The issue of the U.S. federal government’s response to the COVID-19 pandemic was revisited yet again in a hearing in the House of Representatives. While partisanship was on full display, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said he is “cautiously optimistic” about the prospects for a vaccine and that the development of candidates has not compromised scientific principles.

The July 31 hearing of the House Select Subcommittee on the Coronavirus Crisis led with the usual partisan fireworks. Chairman James Clyburn (D-S.C.) alleged that the Trump administration declined to roll out a pandemic testing strategy because the virus initially was spreading in states that vote primarily for Democrats.

Clyburn also maintained that officials with the Department of Health and Human Services have been sidelined by the White House in terms of public appearances. For his part, Ranking Member Steve Scalise (R-La.) noted that the witnesses at the hearing would not have appeared had they been sidelined.

Scalise also noted that the Trump administration has put forth several planning documents in response to allegations that the White House has made no effort to develop such plans. Operation Warp Speed, the vaccine development project, is part of the administration’s plan for reopening the country, he said.

Fauci said the administration’s earlier strategic plans called for a number of achievements, including development of fundamental knowledge of the SARS-CoV-2 virus’s spike protein, the target of nearly all the vaccines under development.

Among the milestones in the strategic plan was the development of standardized clinical study protocols for vaccine candidates, along with standardized outcome measures. “We are cautiously optimistic that this will be successful,” Fauci said of Operation Warp Speed’s vaccine project, adding that early studies of more than one vaccine candidate have demonstrated a capacity for generating a neutralizing antibody response that in some respects improves on the response seen in administration of convalescent plasma therapy. Some of the vaccines under development also have generated a T-cell response, according to recent data.

Fauci continued that any successful vaccine likely will be distributed in a manner that prioritizes those serving essential functions and the elderly. However, he also said that the federal government’s plans call for availability to all in need at some point in 2021. He noted that FDA Commissioner Stephen Hahn has assured him on more than one occasion that any decision about a vaccine “will be based on sound scientific data,” adding that the American public should be assured that the proper steps have been taken to rigorously evaluate any vaccine approved by that agency.

Degree of shutdown a difference between U.S., EU

Fauci also mentioned the website for recruiting participants in a vaccine study, stating that more than 250,000 individuals have registered to date. One of the reasons for the difference in diagnoses in the U.S. vs. several European nations is that some of the better-performing EU countries imposed a shutdown of about 95% of economic activity. In the U.S., “we really functionally shut down only about 50% of the totality of the country,” he said, noting that some states performed better than others in this regard.

“Hopefully, as we’re going forward, we can turn those around … by doing some of the fundamental things,” Fauci said, such as wearing N95 masks and practicing the recommended social distancing and handwashing measures. Regarding the administration's decisions on travel bans and the 15- and 30-day shutdowns, Fauci said he and the White House “were in agreement on virtually all of those.”

Meanwhile, Brett Giroir, assistant secretary of health, reiterated that the U.S. “cannot test [its] way out of this or any other pandemic,” adding that there is no substitute for avoiding crowded indoor spaces and wearing masks in public. As of July 31, half the volume of daily testing is handled by either point-of-care (POC) tests that return results in 15 minutes or in hospital labs that offer 24-hour turnaround, and Giroir said that while clinical labs are strained to keep up with demand, pooling and novel RNA extraction methods are helping to reduce turnaround times.

Giroir said the vast majority of nursing homes in the U.S. have POC tests, and the remainder soon will be thus equipped, adding that the administration is assembling plans for surveillance testing that would allow schools to reopen without taking away supplies from diagnostic testing.

Redfield: Public health infrastructure neglected for decades

CDC Director Robert Redfield said that his agency has distributed more than $12 billion for public health infrastructure since the onset of the pandemic. However, he also highlighted the underinvestment in public health infrastructure – a situation that has existed for roughly five decades. Data modernization will help with efforts to provide more timely and accurate surveillance. Redfield also said reopening schools is a vital public health consideration, given that chronic telelearning already has been associated with increases in student suicide and drug abuse.

In response to a question regarding vaccine programs conducted in other nations, Fauci said, “I do hope that the Chinese and the Russians are actually testing their vaccines” to completion before administering them to their citizens. He indicated some skepticism as to the notion that other nations will have a well-tried vaccine before the U.S., given the speed with which the administration has moved on the vaccine development program.

Fauci said he will be the first to tout the efficacy of hydroxychloroquine if the drug were to show a beneficial effect in a randomized, controlled trial (RCT). “I have no horse in the game” regarding this treatment’s efficacy, he said, adding that the study coming out of Henry Ford Hospital in Michigan was not an RCT and had generated data of low value.

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