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The nation’s top health officials warned on Tuesday the U.S. risks new outbreaks of coronavirus and possibly a broad resurgence if states and cities reopen too quickly. And they cautioned that neither a vaccine, nor surefire treatments would be available when schools are slated to reopen in the fall — a grim reminder that life would not soon return to normal even if Americans resume their routines.

Anthony S. Fauci, the nation’s top infectious-diseases expert, predicted Americans would experience “suffering and death that could be avoided,” as well as additional economic damage, if states ignore federal guidelines, including delaying reopening of most businesses until they see dramatic declines in cases. He also said the U.S. death toll from the coronavirus is probably higher than the 80,000 reported to date.

Fauci’s comments came during a contentious Senate hearing as lawmakers of both parties pressed him and other federal health officials on whether the country is ready to reopen. The panel’s chairman and all four witnesses appeared remotely because they all recently came into contact with people with confirmed infections — a testament to how the virus has transformed life even within the corridors of power.

Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Health, Education, Labor and Pensions Committee, which held the hearing, is self-isolating at home after a staff member tested positive for the virus. Fauci; Stephen Hahn, head of the Food and Drug Administration; Robert Redfield, director of the Centers for Disease Control and Prevention; and Brett Giroir, an assistant secretary in the Department of Health and Human Services, all testified remotely after coming into contact with a White House aide who tested positive last week.

In his first congressional testimony since President Trump declared the coronavirus a national emergency on March 13, Fauci bluntly laid out the dangers of ignoring federal reopening guidelines.

“If some areas, cities, states or what-have-you, jump over those various checkpoints and prematurely open up without having the capability of being able to respond effectively and efficiently, my concern is that we will start to see little spikes that might turn into outbreaks,” said Fauci, director of the National Institutes of Allergy and Infectious Diseases. “I have been very clear in my message — to try, to the best extent possible, to go by the guidelines, which have been very well thought-out and very well-delineated.”

Giroir, who oversees the U.S. testing strategy, told senators the U.S. could be performing up to 50 million tests a month by September — but that would still amount to fewer than the 2 million to 3 million tests a day that experts have said is needed to ensure that people returning to work are infection-free.

The health officials also warned that a surge of cases in the fall could be especially challenging, when a coronavirus outbreak could coincide with flu season — in contrast to the president’s statements that the fall would not be worse. Redfield said the U.S. would need a five-to-10-fold increase in its capability to conduct contact tracing by the fall to identify all the known contacts of someone who tested positive for the virus in order to prevent an outbreak. He warned that individuals needed to remain vigilant in practicing social distancing measures for the next several months.

Fauci at one point contradicted statements made last week by Trump, when the president proclaimed the virus would disappear in coming months even without a vaccine.

“This is going to go away without a vaccine,” Trump said Friday, adding there could be “flare-ups,” including in the fall, but that covid-19 would go away regardless.

“That is just not going to happen,” Fauci said of the notion the virus would disappear on its own. “It’s a highly transmissible virus. It is likely there will be virus somewhere on this planet that will likely get back to us.”

The hearing often became combative, with Democrats criticizing Trump’s response to the pandemic and even Sen. Mitt Romney (R-Utah) scolding Giroir at one point for politicizing testing numbers. Romney said Giroir “celebrated” the fact that the U.S. is conducting more tests per capita than South Korea in a Rose Garden news conference on Monday, but ignored that South Korea had far greater testing capacity than the U.S. at the beginning of its outbreak and has only had 300 deaths.

“I find our testing record nothing to celebrate whatsoever,” Romney said.

Sen. Rand Paul (R-Ky.), who recovered after becoming infected with covid-19 earlier this year, questioned aspects of the scientific consensus during his questioning time, and in a combative exchange, told Fauci he was not the “end-all” for coronavirus decisions. Paul asserted that schools could reopen widely in the fall because the virus appears to be less dangerous in children.

“It’s not to say this isn’t deadly, but really, outside of New England, we’ve had a relatively benign course for this virus nationwide,” Paul said. “And I think the one-size-fits-all, that we’re going to have a national strategy and nobody is going to go to school, is kind of ridiculous. We really ought to be doing it school district by school district, and the power needs to be dispersed because people make wrong predictions.”

After asking to respond, Fauci told Paul, “I’ve never made myself out to be the end-all.” He warned that while the numbers indicate the pathogen is less dangerous to children than adults and the elderly, “we don’t know everything about this virus.” He noted a spate of new cases of coronavirus-infected children presenting with a “very strange inflammatory syndrome.”

“I am very careful and hopefully humble in knowing that I don’t know everything about this disease, and that’s why I’m very reserved in making broad predictions,” Fauci said.

In response to repeated questions about when better therapeutics and a vaccine would be available, Fauci dismissed the notion they might be in use by the time schools reopen in the fall.

“The idea of having treatments available or a vaccine to facilitate reentry of students into fall term would be something that would be a bit of a bridge too far,” he said. “The drug that has shown some degree of efficacy was modest and in hospitalized patients” only, he added, referring to remdesivir, the Gilead antiviral drug that has shown to reduce recovery time for people with covid-19. But Fauci said that remdesivir alone was not sufficient as a therapeutic.

Asked by Sen. Elizabeth Warren (D-Mass.) whether the virus is contained in the U.S., Fauci chose his words carefully. “I think we are going in the right direction,” he said. “But the right direction does not mean we have by any means total control of this outbreak.”

Find live updates about Fauci’s testimony below.

5:35 p.m.
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Fauci says he doesn’t have a confrontational relationship with Trump

Sen. Kelly Loeffler (R-Ga.), the last senator in line to ask questions, sought assurances from all four witnesses that they don’t have a confrontational relationship with Trump — a notion that she said has been advanced by the news media and some of her colleagues.

“There is certainly not a confrontational relationship between me and the president,” Fauci said. “I give advice, opinion based on evidence-based scientific information. He hears that. He respects it. He gets opinions from a variety of other people, but in no way, in my experience over the last several months, has there been any confrontational relationship between us.”

Redfield, Hahn and Giroir all gave similar answers.

“We have a very productive working relationship with each other,” Giroir said.

Sen. Lamar Alexander (R-Tenn.), the committee’s chairman, adjourned the hearing shortly before 1:30 p.m.

5:08 p.m.
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Romney says U.S. testing record ‘nothing to celebrate whatsoever’

Sen. Mitt Romney (R-Utah) criticized the Trump administration’s news conference Monday heralding its increased testing capacity.

“I find our testing record nothing to celebrate whatsoever,” Romney told the health officials assembled at the hearing.

Trump and other administration officials Monday regularly pointed to the fact that the United States was conducting more testing per capita than South Korea, which has been widely praised for its early and aggressive testing efforts that helped stem its outbreak.

Romney said U.S. officials were ignoring the fact that South Korea had far higher testing capacity than the United States early in its outbreak, while the United States was “treading water in February.”

South Korea has had fewer than 300 covid-19 deaths.

Romney also asked why the Centers for Disease Control and Prevention’s data-collection system was so outdated and the agency’s director what Congress needed to do to help modernize the system.

He also asked coronavirus task force member Anthony S. Fauci whether it was a “long shot” to hope for a vaccine that would be ready within a year or two.

“It’s definitely not a long shot,” Fauci replied. “It’s clearly much more likely than not that somewhere in that time frame, we will get a vaccine for the virus.”

4:41 p.m.
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FDA commissioner pledges remdesivir distribution will be based on need

Trump administration officials pledged to be guided in their distribution of the coronavirus treatment drug remdesivir by evidence of outbreaks and patient need, responding at the Senate hearing Tuesday to an uproar over the uneven distribution of the treatment.

Doctors last week complained of a haphazard and opaque process for distributing the limited supplies of the experimental Gilead Sciences drug in the week after the Food and Drug Administration permitted its distribution under an emergency use authorization.

Over the weekend, the Department of Health and Human Services disclosed that seven states had received the drug in a first wave, and it added five more states to the list.

Maine was not on either list, which drew concern at the Senate hearing Tuesday from Sen. Susan Collins (R-Maine).

“I’m concerned that hospitalized patients in Maine will have little or no ability to be treated with this promising therapeutic for the foreseeable future,” Collins said. “As this and more therapeutics and ultimately a vaccine come onto the marketplace, how can these allocations and distribution issues be resolved so that patient care is not delayed and so it doesn’t depend on which state you live in, whether you are going to get access to these treatments, and ultimately a vaccine?'' she asked Trump officials.

Hahn appeared to acknowledge problems in the early distribution of remdesivir and said HHS officials had established a system of sending the drug to areas with the most hospitalized patients who are eligible to receive the drug.

“I think we can all agree upon the fact that we have learned a lot of lessons on the remdesivir situation,” Hahn said.

Moving forward, the drug will be sent to areas based the size of outbreaks and numbers of hospitalized patients, he said.

HHS said in a weekend news release that an initial allocation was sent to Indiana, Massachusetts, New Jersey, New York, Rhode Island, Tennessee and Virginia. It said it added Connecticut, Illinois, Iowa, Maryland and Michigan beginning May 7. It said Gilead has pledged to provide enough donated drug to treat 78,000 patients in the United States over the next six weeks.

4:40 p.m.
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‘The time for magical thinking is over,’ Sen. Warren says

Sen. Elizabeth Warren (D-Mass.), like most Democrats, used her questioning time Tuesday to attack the Trump administration without directly criticizing the nonpolitical officials appearing before the committee.

She began her round by asking Anthony S. Fauci a simple question: “Do we have the coronavirus contained?”

He gave a nuanced answer: In some places, like New York and New Orleans, rates of infection and hospitalization have started to diminish, he said, but in other places they have spiked — contributing to an overall flattening of the national infection curve.

“I think we’re going in the right direction, but the right direction does not mean we have by any means total control of this outbreak,” Fauci said.

Warren went on to question Fauci about the risks of a possible fall resurgence of the virus and whether the federal government would be prepared to handle it. Fauci said his previous warnings continue to hold but that current administration projections are that there will be sufficient testing and health system capacity to handle it.

“If we do not respond in an adequate way when the fall comes … then we run the risk of having a resurgence,” he said. “I would hope by that point in time in the fall that we have more than enough to respond adequate. But if we don’t, there will be problems.”

“I appreciate your hope,” Warren said.

“The president needs to stop pretending that if he just ignores bad news, it will go away,” she continued. “It won’t. The time for magical thinking is over, here. President Trump must acknowledge that the federal response has been insufficient and that more people are dying as a result.”

She did not ask Fauci to respond.

4:13 p.m.
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Murphy presses health officials for more detailed guidance on reopening

Sen. Chris Murphy (D-Conn.) pressed health officials over whether the Trump administration would release more detailed guidance to aid states beginning to reopen, adding that the guidance so far provided is “criminally vague.”

Redfield declined to commit to a specific timetable on when the CDC might issue more detailed guidance. Several media outlets reported last week that the White House rejected CDC guidance because it was overly prescriptive.

“You work for a president who is frankly undermining our efforts to comply with the guidance you gave us,” Murphy told the health officials. “The guidance you gave us is criminally vague. The plan to reopen America was to be followed by more nuanced, detailed guidance.”

Murphy also asked the health officials whether they were continuing to draw a salary while they self-isolated at home due to exposure to a confirmed coronavirus case.

Fauci said he was at the White House on Monday and could return to his NIH office on Tuesday, despite his recent exposure to Vice President Pence’s press secretary, who tested positive for the virus last week.

4:06 p.m.
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Sen. Paul spars with Fauci over immunity, school openings

Anthony S. Fauci, the top infectious disease expert in the United States, warned about the unknown risks to children from the novel coronavirus on May 12. (Reuters)

Sen. Rand Paul (R-Ky.), who recovered after becoming infected with the novel coronavirus earlier this year, questioned aspects of the scientific consensus surrounding the pandemic during his questioning time — asserting for instance that there is compelling evidence that recovered covid-19 patients are at least temporarily immune from reinfection and that schools could reopen widely in the fall.

Paul said U.S. policymakers should consider following the example of Sweden. Schools did not widely close there as they did in the United States, yet Sweden’s mortality rates remained below other European countries where schools did close.

“I don’t think there’s anybody arguing that what happened in Sweden is an unacceptable result,” he said, adding that “we never really reached any sort of pandemic levels” in Kentucky and other rural states.

“It’s not to say this isn’t deadly, but really, outside of New England, we’ve had a relatively benign course for this virus nationwide,” Paul said. “And I think the one-size-fits-all, that we’re going to have a national strategy and nobody is going to go to school, is kind of ridiculous. We really ought to be doing it school district by school district, and the power needs to be dispersed because people make wrong predictions.”

Fauci asked to respond, and then warned that while the numbers indicate that the virus is less dangerous to children than adults and the elderly, “we don’t know everything about this virus.” He noted that there are now cases of coronavirus-infected children presenting with a “very strange inflammatory syndrome.”

“I am very careful and hopefully humble in knowing that I don’t know everything about this disease, and that’s why I’m very reserved in making broad predictions,” Fauci said.

Regarding immunity, Fauci told Paul that he agreed that it was “very likely” that there is a degree of protection for those who have recovered from covid-19. But the level of antibodies necessary for protection and the duration of that protection remain unknown, he said.

“You can make a reasonable assumption that it would be protective, but natural history studies over a period of months to years will then tell you definitively if that’s the case,” he said.

3:30 p.m.
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Fauci says U.S. death toll is probably higher than the 80,000 reported

Fauci said the U.S. death toll is probably higher than the 80,000 deaths officially reported, and added that the virus will not disappear in the fall or winter, contradicting President Trump’s claims last week that the virus would go away even without a vaccine.

“I feel about vaccines like I feel about tests: This is going to go away without a vaccine,” Trump said Friday, adding that there could be “flare-ups,” including in the fall, but that covid-19 would go away regardless.

“That is just not going to happen,” Fauci said of the idea that the virus would disappear on its own. “It’s a highly transmissible virus. It is likely there will be virus somewhere on this planet that will likely get back to us.”

Fauci also agreed with Sen. Bernie Sanders (I-Vt.), who said many experts have said that the death toll is higher than what’s been reported.

Fauci pointed to New York City, where he said the health-care system faced an extraordinary challenge during the peak of the outbreak, and people could have died at home of coronavirus without being officially counted.

Several administration officials, including Trump, have questioned whether the death toll is inflated.

Sanders also pressed officials on whether a vaccine would be available to everyone regardless of income if and when it becomes available.

“I will certainly advocate that anyone be able to access the vaccine,” Giroir said in response to Sanders’s question.

3:21 p.m.
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Premature openings could be dangerous, Fauci says

Pressed by Sen. Patty Murray (D-Wash.), Fauci warned that states that fail to obey federal reopening guidelines and move too quickly to restart their economies would put themselves at risk of new outbreaks that could be hard to control.

“If some areas, cities, states or what-have-you jump over those various checkpoints and prematurely open up without having the capability of being able to respond effectively and efficiently, my concern is that we will start to see little spikes that might turn into outbreaks,” said Fauci, director of the National Institute of Allergy and Infectious Diseases. “I have been very clear in my message — to try to the best extent possible to go by the guidelines, which have been very well thought out and very well delineated.”

Any loosening of restrictions, Fauci added, would lead to new cases, but those new cases could be manageable so long as states have the proper infrastructure in place. “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,” he said.

Murray also pressed Brett Giroir, the federal official overseeing coronavirus testing efforts, on a strategic testing plan required to be submitted later this month to Congress under the terms of recent legislation.

Giroir said that the administration had numerical targets in place for testing in each state but cautioned that they stand to be revised based on the course of the virus’s spread.

“Yes, there will be targets,” he said. “The targets will need to change based on the evidence that we see. … So we really just need to be very humble about this. We need to look at the data.”

3:19 p.m.
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Hahn: Evolving clinical picture of virus affects FDA’s search for treatments

Hahn said new information about the virus and how it manifests itself in the body affects the “endpoints” the FDA is looking for in new drugs to treat covid-19.

For example, the agency is looking at evolving symptoms, such as blood clots — which weren’t immediately obvious at the beginning of the pandemic.

He also said the agency is working with other agencies to ensure that there will be enough supplies, including syringes and needles to distribute vaccines, once they are available.

3:12 p.m.
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FDA head Hahn: Agency is working to ‘bridge the gap’ to a vaccine through treatments

Hahn, head of the Food and Drug Administration, said the agency is working to “bridge the gap” between now and when a vaccine might be available through therapeutics.

The focus, he said, is speeding development and review of antiviral and antibody drugs as well as convalescent plasma products.

Hahn said the agency has created an emergency program to conduct such reviews and is using “every available authority and flexibility that’s appropriate.”

On testing, he said that the agency has worked with more than 500 developers who have submitted or said they would submit applications for FDA authorization for covid-19 tests — including some involving technologies never used before.

The agency also is cracking down on fraudulent tests and trying to provide more clarity to the public on which tests have been authorized by the FDA and which ones haven’t, he said.

3:07 p.m.
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Fauci: ‘A bridge too far’ to expect treatments, vaccine in time for fall school semester

Sen. Lamar Alexander (R-Tenn.), the panel’s chairman, began the questioning by asking Fauci whether college and school administrators could feel safe welcoming students back to campus in the fall, and the likelihood of a treatment or vaccine becoming available by then.

“The idea of having treatments available or a vaccine to facilitate reentry of students into the fall term would be something that would be a bit of a bridge too far,” Fauci said. “The drug that has shown some degree of efficacy was modest and was in hospitalized patients.”

Fauci said whether students will feel safe returning to school will also largely depend on testing capabilities.

Giroir said he expects the country to have the capacity to conduct 25 million to 30 million tests a month by the fall, which could allow schools to have a surveillance strategy in place to quickly identify and isolate confirmed covid-19 cases.

3:01 p.m.
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Giroir: 40 million to 50 million tests per month by September

Giroir, the federal official overseeing coronavirus testing efforts, said the nation will be able to conduct more tests for the novel coronavirus in the coming months, a critical step to reopening the country.

“By September … we project that our nation will be capable of performing 40 to 50 million tests per month,” Giroir told the committee.

The Trump administration has faced criticism that it is not testing enough Americans, with health experts arguing that far more testing is necessary.

Trump has been dismissive about the need for testing, calling it “somewhat overrated” last week.

On Monday, the president claimed that his administration is besting the world in testing and that it will help states expand such efforts, which are a key element of lifting the safety restrictions that have shuttered much of the economy since March.

Trump’s claims about U.S. testing benchmarks do not account for what health experts have criticized as the slow pace of testing capability in the United States this spring, a delay that some say contributed to the rapid spread of the virus, the mounting death toll and uncertainty about the way forward.

2:52 p.m.
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CDC director: ‘We’re not out of the woods yet’

CDC Director Robert Redfield told the Senate committee that social distancing remains “imperative” for Americans as public health authorities continue battling the pandemic.

“It’s important to emphasize that we’re not out of the woods yet,” Redfield said in his opening statement, adding that the battle could continue for months. “We need to stay vigilant with social distancing. It remains an imperative.”

Redfield deemed the pandemic “the most serious public health crisis in more than a century” and detailed the CDC’s efforts to combat it, including expert assistance to state health authorities, disease surveillance and testing and contact tracing strategy.

But he also sounded an alarm that the nation’s public health resources have been insufficient to meet the challenge that covid-19 has posed.

“We need to rebuild our nation’s public health infrastructure: data and data analytics, public health laboratory resilience and our nation’s public health workforce,” he said. “Now is the time to put it in place for the generations to come, not only for the public health system that our nation needs, but for the public health system our nation deserves.”

2:45 p.m.
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Fauci gives overview of covid-19 vaccine, therapeutic progress in opening statements

In his much-anticipated opening remarks, Fauci gave senators an update on potential drugs and vaccines that could treat covid-19.

While several senators will look to Fauci for an honest assessment of the administration’s response to the crisis and whether the country is ready to reopen, Fauci kept his opening remarks focused on the search for medical treatments for coronavirus patients.

He said remdesivir, the drug that showed some efficacy in treating covid-19 and has been distributed to several states, had only a “modest result” and that researchers hope to find a more effective treatment, either through a combination of drugs or through another medication altogether.

Fauci also told senators that there were eight covid vaccines in clinical development, and that the NIH has been collaborating with numerous pharmaceutical companies in various stages of development.

He said the agency hoped to know how successful a vaccine candidate may be in late fall.

Fauci again stressed that a vaccine was at least a year away, at best, and that certain vaccines could have negative consequences.