Good morning. This is the Vermont Legislature, a joint meeting. It is January 13th, Wednesday. This is a joint meeting between House and Senate committees. I am Representative Anne Pugh, chair of the House Human Services Committee, and our committee is joined by the House Healthcare Committee and as well as the Senate Health and Welfare Committee. We will be focused today, beginning our three, our three session joint meetings around focusing on the response to COVID and as well as what we need to do going forward. Before we take testimony, it probably makes sense since this is the first time all of us have gotten together if we introduce ourselves to each other because at least on mine we are over two, over two screens. Might I suggest with all deference to our Senate colleagues that we start with the Senate and then Representative Lippert if your committee would introduce themselves. I don't know if there is an order that you all have and then we can end up with House Human Services introducing ourselves as we have in the past. We'll start with the Vice Chair and then go around the table. Senator Lyons, if you would like to start. Sure. Good morning, Senator Ginny Lyons and I chair the Health and Welfare Committee in the Senate and I will now turn it over to our Vice Chair. Senator Lyons, perhaps you might, just because we're also introducing ourselves to each other, you might say where you're the Senator from or something. Oh, I'm happy to do that. I represent Chittenden County District and that's good and if you would like further information, let me know. Thanks. Hi, good morning everyone. It's nice to see so many faces on the screen. I'm Ruth Hardy. I'm the Senate Health and Welfare Vice Chair and I'm also brand new to the committee so it's very exciting to work on these issues during a pandemic. I am from Addison County and I live in East Millbury. And good morning. I'm Senator Cheryl Hooker from Rutland County. I live in Rutland City and I'm also new to the committee so looking forward to working on all of these important issues. Josh? Good morning everyone. Senator Josh Taranzini from Rutland County. Nice to see everyone today and meet so many of you. I am new to the Senate and I look forward to working with my very talented committee and I wish everyone a great day. Senator Taranzini, is your father in the house? Depends who's asking Representative Pugh. But yes, he is. Most of you know Representative Taranzini who is my father. Well, I have a soft spot for people who have connections to the house such as Senator Hooker who served in the house. Senator, Representative Pugh, we all have close connections. You have muted. I'm sorry, I didn't want to mute that comment. We all feel very connected to the house. I was going to say Representative Pugh is becoming a bit of a family business for us Taranzinis. Great. Thanks for having me. Representative Lipper. Okay, was that everyone from the Senate committee? No, we're missing one more please. One other actually. Yeah, I'm Senator Anne Cummings. I'm other than the chair the one returning member to the committee. I think that makes me the senior. I represent Washington County. I live in Montpelier and my daughter was recruited but did not run for the house. Okay, so shall I go Representative Pugh? Representative Bill Lipper, I live in Heinsberg and I chair the health care committee and I'll turn it over to our Vice Chair. Representative Ann Donahue from Northfield, Vice Chair. Representative Houghton, I'm ranking member from S Extension and I'll turn it over to Brian Cina. Hello, I'm Representative Brian Cina from Burlington, Vermont and I'll turn it over to Woody Page. Hi, I'm Woody Page. I'm from Newport. I represent Orleans District 2 and I actually sit to the right of Representative Taranzini but I'm not making a political statement on where I sit. He's a very good seatmate. Thank you. Would you pass it to another committee member, Woody? Oh yes, yes, I'll pass it on to Representative Cordes. Thank you. Thank you, Woody. Mari Cordes from Lincoln Addison County. This is my second term in house health care. Elizabeth? Hi, I'm Representative Elizabeth Burroughs. I live in West Windsor and represent Windsor 1. I'm going to walk, well, I'll just go. Leslie, I'll just cue people at this point. Thank you. That's really helpful. Leslie Goldman from Rockingham, I represent Wisdom 3. Okay, and I have to check my screen quickly. I think Art, are you here? Yes. Yes, I'm here. I'm Art Peterson, first term guy. I live in Clarendon, represent Roland District 2. Okay, and Alyssa, are you here? I am Representative Alyssa Black. I live in Essex, and I represent Chittenden 8.3. And I think that's all of us. Representative Long is not with us this morning. Am I missing anyone on our committee? I don't think so, but no. Okay, thank you. Thank you, Representative Pugh. Thank you. Representative Wood, would you start us off? Thank you. I'm Representative Teresa Wood. I live in Waterbury and represent the Washington Chittenden District. Representative McFawn. Good morning. I'm Representative McFawn. I represent Barrie Town. I'm Representative Jessica Brumstead, and I represent Shelburne and St. George. This is my second term on House Human Services, but my third term in the State House. I'm Representative Mary Beth Redmond. I serve Chittenden 8.3, or sorry, Chittenden 8.1. And I am from Essex. Representative Payala, I live in Londonderry, and I represent the Wyndham-Bennington-Winsor District. Representative James Gregoire, I live in Fairfield. I represent Fairfield, Fletcher, and Biggersfield. Good morning. I'm Representative Dan Noyes. I live in Wolkett, and I represent Wolkett High Park, Johnson, and Belvedere. Representative Rosenquist, are you here? Carl Rosenquist, representing the town of Georgia. I'm sorry. Hi, everyone. I'm Representative Taylor Small. I'm here in Winooski, representing Winooski and a sliver of Burlington. Hi, everybody. Representative Dane Whitman, Bennington District 2-1. Glad to be here. I think that's great. And just for folks to know, we do not yet have the commissioner here. And so, Senator Lyons, you had some thoughts that you wanted to bring out in terms of what your committee is hoping for out of today's meeting. And I don't know, Representative Lippert, if you might also, as we chart, figure out what we're going to do in the next hour and a half. So, thank you, Representative Pugh. This won't take long. We did spend some time this morning just thinking about what we would like to hear from the commissioner. First, how the CRF funding was utilized during the last stage. Is there sufficient PPE now? And what resources does the Department of Health need or are they under-resourced in any way for the work ahead? What are the needs going forward? What will we have to do around budget adjustment, if anything, to help? Are there sufficient resources for vaccinations? What about long-term care facilities? I'm just sort of shorthanding everything we talked about. Long-term care facilities in places like our corrections institutions, where people are together, and the question around vaccinations. What testing accessibility is there? Is there sufficient testing going forward? What more do we need? Questions about distribution of vaccine and testing. So, trying to sort out just generally where are we with what we have or what we don't have? Where are the gaps? There was a question about our National Guard going abroad and whether or not those folks are receiving the type of protection that they need when they first go to Florida and then go out of country. Questions about whether or not how, whether the Department of Health is engaged in supporting folks with substance use disorder, mental health issues during COVID. We did have questions about the money that's not obligated currently through the last CRF. How much is that? And what are the needs that the Department of Health might have? So, that's an ongoing discussion, and I think it links in with budget adjustment as well as other areas. The biggest area I think was on vaccines, as you will know, the concern that we've heard from our constituents, who goes first, who's second, and so on. Do we have sufficient vaccine available for the people in our state? Then another concern on the medical effects of vaccines, the side effects and that some people are very concerned and perhaps discouraged about the vaccine as a result of hearing about side effects. So, that's a short list of things that we discussed this morning and just to prime the pump a little bit so that as we're listening, if we don't get answers to these questions today, because I know it's going to be a time for listening, then this will give us an opportunity to circle back and get greater detail. So, that's some of it. That helps for what in terms of we will keep our eyes and ears to listen to. I also wonder if some of the information we might get in subsequent testimony tomorrow and the day after. Yes, we're very aware of that, particularly the mental health substance use disorder and long-term care facility, so we'll just leave it at that. I think that tomorrow we're focusing on the use of CRF dollars in particular, so that maybe that given that long short list, Senator Lyons, that we may not be able to cover it all today. I would just say that we did not spend time particularly looking ahead in the way that your committee did, but I know that there are many questions that have been raised or questions are being raised about who's in line next around the vaccine, and I think it would be helpful from my point of view for us to give the department a chance to explain how they are coming to their decision making and conclusions in terms of what they've done in terms of access to vaccines. I'm going to just step out on a limb here. I think I would love if it's possible for us to also express some appreciation to Dr. Levine and the Department of Health and their staff who have been incredible, in my view, throughout this pandemic, so that I'm going to represent a few. I realize you will take the lead on this, but I think there's so much to be appreciated in terms of where we are as a state and the leadership that Dr. Levine and others have provided, so hopefully we can get a chance to express that. Absolutely, and Representative Lippert, I was sort of thinking of starting welcoming Dr. Levine and expressing our appreciation and our thanks and our undying gratitude to him and to the staff. Are you suggesting that both you and Senator Lyons have an opportunity to say that as well? Would you like that as well? Well, however it emerges, it's fine. I'm happy to have you express it on our behalf, but to make I agree. I mean, we have limited time with him and the more he can be speaking and the less we're intruding, I think the better. We are no surprise. He is a man who is very busy and who is being pulled in many directions. He is not yet come on board yet, so we have some more opportunity to have a conversation amongst our three committees. Senator Lyons, you and your committee members have the opportunity and the luxury, you may not use the luxury, of interacting with both House Health Care and House Human Services. In the House side, we share many things as it relates to health with the Health Care Committee focusing and primarily, I mean, not to say that we don't, with Health Care and with the Human Services Committee in that area being more focused on what I might call public health and the social determinants of health as opposed, but of course being overlapping. So you get to do twice the work that Representative Lippert's Committee and as well as House Human Services. And I imagine this year that our three committees will work together as well as we have in past years. Well, you know, I think our committee looks forward to that. We were so productive last session by working together and consolidating our efforts. I think it's a continuum. Just as we talk about a continuum of care from the medical to the public health and social services, I think we are very interested in staying connected with both committees. And I, even though we work twice as hard and get half the pay, we're very pleased to do that. Senator Hooker. Just on a rather somber note, recognition that today marks the 10th month that we left the State House. And it's kind of sobering to think of that. And when we think of all of the work that's gone into navigating through this pandemic, it's certainly Representative Lippert is appropriate for us to thank Dr. Levine and all those who've had a part of that. But 10 months, it's incredible. And if I may represent a few, also that reminds me, I was about to say this, but it is 10 months since we worked so collaboratively between our three committees to do emergency pandemic, emergency COVID legislation that we, I think it, you know, as you say, we left the State House having already taken initiative to set in motion emergency COVID legislation, which we moved through our both of our bodies. And one of the things we met talked about in our committee this morning was the need and desire for all three of our committees to review what we did in terms of those emergency COVID pieces of legislation and to see if there's any updating extensions, et cetera, that we need to be doing. So I just, that's not necessarily our major agenda here with Dr. Levine this morning, but it's certainly an important top-of-mind joint agenda for our three committees as we, as COVID really is our primary and initial focus going into this session. Thank you, Senator Hooker for that reminder. Right, it's a dire reminder, but we've, we've been lucky and we've also been very fortunate to have the Department of Health that we have and the people listening to science-based decision-making. I do want to go back and circle back very briefly around what our concerns were about the CRF funding that we've just been through and that I guess the key question is, does the Department of Health have the resources that it needs currently and going forward? And that relates as much to the money as to the just the stamina and the support services that it might need. So I want to emphasize that. That was, I forgot who made that recommendation. We have such a good group, they're all making great recommendations. So came from, came from the whole committee. It sounds like a a very important question to have the answer to. I might suggest that we ask it in a slightly different way because- You're in charge. Okay. And when I say that, when I say that more in terms of what is it that you or a public health, you know, a health department needs to adequately and sufficiently respond. And then we can ask what they have. I guess part of my, it may be challenging to say you don't have enough, that's all. And I'd be curious as to, you know, what would be the gold star? I mean, I think we have a gold star, but what would be the ideal set of factors for a public for a response? Good. I'm going to ask legislative council or Julie or anyone if we have any ETA for- Madam Chair, this is Julie. I'm checking with his assistant. Okay. I want to just make sure it is my understanding that if need be, and I don't know, we have this time until 1230 that we went a little bit over 12. Some people I know have other commitments. And representative Lippert is looking at me as if this is total news. Well, I'm being reminded if I had known it beforehand. Thank you. Well, and I also, I think there was an early discussion about that, but it's frankly slipped in my mind. Oh, Dr. Levine is currently in the governor's press conference. Okay. Madam Chair, what I knew about was he was at a chamber of commerce meeting until 1030. And then would be joining us. So news. Oh, no. Representative Cortis, sorry. A mistake. Perhaps looking at something. I was like, oh my heavens, we're really having lots of press conferences now. It's Wednesday. There should be no press conferences on Wednesday. Right. So can we perhaps while we're waiting just to recap what our plans are for tomorrow. And then I think we're together again next Wednesday. I believe that what we've talked about today. And do you mind represent you by just quickly go over that? I think that then tomorrow we really are focused more on the use and the impact of the CRF dollars that we allocated last year. I think we're going to start tomorrow at, are we starting at nine tomorrow? Is that my memory? Is that correct? Yep. We're starting at nine tomorrow and we have a very extensive list of folks testifying. Right. But we're going to start with the agency of human services and Sarah Clark, who is their chief financial officer or chief COO. I'm not sure what her actual title is. Am I correct? We'll be hearing from her and then other constituent groups. So just to remind folks that and I'll say this again tomorrow morning, but this is a very packed agenda. We're all going to want to hear much more than we're getting. And there's a commissioner in the waiting room and I'm going to, there he comes. Okay. Fabulous. Good morning, commissioner. Good morning. Good morning. Welcome and thank you. Thank you for being here.  We are trying to be somewhat respectful of your time and not asking you to say the same thing to three different committees. So you are testifying in front of Senate Health and Welfare, House Human Services and House Health Care. And today I get to be the facilitator and Senator Lyons and Representative Lippert will jump in when I make a huge mistake or things like that or miss something. But before I turn it over to you, I really want to say publicly on behalf of, in particular, our three committees, but really on behalf of the legislature and the people of Vermont. Thank you. Thank you. Thank your staff. Thank your calmness, your focus on science, what you all, what your team has put together as challenging over the past 10 months. We were reminded that this is 10 months that we have been in this place. And what you have spearheaded, what you have been the lead on in terms of moving this state in terms of addressing and dealing with this pandemic is nothing short of incredible and are the results, even though they're the results in comparison to what the rest of the country is, I think speaks to you and the leadership that you have provided and the incredible work that your staff has done leaving their existing jobs to really focus on this. So thank you very much, Commissioner. Well, thank you for the kind words. I wish we could just put the check mark in the box and say we're moving on to the next item and talk about the things we used to talk about with your committees, but we'll get there. We have a ways to go. In communicating with Julie Tucker, it sounded like the emphasis you'd like me to take this morning is very much in the vaccine arena. Is that totally correct or are there other things you want me to preface the vaccine discussion with regarding anything? We probably have an agenda that would take three weeks. In terms of some specifics, yes, vaccines, the vaccine rollout, is there enough, how you're making the decisions and perhaps the differences in who is getting them in terms of issues of equity is of course issue, but then there is everything from what does the health department or what does a health department need? What do you need in order to respond for the state to respond sufficiently to this, whether it's in terms of PPE, whether it's in terms of vaccines, whether it's in terms of testing. There's all of that kind of piece. This is your first opportunity to share with us the response. I'm going to look to Senator Lyons and Representative Lippert if they wanted to add. Listen, I thank you Dr. Levine for being here, but I'm not interested in adding at this point. I think there's enough on that plate. I just look forward to hearing what the commissioner has to say. Let me second that again. Welcome Dr. Levine. Let's start with what Representative Pugh is outlined and then I'm sure we'll be able to pick up things from there. Sure. In terms of time allotment, I'm not going to get carried away and talk for hours, but how much time I should talk versus the Q&A portion of this? I almost want to say talk as long as you want. I'm looking at Senator Lyons and Representative Lippert, but we could spend three hours with questions. I think on some level what we need is information first. We have, just to let you know, I don't know what you have, we have until 12.30 if need be. I don't know what your time constraint is. I was listed as 12.15 on my score. That works for us. Thank you. I'll have a few slides that I'll bring in later on if I can actually finesse the sharing part. It doesn't always work well, but let me do it outslides for the beginning. I'll talk a little bit about where we are right now. Before we get to vaccine, where we are right now in the pandemic, why is it different now than it was before and how do we get back to where we felt more comfortable? I think everybody is aware that if you just watch any news network in the morning, it's just shocking what's going on around the country. 4,000 plus deaths yesterday setting a new record. Hospitalizations every day setting a new record. Numbers of cases obviously setting new records. And using the color red, which is sort of what the maps usually look like on the COVID tracking websites, the country is a sea of red. And then you have this little island in there called Vermont, which sometimes looks orange, sometimes looks yellow or green in the past, but markedly different than the rest of the country. And even if you look at the New England region, our numbers of cases are certainly surging ahead. Our numbers of hospitalizations, especially in the southern New England states are doing really horrendously, where their system is actually being stretched to capacity. And deaths variable, but certainly not a pleasant statistic anywhere. I have to say that Vermont has joined that movement, but in a much lesser way, which is great. But certainly, you know, we're not used to the numbers of deaths we've been having in our state. And yesterday at the press conference, I mentioned that we are now at a new high in hospitalizations, though we're nowhere near close to threatening the capacity of our healthcare system or feeling uncomfortable about where we are at that point. So everybody knows we spent the majority of 2020 contending with this new novel virus, but in a pretty good place when it came to our numbers of new cases on a daily or weekly basis, our percent positivity of our tests, and certainly our hospitalizations and deaths were almost negligible. I like to think that most of that is because we have a state that does prioritize health. It's citizens prioritize health. We always rank number one or two or three in the different metrics that people use to say who's the healthiest state in the country. It's a good place to start when you start encountering a pandemic to have a population who believes in all of that. And then the cooperation and collaboration and compliance of everybody in Vermont has been of an estimable help in us getting to where we've gotten to. In addition, we continue to and always began with the premise that this virus is like a little bit of natural selection that chooses the most vulnerable. And if you let it get into the most vulnerable populations, you will have very bad outcomes. So we tried from the start to protect our elders, those in congregate living situations. We had very restrictive visitation policies. We had policies that regarded testing in those facilities, how to deal with new admissions and quarantine in those facilities. We created, unfortunately, a fair amount of mental health issue on the part of those living there as well as those who wanted to visit them. But we protected and preserved life for sure. I won't spend a lot of time on what we've done in terms of how we got to the stay home, stay safe, and then how we opened up the economy in the various sectors in our state over the course of the year, except to say that it was done only after a sufficient degree of viral suppression had occurred. And then when it was done, it was done very slowly and deliberately and in a phased pattern so that we always could have one incubation period of virus, which is 14 days, to watch what the impact of our previous move was before we moved to the next move. And I think that was very, very critical as part of that effort. So that's sort of a summary of where we were through most of the year. And then, as you have noticed, cases have increased here to numbers we've never seen before. Not that they've spiraled out of control, but they're certainly higher than ever, as are our hospitalizations and deaths. Most of that is due to this transition in the season. We're now indoors more naturally, and it would make people want to congregate together more in unhealthy ways because they can't be spread out like they might be out of doors. We also had several major holidays, starting with Halloween, Thanksgiving, Christmas, and New Year's Eve, all of which have their own independent impact on the case rates that we've seen. We also have this phenomena of called pandemic fatigue, which is real, and it's apparent, and it's understandable. And it takes a lot of rallying to get people back into a rhythm where they can appreciate that again and hold on just a little bit longer, so to speak. So that's very, very important. But I want people to understand a little bit about the strategies we've used during 2021 and the latter part of 2020 that were different than what we did in March and April, where we shut down the state and had a stay home, stay safe posture. Now we feel very confident we can be, as it's sometimes termed, more surgical, more strategic in our approach. We had data that supported putting the travel map on pause and markedly enforcing, not enforcing, but trying to get people to abide by our quarantine criteria because we knew travel was a big, big threat to the health of our state. We also knew that even modest-size gatherings were a huge contributor and would become even a more vibrant contributor with the holidays to disease in Vermont. Those are the two things we prioritized as we began to look at how to manage ourselves in this critical time period. You'll notice there was not a lot of change in retail or in other commerce. There was not a lot of change in schools or child cares, which by and large have remained open, and though there are cases sporadically, they've done quite well. There wasn't a huge change in the lodging industry, except that, of course, travel restrictions impaired their ability to have as good a business, and the lodging industry itself was not the site of major cases as the year went on. There were subtle changes in the restaurant business and certainly closures of bars, but again, in Vermont, as opposed to other parts of the country, not major places where we saw cases. And you'll note we still allow one-on-one contact, whether it be a healthcare setting or a barbershop or a hair salon, and we still allow people to go to fitness centers and gyms that are abiding by all of the guidance we provide, because again, these are not where cases happened in Vermont. So a very surgical approach to a significant problem. What we're seeing now is a little hard to predict because hospitalizations and deaths lag behind as indicators the numbers of cases. But we're seeing cases not taking off necessarily. You know, we've made it through the 14 days post-Christmas. We're just about now 14 days post-New Year's. So we're watching very closely to see if there's any further impact. But if we can kind of hold our own where we are, that would be very, very favorable and markedly different than a lot of what surrounds us. And that indeed would be a goal. In addition, we will be watching this hospitalization rates very, very closely. And the ICU beds, especially because on our Eastern border with Dartmouth and on our Western border with some of the UVM health network like Plattsburg, those places are unable to take a lot of new admissions. They're unable to take transfers with higher acuity problems. And that means many of our Vermont patients who would have gone to Dartmouth or many of our Vermont patients who would go to the UVM Medical Center will now be a little harder to get them out to Dartmouth and a little harder to get them to UVM if a lot of the New York State business is coming into the Academic Medical Center. So we have to watch those numbers very, very closely because they are having surges on both of those borders. With regard to deaths, we've seen a little bit of a tapering off, if you will. It's really a race to get vaccine into the long-term care facilities quickly enough and get them immunized. Immunization is not a strategy to deal with the pandemic in terms of an outbreak, but it is a strategy to deal with our future and prevent future deaths. So that's kind of how we're looking at all of that. Now to move us to sort of where we are in the world of vaccine because that's what's really on everybody's mind and is taken over as the primary consideration. Let me sort of divide this into categories. First of all, until further notice, we are completely at the mercy of the federal government when it comes to how much vaccine we will have to deliver. Everyone knows we have Phase 1A, which is the healthcare workforce, and the long-term care facilities, residence, and workforce. We anticipate by the end of the month, all of those will be taken care of. And in some parts of the state, the healthcare workforce is actually taking care of already. The long-term care facilities were part of a federal pharmacy partnership that every state but West Virginia entered into. And we're working our best to move that faster, but it wasn't designed to be as nimble and fast as we would have designed it. So it's taking a little longer to get through those facilities. Three pharmacy chains at work all have their own skilled nursing facilities, assisted living, and residential care facilities to get through for two doses of vaccine. They're using the Pfizer, which requires the most strict storage requirements. That process is taking longer than we are comfortable with. We are exerting pressure where we can. We're getting great cooperation from Kinnies in having a much more local focus, not as much so with the other chains. And with the healthcare workforce, we're getting great cooperation from our hospitals. A little slow to start, but they have learned that we meant to really do business and they really have accelerated tremendously. So the reality of vaccine is we're getting eight to 9,000 doses a week. Totally unpredictable. We only know in the middle of one week what we'll get the next week and we don't know anything beyond that. And it takes us to the middle of one week to get to the next week. The governor and other governors were just in a meeting yesterday with the vice president and this administration on its way out the door is hoping to accelerate the amount of vaccine coming into states. Feeding off of what the president elect has already said, which is that they want that process to go much more robustly as well. We've been told that there's issues with manufacturing, but not so much. More issues with actually the quality control and letting the vaccine that's manufactured go through those processes and then through operation warp speed, they get sent out to the states. We could use a heck of a lot more than 8,000 doses a week, needless to say, and we will have the capacity to deliver to the population way more than that if we can only get our hands on it. So allocation to the states is a core fundamental problem. The current administration has indicated that they will actually reward states that are getting vaccine into people's arms faster. And we are one of those states based on the CDC ratings were the second state with only Alaska ahead of us based on other metrics were in the top seven states for numbers of doses that came into the state being delivered to people. So that puts us in a good posture. If we say we can accommodate X number of doses, they need to do their best to give us that number of doses and they will if they stick up to what their words are because their words are if you're one of the states that are higher performing will get you more vaccine. So we shall see how that plays out. That's news just from yesterday and God knows how it will evolve over the next week of that administration's existence. The allocation and distribution is one issue. The other issue is access to the vaccine. So certainly what we've been proposing and what we're assembling and we are going to say a lot about this at the Friday press conference so I won't get too far out over my skis on this is that first of all regionally there'll be access completely not just at one hub here or one hub there. We need to worry about higher risk groups and making sure they have access in a fair and equitable manner. We need to worry about homebound Vermonters who might not be able to go to a site to get vaccine and have it delivered to them especially if they're in one of the highest risk groups as homebound Vermonters tend to be either by age or by disease burden and then we need to worry about those populations that have not fared as well with the virus who we need to actually provide equitable access to like the BIPOC population. And the BIPOC population is interesting because it's actually a bifurcated population. There's if I could call it the more traditional BIPOC population which I would regard as African American Hispanic and Indigenous people in Vermont and then there's the new American as they're called I'm not sure I'd like that term but that population which is tends to be younger skews on the younger end so by our traditional metrics of who's going to do worse with the virus well being older sicker people they're not going to qualify into that metric like the more traditional population would and we need to take that into consideration because they're just as important and as we know from some of the outbreaks around the state they have suffered disproportionately from the virus thus far. So all of that is being taken into account if I may put it that way the variables are federal as I mentioned their manufacturer level their number of platforms that vaccines are prepared with right now we have Pfizer and Moderna people are really getting optimistic about several other platforms getting approval end of January or into February some of them may have actually been part of the operation warp speed where they've already been provided with funds by the federal government to have manufactured something that they never knew would come to fruition or not so there'll be a little bit of a supply already available and then the other variable would be uptake by the population and I get asked even now you know how many people are refusing to take the vaccine don't have a really good handle on those stats this early in the game we know that people in long-term care facilities are taking it at high rates if the consent process can be gotten through quickly enough because many of them are not in a position to provide that consent so it needs to be family members we know that the staff at long-term care is not so great we know that healthcare workers in general surveys have shown early in the game 50 uptake more recent surveys 70 to 80 percent herd immunity is supposed to be somewhere between 70 and 90 percent nobody actually knows what this new virus so and we hear regionally different estimates of the percent of the healthcare workforce that's taken the vaccine we also hear that many people in week one two and three said no way and now that they've seen their colleagues not drop dead and still walk around the healthcare settings they're saying oh maybe I'll take it now so they're coming in sort of as a laggard they're not early adopters on the diffusion of innovation curve so we'll see how that kind of works out as well I don't know the general population in Vermont what number that will be one can predict that the older you are the more likely you are to take the vaccine that's been supported by data from lots of other experiences in the past but besides that a little hard to tell we always have a vaccine hesitant contingent in Vermont like there is everywhere in the country and in the world hard to know how big that is often those are people that you can't actually convince to take a vaccine and god forbid it be a novel vaccine a new one from a novel virus because it's even true for the traditional vaccines for those individuals but we don't think they amount for more than a certain small percent of the entire population so we'll have to see how that plays out we do believe distribution should be somewhat on a per capita basis acknowledging where people live and don't live in Vermont so it should be equitable in that manner that's the way we've kind of done it with the healthcare workforce I'm not sure how successful we've been because again it's all real time data really hard for us to tell people always ask now about the priority groups and I'm gonna try to share my screen and if I can't do it it's not the end of the world can anybody see a slide on there awesome hopefully just one slide yes all right and I'll even so some of this you've heard at press conferences now did I just change things yes how's that back to that slide okay perfect we have three priorities in Vermont and I would love to say that all three could be accomplished concurrently without compromising one for the other priority one which I'm going to say first is having less cases of COVID that lead to less hospitalizations and that lead to less deaths so in a nutshell priority one is saving lives preventing more Vermonters from dying from this virus priority two and you get a sense that I'm putting these in an order but please don't accept this as a rank order priority two is keeping our kids in in-person instruction in school and where they aren't yet in in-person instruction making sure they get to that point because we know how much our educational system our kids have suffered in both hybrid environments and then worse and priority three is of course an economic priority to keep our economy thriving and reopen as much of the business world as we can and have it go back to the way it once was non-pandemic time all I'm going to say is our north star right now is saving lives and we we're not mincing words about that at all we're not saying that schools and teachers and workforces and businesses aren't important we're just saying the preservation of life is what we've all chosen and when I say we all this is from the governor down and this is not just the Vermont Department of Health that we've all chosen as our north star right now so if you look at this slide you'll see that every age band of five years has a case fatality rate associated with it case fatality rate means of all the people who get COVID in that age range how many are dying you can obviously see that the majority of deaths from COVID in our state occur in people over age 65 and um and certainly the older you get the higher the risk gets it's pretty clear from the data that if you're under age 65 and certainly under age 60 you have I will say negligible but that doesn't do justice to people who have had a poor outcome but a negligible statistically speaking risk of dying so that data has informed us tremendously about our approach to the virus looked at another way in terms of a heat nap you can see on the left march and on the right where we are now for dates all the deaths again are occurring in those age brackets um in these very peak times of the introduction of the pandemic and now the sort of surge that's happened worldwide and certainly nationwide and region-wide it doesn't mean you have no risk if you're younger of dying but you can see that the majority of our deaths have been in those older age brackets and certainly 70 percent of our deaths have been in older people who are in long-term care facilities uh as well many of them um not necessarily uh so sick that you would say that they were ready to die in their life life life cycle but they succumbed at a time of an outbreak the purpose of this slide is to show that it's essentially somewhere between 35 and 50 000 people in each of those five-year age bands no matter what age you look at in the state of Vermont that's how it breaks down what it means is if you have a strategy of vaccinating everybody over 65 first to prevent deaths you're already in the ballpark of 125 000 people now having said that some of them are in long-term care but really there's only about 6 000 people total in across long-term care settings so um that's negligible when you're looking at 125 000 so most of that 125 000 hasn't actually been taken care of yet this slide just shows a little bit about um who's high risk and what high risk means so if you're high risk which generally means age or having a chronic condition which i'll get to in a second you have um a big chance to have a longer illness a more severe illness an illness associated with hospitalization or god forbid an illness associated with eventual death and succumbing to the disease probably something everybody kind of knew but there's data to support that as well and then lastly today are we have a you know we have the cdc with its advisory committee on immunization practice and then in vermont we have our own advisory committee on immunization that's making suggestions to us all they're looking at these chronic health conditions that are called high risk a high risk health condition means if you have that condition and you get COVID number one you're probably more likely to get COVID because you had the condition but number two you're more likely to have a severe case of COVID and obviously a severe case means hospitalization and or death so most of these make a lot of sense emphysema COPD heart disease kidney disease cancer or some other chronic immuno immunosuppressing illness or set of medications like for an organ transplant something like that nobody's going to argue with any of those but also on this list from the cdc is obesity and severe or morbid obesity if you start saying we're going to vaccinate just obese people that's way too much of the vermont population or and god forbid if you were in another state it's really way too much of the population so there's questions if that should remain on the list likewise smoking as a poor choice in lifestyle habits but should that remain on the list compared to some of these other diseases pregnancy obviously would only involve a small number of people had any one time in vermont you know we don't have that many births per year that's one of our problems in vermont actually but at the same time pregnancy is now recognized as a higher risk condition and the OBGYN world is doing a lot of shared decision making with pregnant women but it's airing on the side of vaccination more often than not so let's see a few other issues on vaccine and so I presented you know this kind of data to you to show you why everything we've been messaging to date is talking about people who are older and people who have high risk conditions as the priority populations if we do nothing else right with our vaccine protocols we need to reach these populations sooner than later if we want less people dying in vermont so preservation of life is key just a couple other points to make phase 1a of course is the health care work is a long-term cares the strategy is what I just said that still leaves a lot of romaners who haven't yet received vaccines so we will discuss those in a minute and how long will those priority phases take to get through well we do the math if we got 125,000 people who are older we have maybe another 100,000 who are younger than that but have some of those high risk conditions and you're getting 9,000 doses of vaccine a week it's going to be short time by the time you get to the next population I don't believe that's going to be the way it plays out because I do have optimism about these other vaccines being approved and I have optimism about the federal government revving up its rate of distribution and allocation of vaccine but I'm just giving you the math as if it were today that's a lot of weeks just to get through the 75 year and older 50,000 people you're talking six weeks so if we started at the end of january beginning of february it would be march before we even got to people 70 to 74 I think it's going to be faster because of the things I just said my optimism but everybody in the state including people on this zoom meeting I'm sure are saying when can we get the vaccine because it's a very personal thing as well if you believe in the vaccine and you see it as a potential pathway forward for yourself you want to know when you're going to get it and it takes some good forecasting to be able to tell people that and we need much better transparency from the federal government than we've gotten yet to help answer that but you can tell that many of the we's are going to be not in the groups I just presented and that's going to be many months down the road why should I trust the vaccine number one because even though operation warp speed is a cool star trek kind of thing and I'm a star trekker person I won't call myself a Trekkie the fact of the matter is the vaccine was not developed at warp speed cutting corners not paying attention to quality and performance measures not gathering the right data not looking at outcomes over a period of time we can trust the vaccine it's also a new platform these two that are out the messenger RNA platform people are scared of that because it's never been used for another infectious disease but it's not the first experience the scientific world has had with mRNA and it won't be the last and some of the other vaccine platforms actually are older technology if I could call it that and how will the vaccine impact getting back to normal here's where I always talk about the dual pathway the fact that we have a vaccination pathway that hopefully gets us closer to herd immunity sometime in the future but it's going to be many many months of masking distancing avoiding crowds etc all the guidance that you've been given ad nauseam is going to continue to be given well into the summer possibly till the early fall maybe later fall we can't really pin it down just yet but certainly for the winter and spring right now unless we continue to do all of that people are going to get sick from COVID because there's going to still be enough virus around I truly believe what many pundits have said every infection prevented does help lead to health and economic recovery it's just so clear and look where we were in the summertime last year we really had done a great job of preventing a lot of infections and though nobody on this call would say Vermont was economically where it always had been and on the ups up tick we certainly weren't as bad as things could have gotten and when you look at some of the metrics that Commissioner P check and others in the financial world gather we're one of the top states actually for getting back to a certain percent of our prior economic activity it was in the 80s per sense which is actually as good as it gets in this country and when you compare us to that actually said we're just reopening we don't care about the public health guidance we're just going to reopen because we're sick and tired of this pandemic they have not necessarily done better they've done worse because they've had a significant public health crisis concurrent with trying to get out of their economic crisis what does it take to achieve herd immunity i've mentioned already the level being maybe in the 80s or 90% range the how long it's going to take is up for grabs but you know depending again on vaccine allocation we have a dashboard that you should start to get familiar with because it's going to give you a good handle on how close we're getting to that goal right in the first page of that dashboard it's also going to depend on vaccine platforms and uptake as i've already alluded to i'll stop sharing right now and just make a few more comments so you've heard our priorities you've seen the data you understand there's a dashboard another question is why are we going strictly by cdc well i'm not announcing exactly exactly where we're going because we're going to announce that friday but let's do a hypothetical here cdc and its current guidance lumps together get everybody old done get everybody with chronic disease done do these so-called frontline essential workers however you define that if if we can make one promise to one another we should eliminate the term essential worker from our lexicon because if you really look at what an essential worker is 80 plus percent of people who work in vermont would be considered an essential worker and even if they weren't they would make a case to you that they were and convince you because that's how that term gets used so there you are you have a vaccine protocol that essentially takes into account 80 of the population but they all have to get it as the priority right up front then there are others who i call frontline workers and i prefer that term a lot more there were the frontline workers who have patient contact which are already taken care of in 1a and then there are frontline workers like people who work in the grocery store people who work one-on-one in uh hair salon or people who work in schools um who are all frontline workers um and how do you do all of that at one time which is essentially what cdc uh guidance would have you do i think we should try to disappoint the least number of people we can at any one time and if the expectations are that every group is a priority every group will be disappointed because i already told you if we just focused on the 75 and older it's going to take us six weeks well if we did that in the same time frame as focusing on all these other groups it's going to take six years um and the and the amount of people in each group that gets a vaccine is going to be miniscule and they're all going to be disappointed that they can't even register and get an appointment for so governor scott is a person who i respect tremendously for his understanding of what a vermoner would think he has a ability to get his head into the minds of vermoners and express what they really think he thinks and i believe that simplicity is important when you embark on a complex program program of mass vaccination of a whole population this has never been done anywhere never mind in vermond uh so simplicity feasibility um i would also use the word pragmatism i would also use the word respecting prioritization but taking it only as far as one can go and tempering expectations from the start and making sure that people understand where they will fall in line so that they don't feel they've been forgotten from the outset so some of this does require people to accept that saving lives is indeed as noble a cause as we say it is and that it is using public health data to drive policy uh and i'm certainly telling you all of that um and that's sort of the way this is playing out but it can only disappoint a lot of people even without telling them they're included in the first group but certainly telling them they're not included in the first group um if we get into a point of much grander vaccine allocation and distribution this will become so much easier um assuming we have the setup to allow people to access the vaccine in the state so what is all of our future planning well it's really current planning it's really where will vaccines be delivered so some vaccines will be delivered traditionally through the health care system just like everybody imagines however think about this Pfizer vaccine that is 70 below zero you can't just expect a primary care practice to have a freezer for that and have the need to deliver 975 doses of it all at once because that's what you have to do with that vaccine larger health care systems or regional health care systems can actually use a central location that can deliver the vaccine through their system but not at the site of a primary care practice so that the primary care practices often of which will have the same health care records um electronic records as the ones uh in their region will be able to join together and be delivered vaccine from the health care system through there however i don't think that's the most efficient way to do it but if you think about many of our sickest and or oldest Vermonters that is how they will feel most comfortable accessing the vaccine and having those conversations with their health care provider a second way is the way we've done it for years and years through pharmacies and pharmacies actually do want to play a role in this and there's no reason why they should not be allowed to play a role in this um and they can be a point of access as well we also have our district health offices which are called pods points of distribution which have the capacity to deliver a lot of vaccine especially to Vermonters who have no insurance but to anybody really um and that's a pre-existing framework but building on that framework we envision that we will have larger sites that these health care district offices will operate out of and won't be operating out of their district office where they have like five parking spaces uh they'll be in a larger setting whether it's in a mall whether it's in a Champlain Valley Fairground whether it's in another large um setting that you can line a lot of people up have a big parking lot etc we uh have identified a whole bunch of those in different regions of the state those will be sites of what we'll call community vaccination but it can't be chaos if you've been watching the news there are 90 year olds with walkers lining up in Florida in the middle of the night to be first in line for 11 o'clock in the morning when the place opens up and get throughput uh i don't think we're gonna do that in january and vermont or february or march um there are other places where the registration systems are crashing left and right i can't pretend that ours wouldn't either but people are being very thoughtful about that what we envision though is having a registration system and having people be educated about where they can access the um site that they want to access their vaccine in and get themselves uh in the queue so to speak for that to happen we also want to make sure that whatever system occurs is not one that allows wastage of this valuable scarce resource um people are already asking well some of the hospitals are running out of health care workers to vaccinate we want them to be able to smoothly transition into the 75 year old group um not just say february 1st 75 or older you start then we risk having the unused vaccine or god forbid wasted vaccine uh for a week before that so hopefully everything that goes on from this point forward will have a transition period as well where as you come to the end of one cycle and you'll see the appointments diminishing and the demand diminishing for that cycle you rev up for the next cycle and allow people to start coming in so smooth transitions is really important and then the other factor of course is safety god forbid we have anaphylactic reactions in multiple places we haven't seen much of that we've seen a couple cases and some people have had to be transported to an emergency department so we need to make sure that every vaccine site has the capacity to manage somebody who gets a severe allergic reaction whether it just requires an epi pen whether it requires somebody to be transferred to an er make sure that we're not having people sitting in cars getting somebody through the window vaccinate them having them go park out in a field and then 20 minutes later they're unconscious we've got to have a strategy that allows for safety to make sure that that is factored in a little easier with the test sites the mass testing sites because people don't die from getting their nose probed with a swab to get tested vaccines are different proposition so I think I've covered a bunch of the things that I was asked to cover some of them more superficially than you would like some of them maybe more deeply than I should have been allowed to and this might be a good place to stop and hear from you Commissioner Levine thank you thank you very much for also focusing so specifically on vaccine distribution because I know that that was that is a very that's a very current concern and need for information I guess I would I would want to begin before I ask if any for people to raise their hand with questions um Commissioner Levine I believe you there is a web page where should people um where should we be as legislators directing our constituents to ever changing information about vaccines yeah so everybody's familiar with just the COVID part of our website you know you go to the VDH healthvermont.gov and go to COVID-19 and then you can automatically within the COVID-19 part of the website go to the vaccine pages and within those you can actually go to the dashboard page the public facing dashboard which will give you a sense of how many doses of vaccine have been delivered to people thus far thank you and as I said we're one of the best states even though the number won't look very impressive when you look at it um thank you um right now we have three questions on deck we have Senator Lyons we have to go first and then we have Representative Small and Senator Hardy I can only keep three at once so in that order and then we will continue and as a chat box too I haven't really been keeping up with it because I've been talking but I am hoping that the people who wrote on the chat box will raise their hand because sometimes questions evolved and might have gotten answered um Senator Lyons uh so thank you and thank you so much for a comprehensive overview of what's happened and where we're going um and I think we all get it I really do I guess the question that is is never answered adequately for any for some of our teachers and educators is how come you know how come we haven't been prioritized and I think it would be extremely helpful if you could um address that question and then the other question I have is I hear I hear the comment about staff needs and and needing folks who are available to do testing or vaccinations or other um other uh services so if you could address each of those that would be extremely helpful thank you yeah and you know publicly we're gonna have to stay slough this friday about uh many of the things I've talked about um and god forbid any teacher in the state think that we don't value what they do and we don't think they're important um and and respect what they've done and sacrificed for to date um but again in a policy of trying not to set unrealistic expectations for a scarce resource um there are harsh realities which are unfortunate I do know there are states that are trying to do everything at once and I don't know how you know they can possibly uh create any sense of real expectations that are um practical as well as realistic for anybody who falls in the categories that they're vaccinating and then we just heard uh from um health and human services in washington yesterday that they just think everybody over 65 should be vaccinated well we do too but can we just do that that's basically saying we're gonna try to vaccinate 120 000 plus people in vermont all at once as quickly as we can and that's gonna create unrealistic expectations and disappointments as well so this is sort of what we're in now the only thing that will help it will be better allocation of vaccine to the state and the state being prepared no matter what number of doses come in to be able to deliver those very expeditiously and indeed uh that is our goal uh and um one thing you know we've done throughout the pandemic has tried to be the number one state and as many of the good parts of managing the pandemic as we can so that will certainly stretch the vaccination as well uh we want to be up there in the top states that are doing a good job doing this so that people who are teachers or another frontline work will appreciate that maybe we'll get to them faster than uh anyone would have imagined can you can you briefly uh talk about the um transmission of covid for the younger younger age you know kids versus adults and so on i think that is also very um illuminating it is very illuminating so you know we spent a lot of time and worked in a very multi uh component team that had pediatricians pediatric infectious disease public health school nurses um educators obviously a huge team all looking at what would it be like to get kids back into in school in person instruction and we looked at world data we looked at some emerging us data though there wasn't enough of it and the vast consensus was that younger kids and we'll call that age 11 and younger k through six ish k through five k through six um really don't appear to get the virus as often and certainly don't seem to be vectors of the virus to the adult population now part of that is biologic and we believe it has to do with these ace a c e receptors that are in the nasal and oral mucosa um and the development of those receptors with age over time and the lack of expression of a lot of that in the younger kids but the data even in vermont supports what we saw around the world which is that we're not seeing abundant cases of virus transmitted within schools from kids to the adult population more often we're seeing either a kid with a case acquired in their household where there were other cases or an adult who works in the school becoming a case and having to go home and isolate because like anybody who goes to any work site they happen to bring it to the school we've had a number of times when schools have had to cancel classes or close the school but none of those times have really been because they had virus being transmitted within the school it's because they had adult contacts of cases in sufficient numbers that they couldn't operate the school so if they had one or two people in the adult community at the school who had the virus they would then have a number of people who were contacts of those people who had to quarantine and they had to say for staffing considerations we need to go remote and that's what they did in this later part of the surge that we're having right now we are seeing more cases in schools like we are in every work site in the in the state but even those are again a couple cases here a couple cases there a student here an adult there and they're not causing major trauma if I could say with what's going on in the school in terms of keeping the kids in the kind of learning environment that they've been in certainly isn't helping us open up more schools from hybrid to more in person but that will come with time but clearly it's not setting us backwards either which is important so again teachers make a good point they are frontline and they are working with kids all the time but the fact of the matter is when we do surveillance testing in the school population we find out that the teachers have an infinitesimally small positivity rate in the 0.25 percent range compared to what our current state rate is which is 2.5 percent and that's just testimony to how careful the school teachers and other workforce in the schools have been trying to preserve education for their kids and I would love to be able to reward them for that move them to the front of the line but we got to get through this higher priority as I said of saving lives first and certainly we're not seeing tremendous amounts of cases in schools that are evolving into severe outcomes in any way did that answer the question thank you thank you commissioner we then have questions from representative small and senator hardy followed by representative cordis and I have the other three of you as well representative small thank you madam chair and thank you dr levine for your thorough explanations today I know you touched on this briefly when thinking about our new american families and I was wondering what the plan was in the vaccine rollout especially when we're thinking about the diversity of age brackets and risk factors among those families and wondering what the plan is from your perspective yeah very timely time to ask this question I'm not going to give you the answer I'm going to lay out the issues because we have a lot of people working on the answer we have our own health department's health equity team we have members embedded in the wanouski weekly meetings that occur amongst the new american communities and their advocates there along with the city government we have uh susanna davis's racial equity task force and susanna as the lead of that we have what we call cultural brokers that dr avila from the medical center and others have worked closely with in their development uh so we have a lot of input coming in here are the basic issues number one by pock depending on what time in the epidemic you look at it had a three to four times rate of cases compared to non-by pock uh vermoners uh so more susceptible to the virus and uh a higher rate of hospitalizations thank god not a higher rate of death but that's because most of the time our deaths have been few a number and uh there's nothing statistically significant about death in that population um I kind of look at the um by pock community in two ways um and I think it's in an informed way there's the more traditional way of looking at it which is uh african-american hispanic and parts of our indigenous people in vermont uh who have been here in america for generations they tend to skew a bit older and uh fit some of the other criteria for risk for severe illness then we have the what I have been instructed to call the new american community and i'm still not comfortable with that term um but we all know who i'm talking about people who have specifically come here often as refugees from very dire circumstances and are now living amongst us in vermont um and uh hopefully thriving that tends to skew to a much younger population um and the households are often filled with young children younger parents occasionally an elder like a matriarch or patriarch who came with them but not not universally and often living in congregate settings and in multi household arrangements which are of course by themselves risk factors for covid even if you're completely healthy and young so uh there are a little bit differences in risk and needs for both of those sort of sides of the population in addition if we truly recognize uh the construct of racism of historical injustice of uh inequities that have persevered over time uh we all know that um we need to remedy much of that that can't be done in one fell swoop overnight that takes a long time but part of that process is becoming alert to it and actually factoring it in when you do something like try to vaccinate every vermont so there we have the sort of dual vying strategies of one let's prioritize everybody in this community because they have shown worse outcomes and they need to be at the front of the line well some might say of course that's what you do others might say that doesn't show that you're truly informed about this historical aspect to their experience and indeed haven't thought about things like the tuskegee experiments and things of that sort we're moving you to the front of the line actually makes it look like you're part of an experiment and you're dispensable as opposed to you really are the priority that's a delicate kind of issue but it's not one that we can just ignore another way to look at prioritization is we may not say you're the front of the line and you know in front of everybody in the state but when your bracket comes up we're going to do our darnedest to make sure that we have educated you well that the messaging has been clear that interpretation services are available so that you understand everything about this vaccine and most importantly you may have access needs that other Vermonters don't have and we're going to make sure we prioritize your access to the vaccine so that may mean setting up a clinic in a place that actually you can access and don't have to drive somewhere to and you don't even have a car or a place where you don't have to take nas transit to and put yourself at more risk for being with other people who could give you COVID so everything I've just thrown at you is being looked at as part of a big picture then I can't tell you the final pathway of how it's going to look but I'm hoping this week that we will actually arrive at that but I wanted you to be sensitive to all the things we're trying to be sensitive to all the data all the aspects of history and all the aspects of what their current reality is lived reality so that's where we are with BIPOC and there's no way we cannot assign some sense of priority to the population that's just a matter of how we do it and how we fulfill the expectations that we should fulfill I hope that answered your question thank you thank you Dr. Levine thank you Dr. Levine and we have Senator Hardy and after Senator Hardy we have four more people and we have give or take about 15 minutes so Senator Harvey then Representative Cortis, Representative McFawn, Representative Patterson and Senator Hoker. Thank you Representative Pugh and thank you Dr. Levine it's really good to see you and thank you to all of your staff they've been amazing and just incredible work that you're doing so thank you on behalf of all Vermonters I have a few questions I'm going to just list them all and then let you take it from there I appreciate your comments about long-term care facilities I've been in touch with Commissioner Hutt about this this is a particular concern of mine right now because as you said the the rollout to long-term care facilities has been slow it sounds like a lot of it is beyond your control unfortunately but I'm wondering if you have explored any possibilities of of taking control because you're doing a better job at it than the feds are so that's they're just they're people in these facilities that have been in isolation and that are you know have all these other impacts on them for and on 10 going on 10 months and so I just wondered if you could speak a little bit more to that the second thing is in terms of schools I echo the question that Senator Lyons asked but I'm wondering digging deeper and there was a little bit in the chat about this there are certain staff members in our schools that are essentially healthcare workers frontline healthcare workers in the the jobs that they're doing school nurses in particular some para educators and special educators and some counselors in schools and I'm wondering if they are included in the A1 category and are getting vaccinated now I spent my off session as a substitute in our in a school and I I see the work that they're doing on the front lines that is the equivalent of healthcare workers and I'm wondering if they could potentially be included in this first list and then my last question then I'll let you take it away is I'm getting a lot of questions as I'm sure we all are about when it is my turn how do I sign up for a vaccine will there be some kind of online system like we have with testing and what is the plan for the sort of logistics of signing up for your vaccination thank you great and I can be briefer with these answers on these two with the long-term care we have exerted some pressure that's worked with one of the three pharmacy chains very well the other two not so great we've explored having some of our hospital systems deliver some of the vaccine and they've had some enthusiasm the problem is we don't want to screw up the entire system because the way the vaccine comes into the state as part of this federal pharmacy program is pretty programmed and we don't want to disrupt it in a way that will interrupt second doses or will interrupt even getting the first doses to the right places that haven't gotten them yet because these pharmacies have schedules set up over the ensuing weeks it's just we'd like them to speed up those schedules so we have not abandoned looking at it but we are being more cautious because of the fact we don't want to screw it up second thing about the schools school nurses were clearly in 1a 1a we've tried to message the fact that it's patient facing now i know that that can be interpreted broadly too because i've heard from plenty of teachers even my daughter who is in another state but has cleaned up her share of vomitus on the floor and on a student's clothes in the second grade so does that make her a health care worker you know most people in their own businesses and whatever don't have to go to that extreme and do that but teachers do you mentioned para educators who may be exposed to a higher risk population as well right now the definition is not included in health care workers we've tried to be fairly strict and specific about that patient facing and patient being truly a patient not a sporadic kid who gets sick uh and comes to school uh ill um i know that's not going to be super popular but that's kind of how the line has had to be drawn just to be effective in messaging how that works thirdly there's going to be a registration system and the date for that is later this month i won't give you a precise date because then i'd have to be held to it and i'm not part of the ads part of government they will hold themselves to the date but that will have a very simple program because there's got to be some questions that have to be asked that allow people to know if they should just go get their vaccine or if there's some steps in between in terms of getting a physician's uh decision-making involved uh allergy issues things of that sort um there'll be the basic demographic stuff they have to input which will be very straightforward um and then they'll be depending on where they are in the state where their options are for getting the vaccine and where appointments are for those options we know that some of the people who are in the older age strata will probably want to use the telephone more than the uh technology not to be totally uh stereotypical about this because there's plenty that are well versed but we know from other systems that experience tells that many will want to use the telephone so we're going to have to have a apparatus and we're already contracting with other firms to make sure that that's available as well so if people need help with registration they can just do that they have to still know that it's time for them to do it though and that's going to be you know through the press conferences through mass media through social media uh there'll be a lot of ways to let the population know that their turn is up uh whether it's an age-based or another basis so I'm hoping that will go smoothly uh I've never seen anything in the IT world go as smoothly as it was advertised so I make no promises but at the same time a lot of good effort is going into this and we'll need to have some faith thank you um I just hope that if if you're not able to um vaccinate people in school buildings that you are cautious about your plans to try to get all the students back into the school buildings I think that's going to be really tough if you're not able to do more vaccinations for our teachers and frontline workers in schools yeah and and just to make one other quick point I think you're all aware but the two vaccines that we're using right now the cutoff age is 16 and 18 so we're not even able to vaccinate the students that the teachers are concerned about uh because we don't have a vaccine that's been authorized for use in the child population yet I'm hoping that will change but so far that's what it is um we now have um about 10 minutes left um so uh Representative Cordis followed by um hopefully Representative McFawn and Representative Peterson and Senator Hooker might I suggest that the those of you at the end that you put your question in the chat and we'll then send it to him if we don't have time Representative Cordis thank you and Commissioner it's good to see you speaking as a healthcare colleague and a legislator uh Senator Hardy asked my question about the frontline educators that work closely with kids toileting etc so my next question is a comment and maybe a consideration for us legislators in that we may be able to help with this issue I volunteered um at UVM Medical Center to assist with uh immunizing people and was told that I couldn't because it would be putting me in overtime so I would like to advocate for um the ranks of volunteers I don't need to get paid for it um I would like to be able to get my colleagues who um are licensed and skilled at offering immunizations and working with the state um to help um get the shots in arms so to speak as quickly as possible and indeed we have this entire entity called the Medical Reserve Corps the MRC where a number of people have come forward already and had that same slot I think we're integrating that into our planning process but I'm going to have to uh check in on that later today during our vaccine meeting uh but wonderful suggestion and I agree there's plenty of people that want to volunteer they don't want to get paid to be part of the vaccination force thank you you're on mute representing a few representative mcfaun a question thank you thank you madam chair um thank you dr levine for being here um the question is if staff in the healthcare and long-term care facilities uh uh refusing the vaccine how are the patients and residents of those facilities being protected against the virus until they develop uh sufficient immunity that's question one question two is you're getting eight to nine thousand doses a week how many shots are actually being given out thank you good so that's far we've given out over 25 000 first shots plus a number of seconds yeah I know I'm just saying yeah total 25 000 uh over several weeks um I believe uh I'm not sure I can give you the number per week I can give you the percentage of the of the vaccine that came into the state how much we delivered to people and the highest number we have was last week which was 58 percent now you may go well gee can't you do better than that but realize 58 percent takes into account what you're getting in what you have to plan to allocate at a future date if it comes in on a wednesday which it does quite frequently the health care system has to set up clinics based on when it came in so that they can deliver it so they're going to set up a clinic for thursday friday saturday even though they wanted to do it monday through friday but it didn't come into wednesday then you've got the pharmacy partners who have scheduled their long-term cares out for three weeks and have them sort of rationed in a way so they have enough vaccine for all of them 58 percent is actually remarkable if you look at it from the way I've just described that was going to be very different than the subsequent phases where we're no longer dependent on the federal pharmacy partnership we're not totally dependent on the hospitals and the health care system and we can basically get the vaccine to where it needs to get to uh to keep up with the appointments that have already been set up in those locations so we should be able to do way better than that certainly in the 80s to 90 percent knowing you'll always have to be withholding some vaccine just as part of your planning allocation for the subsequent week it also gets complicated when it comes to second doses but I won't even burden you with that right now with regard to your first question the long-term cares are totally dependent on everybody who works there doing everything they're supposed to do in terms of asking and being in society respectful of all the public health guidance obviously they can't distance from the patients they're working with but they can do the distancing in their community so the best thing we can do for the long-term care facilities or for your corner grocery store or anywhere else is to reduce the amount of virus in our communities right now and the only way to do that is these dual pathways of all the right behaviors from a public health standpoint and vaccinating more and more of the population so that's how that's the simple answer to the dilemma you provide you didn't ask me but many ask well can't the places mandate that their employees get the vaccine but right now and I know David is on from a legal point of view but this will be an important legal question for the world to be looking at in the future a lot of employers of various sorts will want to mandate their employees have the vaccine but at the same time the commissioner of the FDA has told us very clearly these vaccines haven't actually been approved in that sense they've all achieved the EUA emergency use authorization emergency use authorization is not synonymous with approval only an approved FDA medication or treatment or procedure can be mandated by someone this is not at that level yet so that's the answer to that question thank you thank you represent Patterson and then senator hoker peters represent peterson oh okay I didn't quite get the sorry madam speaker thank you very much dr. Levine for a very informative presentation um you mentioned that we would get or we're getting eight to nine thousand doses a week and you said we could do way better than that or we could use way more than that how much how many could we how many doses could we distribute right now if it's more than the eight to nine thousand yeah that's a challenge because we don't yet have these community sites officially set up yet that will be another week or so so I don't want to get ahead of that but clearly the hospitals have already told us in many cases that they could administer more than they've been getting right now because they're getting it on a per capita basis as well and many of them have exhausted the healthcare workforce so they can actually move into the 75-year-old band pretty quickly so you know I would certainly say that would be in the thousands of doses across the state so if I were so bold to say if we had double the allocation we would find a way to get that in I'm sure and that's indeed what we're planning for you know even more than that someday but right now you know just through our district health offices uh uh throughout the state alone we could deliver 7 000 doses in a week we're not even utilizing those right now so that gives you an idea that we could go way higher okay thank you thank you thank you madam chair uh Dr. Levine I am amazed and very very grateful that you and your staff haven't succumbed to COVID fatigue and we'll we're all benefiting from that to direct the conversation away from vaccines for a second I'm curious to know how contact tracing is going in the department have things been going well and and continue to go well yes so a number of weeks ago we markedly enhanced the workforce in that arena uh we're capable of contact tracing way over 300 cases a day now God forbid we get near that number uh we've been in an average of 160 over the last several weeks last night I think the count was in the 100 teens which uh I'd love to see that trend continue if that will happen but that's not a trend yet um so um the contact tracing workforce is actually certainly more than adequate to the task right now and when we look at our turnaround time meaning connecting with a case or connecting with contacts within a 48 hour period it's certainly in the 80s to 90s percent that are being uh connected with and often when they're not connected with it's because we just can't find the person on the other end of the line not because we haven't tried so uh I'm I'm not just trying to present a rosy tale here we actually have really bolstered the workforce and though many are new they've come online and are doing a great job thank you and and thank you commissioner and thank you committees uh I'm somewhat amazed we have four minutes and so in that four minutes I want to turn it over to Senator Lyons or Representative Lippert if they have any final comments or and I just want to again say commissioner please thank your staff for all their work Senator Lyons and then Senator Representative Lippert oh uh simply thank you uh thank you for your continued efforts um your work keeps us from having COVID fatigue and we greatly appreciate what you're doing yes uh Dr. Levine likewise thank you thank you so much uh I would I would simply also say that uh I believe that we as the healthcare committees of the legislature will remain very receptive to updates from you and also um frankly uh information as to what we can do to support you and the health department who I know have to be beyond code fatigue uh and from what we hear directly and sometimes indirectly uh the level of uh stress on your staff and I can't imagine on you personally but uh let me say that do not be shy I speak for myself at this point but I believe for others do not be shy in bringing forward a clear message to us as to what we can provide to the you and the health department to protect for monitors so that you can continue to succeed as you have been so dramatically I I want I do I do not want to learn that there was something we could do that we did not realize that we could do to support you and your department so thank you and again thank you thank you all for your very kind comments and I will convey them to the remainder of the department as well um and uh as you've alluded to it does take a village yes we have a pretty large village within the department but it also takes a large village across state government um through the all the branches of state government to be quite honest and certainly uh there are many on the governor's team um that have been very instrumental and supporting the kind of success we have here and I I said in my opening comments about having a population that is really focused on health and wants the best outcomes in health well it's always important that that population be supported by a government that wants the best health and wants the best outcomes in health and in that sense we've got a great rich tradition that we've built on and are continuing so thank you all okay thank you and uh this ends the joint meeting with uh house human services house health and welfare and senate you know house health care and senate health and welfare on uh Wednesday January 13th with the focus on the uh COVID and vaccines with uh commissioner Levine