientific evidence is key to the response going forward. A framework is in place for reopening America safely — the Opening Up America Again plan — with a number of checkpoints in place, but the number of outbreaks in given areas is likely to determine the speed of reopening.
“It’s the ability and the capability of responding to those cases with good identification, isolation and contact tracing that will determine whether you can continue to go forward as you try to reopen America,” Fauci said.
In his opening remarks, U.S. Sen. Lamar Alexander (R-TN), chairman of the Senate committee, said, “All roads back to work and school go through testing. The more tests we conduct, the better we can identify those who are sick and exposed, and we can quarantine the sick and exposed instead of trying to quarantine the whole country.”
To date, Johns Hopkins University reports that more than 1,351,000 people in the United States have been infected by COVID-19. It has also killed more than 80,000. Both are by far the world’s largest figures — more than five times the next highest number of national cases (Russia) and more than double the next highest number of deaths (UK).
Troublingly, Fauci noted that most experts believe the actual death figures are likely even higher.
“Given the situation, particularly in New York City — when they were really strapped with a very serious challenge to their health care system — that there may have been people who died at home who did have some COVID who are not counted as COVID because they never really got to the hospital,” Fauci said.
Still, there were positive notes. According to Giroir, the federal government dispatched 12.9 million swabs and tubes of media to states over the last month alone. By the end of 2020, they hope to have procured more than 135 million swabs and 132 million tubs of media for distribution to states as requested. Figures are on the way up, though the government has come under fire for months due to slow production of COVID-19 tests. Now, with a goal for states and territories to perform 12.9 million tests over the next four weeks, Giroir attested the federal government is able to and will support that goal.
“By September, taking every aspect of development, authorization, manufacturing and supply chain into consideration — we project that our nation will be capable of performing at least 40 to 50 million tests per month if needed at that time,” Giroir said.
That does not mean the situation is completely under control.
“We are going in the right direction,” Fauci said. “The right direction does not mean we have, by any means, total control of this outbreak.”
Social distancing remains imperative and timely testing is essential, according to Redfield. Contracts with private companies are underway to enhance biosurveillance and technical assistance is being offered to states. When pressed about reports that a government response and reopening plan crafted by health experts had been nixed by the Trump administration, however, he noted it was merely going through review, while a similarly pressed Fauci said that he had never been told to pull back from his efforts by anyone.
For those hoping for solid medical advancements in the next few months, however, the hearing guaranteed some measure of disappointment. Pushed on the potential for getting students back into classrooms this fall, Fauci labeled the idea of having a vaccine, or even treatments available by then, as a bridge too far.
“If this were a situation where we had a vaccine, that would really be the end of that issue in a positive way,” Fauci said. “We don’t see a vaccine playing in the ability of individuals to get back to school this term.”
While Hahn added that the FDA has worked with hundreds of developers who have or will be submitting applications for emergency use authorizations for a variety of products, and dozens have already been issued, and efforts are being undertaken to get authorizations issued more quickly, even the promise of drugs like the oft-touted remdesivir have shown limitations. While successful in treating hospitalized patients with lung disease, it was being tracked largely by time to recovery, and as Fauci pointed out, its results were statistically significant but modest overall. The hope is to build on that success by pairing it with other drugs.
No one has yet confirmed to what extent survivors of COVID-19 have immunity, though there are positive signs. Further, evolving data has shown that even the young are not safe from the effects of COVID-19. Worse still, Fauci floated another reason to take time and care with vaccine investigations: the wrong vaccine could actually enhance the negative effects of a virus like SARS-CoV-2 rather than help.