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Senators Quiz Health Officials on Coronavirus Basics

WASHINGTON — How frightened should we be? That was the underlying question senators seemed to be asking administration health officials Tuesday during a hearing on the COVID-19 coronavirus.

Lamar Alexander (R-Tenn.), chair of the Senate Health, Education, Labor and Pensions (HELP) Committee, said the goal of the hearing was for lawmakers and the public to obtain accurate information to help guide response to the crisis.

Other more direct questions were: How quickly can testing for the novel coronavirus be scaled? What does community transmission really mean? Is there enough personal protective equipment to keep medical providers safe?

Sen. Tim Scott (R-S.C.) suggested that the news around the virus had been “hyped up,” and seemed to look for reassurance from the witnesses that things aren’t as bad as some believe. He said he wanted to put coronavirus “in context,” particularly in comparison with influenza.

“I think there are those who are alarmists, who are really painting a picture that is very difficult to digest and then there are those who are acting with a sense of urgency. I think the [panel of witnesses] are acting with a sense of urgency,” he stated.

Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, noted that because novel coronavirus “is a new virus, we don’t really know exactly where it’s going to go.”

Fauci stated that influenza causes a significant amount of “health damage,” in the U.S. and globally on an annual basis, but health officials have an understanding of influenza’s disease burden.

“When you’re in the area of the unknown [as with the novel coronavirus], you have to walk a delicate balance of not overshooting and having panic, but not also undershooting and being in a situation where you don’t respond as aggressively as you should,” he said.

Anne Schuchat, MD, principal deputy director for the CDC, noted that in a large population, most of those who get sick from the novel coronavirus will have “very mild symptoms” but “some will have severe illness, pneumonia, and be critically ill, and what’s unknown right now is what that full total will be.”

If there are “many more cases” of coronavirus than flu it could be “very difficult to handle,” she said.

Access to testing was a hot topic at the hearing. Ranking member Patty Murray (D-Wash.), whose state has seen deaths from novel coronavirus (nine as of March 3, 2020), said people aren’t being told where to go for testing. For people in her state who have undergone testing for the virus, “the results are taking way longer to get back to them,” she said.

Murray said she’d heard that a million novel coronavirus tests will be available by the end of the week, but the experts called that timeline “unrealistic.”

FDA Commissioner Stephen Hahn, MD, said the agency has been working with the private sector, and those companies have stated that they can manufacture 2,500 kits, with 500 tests per kit, by the end of the week.

As for personal protective equipment, particularly for healthcare providers, Sen. Mitt Romney (R-Utah) asked whether there was enough personal protective equipment in the national stockpile if the country were to see a “full-blown epidemic.”

Robert Kadlec, MD, assistant secretary for preparedness and response at HHS confirmed that there would be a shortage. In a “severe event,” he said, 3.5 billion N95 respirators would be needed, whereas about 35 million are currently available.

Committee members also asked about the term “community spread.” Schuchat explained that when a person becomes ill with the virus, and the source of their illness is unclear, that’s community spread.

“It doesn’t mean that the whole community is affected,” she stressed.

When this type of transmission is identified, public health experts may shift from “man-to-man” to a “zone” defense, Schuchat said, borrowing sports terminology.

In a “man-to-man” response during an outbreak’s early stages, health officials will interview contacts of the person with the virus, and monitor those contacts to see if they develop symptoms, as well as ensure that they aren’t exposing others, Schuchat told MedPage Today after the hearing. But this approach is labor-intensive.

“At certain points in an outbreak, you might move on from really having … to trace every link, to steps you can take to protect the whole community or parts of the community,” she said.

While school closures have been considered, it’s not clear how much of a driver children are in spreading novel coronavirus, but “assemblies, or concerts, or mass gatherings might be a thing that you would start [with],” she said, “asking the older [and] vulnerable not to go to those things.”

Schuchat described other ways the CDC is assisting clinicians, such as teams in Washington state and California who are helping with investigations and providing advice, such as through Clinician Outreach and Communication Activities (COCA) calls.

As to whether healthcare providers might be more vulnerable to severe COVID-19, Schuchat said findings on that issue are “mixed.” She noted that with SARS and MERS, healthcare workers appeared more at risk in the workplace, but with the novel coronavirus “there’s a lot of risk of spread when you’re very minimally symptomatic. So we don’t yet have that clear information.”

In any case, healthcare workers must be protected “because they need to be able to care for people, and that extra surge of illness needs to be managed,” Schuchat emphasized.

Last Updated March 04, 2020