Now that U.S. Health and Human Services (HHS) Secretary Alex Azar has declared a nationwide public health emergency due to the 2019 novel coronavirus (2019-nCoV), HHS is saying it may need more money to help it be as proactive and aggressive as possible in detecting the virus and containing an outbreak.

In recent years, Congress has set aside $105 million as an emergency fund to be used to respond to infectious disease emergencies. That may not be enough, according to HHS. It wants the authority to be able to shift up to $136 million from other departmental funds.

While lawmakers understand the need for more funding, there could be disagreement about how to go about it. Rather than give HHS the authority to transfer funds as it sees fit, some members of Congress may insist on holding the purse strings and deciding how much comes from where.

HHS isn’t the only government entity needing money to effectively respond to the threat. “As this emergency response evolves, states and localities may foot the bill for medical screening, countermeasures, deployment of medical therapeutics and quarantine procedures,” Sen. Tina Smith (D-Minn.) wrote in a letter to the leadership of the Senate Appropriation Health Subcommittee. “At the same time, they will be expected to maintain their existing public health infrastructure.”

Smith’s solution is to replenish the Public Health Emergency Fund, which was depleted eight years ago after two decades of Congress refusing to put any more money into it. Citing the increased demand for screening and testing of suspected 2019-nCoV infections, Smith said, “As this outbreak is evolving … it is critical that we take swift action.”

In a press briefing Monday, Feb. 3, the CDC reported that while most of the confirmed coronavirus cases in the U.S. involved people who recently had been in the Wuhan, China, area, the epicenter of the emergence of the virus, two confirmed cases stemmed from close contact with infected people.

On the lookout

Nancy Messonnier, director, CDC National Center for Respiratory Diseases

“We expect to see more cases of person-to-person spread among close contacts. And we continue to expect this will happen, given the explosive nature of this outbreak in China and our very aggressive public health response where we are putting a lot of resources into finding infections this virus,” said Nancy Messonnier, director of the CDC National Center for Respiratory Diseases.

Part of that response is making available to public health officials the CDC’s real-time reverse transcription polymerase chain reaction (RRT-PCR) test that can detect the virus. The CDC developed the test within a week of China releasing the genetic sequence of 2019-nCoV.

Since then, the CDC has publicly posted the assay protocol for the test and is planning to submit an emergency use authorization (EUA) package to the FDA. Once approved, the EUA will allow public health labs across the U.S. to use the CDC diagnostic assay, enhancing the national capacity to test for the virus, Messonnier said. Already preparing for that approval, the CDC has shipped the test to the International Reagent Resource so states and international partners can begin ordering it.

Messonnier used Monday’s press briefing to clarify remarks she had made a few days earlier that caused some confusion about the accuracy of the RRT-PCR test. She had noted that some people who initially tested negative to the virus later tested positive. “Some people have taken that to mean the test doesn’t work. That is not the case at all,” Meissonier said. “This is an accurate test.”

Negative readings mean either the person is not infected or the infection hasn’t developed enough to be detected, she explained. “This is a new virus. And the best timing and right type of sample to determine if someone is infected with this new virus has not yet been determined,” she added.

In another effort targeting the virus, HHS’ Office of the Assistant Secretary for Preparedness and Response is expanding its collaboration with Regeneron Pharmaceuticals Inc., of Tarrytown, N.Y., to develop multiple monoclonal antibodies that, individually or in combination, could be used to treat 2019-nCoV. The collaboration, which began in 2017, uses Regeneron’s Velocisuite technologies to quickly identify promising antibody candidates targeting specific pathogens, validating preclinical results and then developing the antibodies.

The technologies were used to develop a promising investigational three-antibody therapeutic that was deployed to treat Ebola in the most recent outbreak in the Democratic Republic of the Congo and an investigational two-antibody therapeutic to treat Middle East respiratory syndrome coronavirus, according to HHS. The technology shortened multiple aspects of the product development timeline for those therapies from years to months.

Emergency declaration

While the number of 2019-nCoV cases in the U.S. is still low, Azar declared the public health emergency Jan. 31, just two days after holding a media briefing in which he said there was no need to declare an emergency yet.

Azar characterized the declaration as “the latest in the series of steps the Trump administration has taken to protect our country,” adding that the declaration gives federal, state, tribal and local health departments more flexibility in responding to the virus.

Azar’s declaration came a day after the World Health Organization (WHO) made a similar announcement, citing the spread of the virus to other countries. While WHO is trying to orchestrate a global response, it so far has refused to share information with health officials in Taiwan or allow them to attend emergency briefings.

Noting that at least nine cases have been confirmed in Taiwan, several senators wrote to WHO Director-General Tedros Adhanom Ghebreyesus urging WHO to grant Taiwan observer status at its meetings and gatherings and to provide Taiwan with the information and assistance it needs to deal with the outbreak.

“The inability of the government of Taiwan to obtain important information regarding current global health concerns could mean that they are not provided all data necessary for a quick response. Additionally, the global community suffers as Taiwan is unable to coordinate with WHO officials and health officials from member states to craft a more harmonized global response to active crises,” according to the letter signed by Sens. Ted Cruz (R-Texas), Cory Gardner (R-Colo.) and five other Republican senators.

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