Good morning everyone. We'll start today with an update from our commissioner of health Dr. Levine Morning all up. I'd like to start with a quick update and then a couple comments on two topics Senior living facilities and masks yesterday's labs brought 51 new positive results out of Approximately 470 labs Bringing our state total closer to 400 it's 389 There were no deaths yesterday And we continue to be actively Working with eight different facilities around the state And if the experience of other states could serve as an example that number will unfortunately grow I want to say a few things about our long-term care and senior living facilities They present special and high priority challenges As you know, these are group settings They provide housing and care for Vermonters who are most uniquely at high risk of serious illness and even death from COVID-19 The staff and caregivers in long-term care facilities Really depend on our response and our support Both immediately and in the long term At the health department our health care infection prevention and response team is our first responder unit Outbreak prevention and response starts with primary prevention Including working with facilities to provide intensive infection prevention planning And messaging before any illness occurs This work is happening now with every long-term care facility in the state and it has been ongoing For weeks, if not months Our team works with facilities to identify illnesses in vulnerable settings Then moves on to rapid response when a COVID-19 positive case is identified The response clock Starts the moment we receive information about possible exposure to patients Residents or staff at these facilities Specimen testing is prioritized and turned around quickly in our laboratory The team is in constant communication with each facility and is available around the clock When facilities request or we see a need for additional personal protective equipment PPE The state provides it And indeed in our most recent facility birchwood that happened rapidly and successively over several days The team works with the facility to evaluate the exposure risk Of facility patients residents and staff And begin our contact tracing efforts The team helps the facility determine the best way to prevent spread That may mean testing everyone Checking temperatures of staff Changing how the facility is delivering meals or cohorting the residents They also evaluate the facility to identify what additional supplies May be needed Our public health response happens quickly. We know that lives are at stake All of this is done in communication with other teams at the state emergency operation center and health operation centers To ensure that the response is coordinated Such as people needing to be in isolation or quarantine situations The state's action with senior living facilities are coordinated through the essential services rapid response teams So this is just what it sounds like rapid response planning and intervention To ensure Those vulnerable members of our communities, especially those in quarantine Have the supplies they need and that their basic needs are met My final comment is just going to be about masks Because anyone who's been paying attention to the news in the last 24 to 48 hours has heard the topic repetitively At this moment in time on 11 o'clock in the morning on this date CDC and health departments, Vermont included, have been advising people who do not have symptoms of the coronavirus to not wear masks when out in public Saying that they offered little or no protection to the public But in the past 24 hours That advice is evolving Even though the definitive advice has not yet come from cdc or other organizations And it's evolving fast like everything else in the coronavirus epidemic So now I am joining other health leaders In recommending that vermonas wear cloth face masks in public even if they have no symptoms Now we know for more recent data That pre-symptomatic spread of covid is possible Especially in the 48 hours prior to symptom onset So wearing a face mask may help people From spreading the virus I fully expect that cdc will be formally making the same recommendation Today or in the coming days But I want to stress two important points We must still reserve medical grade masks for healthcare workers who are on the front line with patients And secondly Social distancing To stay at home Stay safe order of the governor is still the most effective way to slow the spread So what vermonas are already doing The sacrifices they've been making with social distancing Is beginning to show promising results in slowing the spread But we still must keep up this good work For a little while longer Even as we see the curve of illness in vermont potentially flattening So that in the future We can get together again in health and safety Thank you I want to take some time today to recap some important information and requests we put out this week First My team presented our modeling and projections yesterday as you all know Which is data that we use to guide our decisions and plan our response It's important to know that with uh while recent trends have given us some hope We know this can easily change day to day for instance today. We saw a significant increase in positive cases Well above what do we've experienced in the last few days? So while I want everyone to stick together and remain optimistic We have to be realistic as well We're going to see ups and downs We're going to see outbreaks and my team will continue working hard to adapt as we've done with our rapid response teams To address these challenges in order to keep vermonters safe And we can't take our foot off the gas Social distancing and washing your hands continue to be the most effective tools we have to reduce the spread And make sure we don't overwhelm our hospitals As dr. Leene said We're also hearing a lot about wearing masks But I want to be clear This is not a substitute for staying home And it is not an excuse to mingle with others Please continue to follow the measures we put into place Even if you're wearing a mask As I've said many times public safety is a top priority of any government And that's what I've had in mind as I've made decisions during this pandemic In order to save lives we've taken many aggressive steps to slow the spread of covet 19 Flatten the curve and keep as many as our friends family neighbors healthy as is possible But again, I know this has caused a lot of economic uncertainty And put a strain on many families and businesses We basically had to shut down our economy in order to save lives, and I know how hard this has been So I wanted to take a few minutes today to remind you of the resources available Due to actions on the state and federal level First As a result of the cares act passed by congress Most will receive a one-time check of 1200 dollars And if you filed taxes last year, you don't have to do anything The money will either be deposited into your bank account later this month Or a check will be sent in the mail Second, we've expanded unemployment eligibility and waived many requirements For the first time you can file up for these benefits online And there will be an additional 600 dollars added each week Third Support will also be available to self-employed from honors and independent contractors Although we're still awaiting guidance from the feds, but we expect to see that soon There are also programs available to help businesses get through this This includes the paycheck protection program, which is an incentive to keep workers on your payroll It provides loans through your banks and credit unions to cover these expenses And if employees are are kept on for eight weeks Up to 100 percent of the loan is forgiven This program is open today. So please visit sba.gov Slash paycheck protection to learn more Small business owners are also eligible to apply for a disaster loan And you can receive a grant for up to 10 000 dollars, which will not need to be repaid This is also available to self-employed individuals in the turnaround time. It's just a few days These are just a handful of what's available And you can find all this information at accd.vermont.gov And while we know there is much more to do and we'll continue to focus on economic relief as part of our response to this pandemic It's important to use the resources that I described to help get through this Earlier this week, I also called on Vermonters to support our COVID-19 response Even before this crisis, Vermont faced a workforce shortage across all sectors But especially in healthcare With all the hours these workers on the front lines are putting in and knowing some will become ill We need to build our reserves So we're asking those with medical experience to volunteer for our medical reserve corps If you have this experience Please visit vermont.gov Slash volunteer Others are maybe looking for ways to help as well And can find additional volunteer opportunities on this website While we're asking a lot of people We also want you to take care of yourselves. It's so important for everyone to continue to stay home to save lives But this doesn't mean you can't get outdoors and enjoy some fresh air In fact Being outdoors is probably never been more important Exercise fresh air and nature can help help us manage the stress and uncertainty that we're experiencing However, we've got to be smart about where and how we get outdoors So I'm pleased to have secretary more here to talk a little bit about what you can do and what you can do safely Julie Thank you governor As you indicated, it's never been more important for Vermonters to get outside but also to stay close to home And we need to choose smart ways when we're thinking about outdoor recreation Nature can it is helping maintain our physical mental and even spiritual well-being Exercise a sense of normalcy and the beauty of vermont as we transition into spring However, we have to be thoughtful about all of this Under normal circumstances I'd be the first person to encourage everyone to discover all that our state and in particular our state parks And state lands have to offer in terms of outdoor recreation opportunities But in these unprecedented times, it's important to be smart about if and how far you travel for time spent outside With gorgeous spring weather forecast for tomorrow Anyone planning to spend time outdoors this weekend should do the following First stay close to home We're fortunate to live in a place that has outstanding outdoor recreation and nature And much of it within walking distance Now is not the time to explore far flung far flung corners of vermont but rather to focus on backyard adventures Spend time in places that you can walk or bike to and if you must drive to get outside Work to limit your trips to less than 10 miles Be sure to continue to observe social distancing outdoors If you arrive at a crowded trailhead or a place with an unmanageable parking situation See that as a sign Please turn around and choose an alternative. That's not as crowded And also it's important to leash your dogs. There are members of our households as well and need to keep their social distance When choosing a recreation opportunity Skip the risk when you're outside engage in low risk activities Be smart and cautious to avoid any incidents that could require medical attention If you have an accident you're putting health care providers and emergency responders in danger Their sole focus should be on combating the covid 19 crisis And we can't afford to have them called to respond to other emergencies, especially those that could have been prevented And please respect the signs and respect the land Stay off trails that are closed. They've been closed for a reason whether it's for mud season Because they've been overused and are at risk of being irreparably damaged Or because they require maintenance to allow a safe passage For areas that remain open. We ask that you practice leave no trace principles And if you brought it with you bring it out with you There's current information on the department of forest parks and recreation website about the status of trails Um, and we're pulling in information from our partner groups including the green mountain club Vast and vasa the catamount trail vermont huts and the vermont mountain bike association and kingdom trails As well as land conservation organizations And if you are interested in supporting our local outdoor gear stores, please do so but do it online We all love our gear shops and we know that they're the lifeblood of vermont's outdoor recreation at the community level Without them the outdoors and our lives as lovers of the outdoors would be vastly different So continue to support your favorite outdoor retailer campground tackler bike shop But please do so by visiting their online store In some as the weather warms as soon as tomorrow The pull to be outside for many of us myself included will be incredibly strong And the restorative powers of being outside and being able to make a little vitamin d Is more important than ever with a bit of consideration and planning We can keep nature close keep our parks and our trails open And keep ourselves and our families and our communities safe all by recreating close to home. Thank you We'll now open up to questions All right, thank you everybody. We're going to follow the same path we did on wednesday Please know you're muted by our system You'll need to hit star six to unmute if you've also muted your own device keep that in mind and unmute manually from that I'm going to uh, we'll be allowing for follow-ups for clarity. You don't need to wait for me to prompt you Just go ahead after the answer is finished But please keep in mind We do also again today have a long queue and just need to get through this And get these folks on the stage back to work Uh, we'll start in the room with stewart Dr. Levy could we ask you about the uvm medical center uh capacity is the Does birchwood threaten that to somebody's senior care facility is now threatening that we understand yesterday Hospital census is very low And they have a lot of capacity So you're worried about uh ill birchwood residents taking up hospital beds. I'm wondering is that a concern of yours? Yeah Um, at this point in time for the reasons you actually stated Uh, not a concern also I'm not aware of a high percentage of the birchwood residents requiring hospital care. Of course that can change on a day to day basis Many of the residents of birchwood were in the uh rehabilitation portion of the facility Which makes them if I could put it in a little bit of quotes a healthier Uh facility population So at this point in time not as concerned Calvin Um at uvm, we're hearing from medical workers that are concerned about potentially bringing the whole virus to their families Some are Raising questions of maybe they can stay in dorms at uvm. I guess have you guys have any uh discussions That I have not had any uh any conversations uh with Suresh garemella, uh or anybody from uvm at this point in time, but I know that they're uh Community a part of the community and I'm sure that they'd be willing to help in any way they possibly can But I but I'm not aware of any of those conversations Greg from the county courier Okay Um, there was some discussion in the briefing yesterday Uh commissioner scherling discussed a bit about the state's request from the federal government For ventilators and PPE and I just had a couple follow-up questions I was curious if you could specify the percentage of the state's request from the federal government that happened fulfilled And then how the state is prioritizing how that equipment is distributed among hospitals nursing homes and EMS I'm hoping that commissioner scherling is on the line. Are you on the line commissioner? Maybe we can come back to that We can try and get a hold of commissioner scherling to see if you call in because he would have the answer to that I don't want to give you anything that's uh incorrect We'll try to get them on the line Anybody else in the room? Okay, uh, we're gonna go to the phone now beginning with neil allen from the vermont standard Neil vermont standard star six to unmute All right, we're going to move to mike donahue vermont for the islander Star six to unmute. Thank you Thank you, governor We've been told vermont cases are still projected to be a month away before they're maxing out and i'm wondering uh, what are the next uh well three or four Possible directives that you have In your game plan to try to beat this virus And to try to get everybody to come into compliance and defeat the covid 19 Yeah, again our hope is that uh, what we're trying to to do today To socially distance ourselves trying to put measures into place to prevent people from congregating in in different places like the Um Directive yesterday or the day before about some of the bigger facilities the big box stores And trying to encourage them to do something online curbside service and so forth And just get the essentials uh in in their stores to prevent people from going on family outings and just shopping Trips in some respects So we'll continue to monitor Making sure that we're enforcing some of the actions that we have And encouraging and educating the actions we've already put into place But um, but at this point in time, we have some in the queue, but but at this point I would rather continue to do what we've been doing because as As we noted yesterday in the briefing Um, uh, commissioner p check had had shown in the graphing. We're moving in the right direction In the mitigation efforts are having a beneficial response. So we want to continue down that path But but some people clearly are not getting your message or they're ignoring it And I guess I'm wondering if you're ready to go into uh Governor charlie baker mode and go to china or wherever to make sure people on the front line have What they need like admission stats at hospitals janitors and making sure people You know stay in when they shouldn't be driving around or just going out to get cigarettes or something Yeah, again, we're trying to educate as much as possible and direct them to do the right thing But but as far as the PPEs and so forth We're constantly Trying to make sure that we're fulfilling our inventory And getting those to people who are on the front lines and that includes the custodial staff and so forth. So We'll continue to do that. We're having some success And so that's encouraging. Many people are working on this. I am as well And we'll we're finding opportunities every day And we we continue to to work on those to make sure that we have the equipment available When and if this This increases which we know it's going to increase but again our our whole goal here is to not exceed The the the line the capacity of our health care system That's continues to be our goal. And that's why we've taken a lot of the actions that we've we've taken thus far Thank you Hi, hi, can you hear me? Yes Um, this is a question for the I guess for the governor There's still continues to be so much Uncertainty and confusion about who should be wearing what kind of mask when in the public doctor health providers That's the people. Um, do you think it's appropriate for the state of vermont just to issue some kind of guidance for vermonters about mask Again, given the fact that um Right, I'll let it not happening from Yeah, sorry Go ahead. I'll let dr. Levine answer that So I think we shouldn't get too far ahead of the game in terms of awaiting some of the federal guidance regarding this Um, but it's quite clear from what's already been stated today and uh in washington that It's really I guess the term facial covering Rather than using a mask The president went as far as you know woolen scarfs and things like that which may be reasonable But it may not be the most effective But there are other cloth materials that can be used in lieu of an actual medical grade mask And I think as the time evolves we're going to find out how We can interpret What is thought to be most effective in the cloth facial covering category? And I know the governor has you know been very interested in enlisting the aid of numerous Uh companies across the state who actually have even asked questions about what they could do And once we get this more direct and specific guidance, I think it will be easier for people to either go into their own closets and drawers or for us to give guidance to Organizations and businesses that are interested in preparing us the best we can So I have to be a bit vague, but uh Yeah That's where we're at now So you're you it doesn't sound like you guys are going to um anytime soon just issue sort of um simple A simple guidelines or standards for what people should be wearing outside at all times or anything like that Well, when you when you say anytime soon again, we're waiting for federal guidance on this the cvc guidance But at the same time, I think as you heard in the previous question About some of the inventory the PPEs that are necessary for those on the front lines to protect them So we certainly don't want to take away from their stockpile We don't want to use a n95 mass mass for instance That would take away from those health care providers that that they need them today um, so uh, you know, I we've thought a lot about this over the last week or so and it's um We don't want anyone to to Be given the false impression that this will protect them themselves from from Contracting this virus But it could it could in an altruistic way Provide relief for someone else from you spreading it to someone else So while encouraging that We do not want to take away from the stockpile that we have now, especially the n95 mass All right, thanks Sean from the chester telegraph Thank you. This is a question for dr. Levine Could you tell us what the definition of recovered is and how many have recovered in vermont? That definition is evolving just like everything else is evolving um, but in terms of guidance about If you're recovered enough to for instance go back to work or if you're an essential job or a health care worker The guidance from cdc has been Seven days from the onset of your symptoms And then three days without fever or any of the associated symptoms that you had It's a real hard number to get a good handle on because We know perhaps from the hospital level if you've Been hospitalized because you were ill enough and then you became well enough to be discharged If you fit into a recovered definition But think about all of the people who are not needing hospitalization So it's very hard to get your handle on exactly What percentage of the population? That you're not aware of Had a mild or moderate illness and then recovered from that illness And we're able to leave their isolation status if you will So it's too early for us to give you very precise statistics. Unfortunately So is there is there a way that the state is asking people who have been Identified as being infected and who are self isolating. Are they are they reporting in that they Have been three days without symptoms Uh not to my knowledge at this point in time Okay, thank you Hi governor, thank you. Uh yesterday your uh staff had to guess of when we might peak with the virus Have you thought ahead about when uh workers you might lift at least part of the stay home Um order and I'm thinking of construction uh golf courses getting a lot of comment about that, frankly Lawn lawnmowing people even if if you would roll out When people can get back to work in in some order if you thought about that and when that might be These are low density outdoor kind of jobs, which Might naturally be more socially distant Yeah, obviously, we've been giving some of that some thought in in preparation for What's coming in the next month or so? Um, and we'll as you might have noticed when we've managed our way into this And took the different steps to to make sure that we're protecting vermoners We uh, we continue to do that on almost a daily basis So we'll Unwind in the same fashion And we'll pay attention to the science and data and the experts That that are coming forward to guide us and we've done that throughout this whole Pandemic and we'll continue to do that throughout The the other side of this so we'll continue to To wait until we peak And then make certain that we've done so and then we'll mitigate our way out of this as well Oh, thank you and galloway digger and star six to unmute Hi, all can you hear me? Okay We can Oh, great. Thank you. Um, I wondered how many days of n95s and pte's the state has Stockpiles so far. I also want to know how many health care workers have been tested positive And I also wondered um, you know, how The state is dealing with new with nursing homes is the policy to keep covet patients in place rather than move them to the hospital We'll uh, we'll go with the first Question, uh, and I believe uh, commissioner shirling. Are you on the line at this point in time? And if you're on you might have to star six Let's go to the second question. We'll go back to uh, commissioner shirling Dr. Levine I think it was the question was the number. All right, let's try let's try this. Can you hear me now? Yes Go ahead, Mike Uh, give me just a moment governor I've only been on for a second after being on a call with the oc managers, um To get to the ppe information in front of me Okay, all right. We'll uh, we'll come back to you That's Levine I think the second question was the number of health care workers that have tested positive And that's not a number I've memorized and have at the top of my head. So we'll have to get back to you with the exact number I can tell you they continue to be a priority group so that the results come back as quickly as possible But I can't give you a precise number right this second The other part of the question and can you uh, it was about nursing home facilities Could you repeat that? Yes Yes, is the preference of the department of health to make to ensure that nursing home Patients stay in place rather than moving them to the hospital I'm going to interpret the way you phrase that question as actually Maybe prohibit them or prevent them from going to a hospital No, that wasn't actually what I was asking because we're certainly not going to interfere to make sure they stay in place Yeah, no, I mean the decision to be hospitalized really is A medical decision and every one of the nursing home patients is under the care Of a physician or a nurse practitioner So if their decision was the level of illness was acute enough that hospitalization would be warranted And it was in the goals of care for that particular nursing home resident to go to a hospital setting We would certainly want that to happen No, no problem with that happening. I mean hospitals are prepared to receive covet positive patients So just because they're coming from a nursing home wouldn't really matter And from the nursing, but if that's true, that's true why Are some of the nursing home patients dying in place? Yeah, so I actually have addressed this at previous press conferences Um, there's a large number patients Specifically because this was in reference to burlington health and rehab Who had orders on their charts based on their advanced directives That were instructions to not transfer to hospital To live out their last days In place if you will There's also A bit of a success story at burlington health and rehab, which isn't well advertised And I don't want to be premature in it, but there's a cohort of patients Who Remained there did not go to the hospital Were positive patients in testing And have survived in spite of numerous Comorbidities chronic illnesses immune suppressing conditions So it's not necessarily even when one doesn't go to the hospital A death sentence if you will there are a cohort of patients who have actually survived the illness And I hope to hear more stories like that to be honest So and uh relative to PPE we measure it at the moment in in terms of patient days So based on an estimated consumption rate Daily And the total quantity on hand that's measured in patient days So i'll give you just a couple of examples In n95 respirators. We have 21,693 patient days of stock available In face protection We have 11,795 patient days available Uh in gloves 52,908 and so forth So I i'm sorry that that that Is all greek to me. What does any of that mean? I I don't understand when you say patient days. Do we actually have so if we have um 600 patients in hospitals across the state, how long does that last? I don't really understand You would divide the number. So let me give you just raw numbers Gloves we have 1.9 million gloves in stock We have face protections about 59,000 units N95 respirators. We have 283,000 units And how often do these things need to be changed out by staff The medical question that that's a medical question. I don't have the answer to right, but aren't you Purchasing these things based on estimates of what you'll need As we've indicated before we're not using estimates to purchase We're purchasing any and all available PPE at the most rapid rate possible So what you're saying is we have enough to get through the crisis or That is not what i'm saying. Uh, as we discussed with the modeling yesterday There are a variety of different trajectories that this can take based on um folks compliance with the The key measures that have been put in place So if if everything holds And our trajectory remains where it is today We will have plenty if uh folks begin congregating and Not paying attention to the guidance that's been given by the cdc and the executive orders The burn rates will go up or the number of cases will go up And we will be at risk of outstripping our supply of PPE ventilators and beds Is there a better way to translate the data that you gave me originally in terms of patient days? It's just it doesn't it's meaningless to me. Is there a better way to say it? Is there a way that any normal person could understand it? And can we get back to you on this? We have several more or a dozen more Yeah, I think we can simplify this And and and we'll do that. I understand Thank you saying the dilemma Good morning Um, I think my question is for uh, dr. Levine. Good morning. How are you today? Great. Thank you Uh, dr. Levine earlier you talked about how the rapid response team works with the Facilities where we've seen the outbreaks and such um In in particular when we talked about birchwood terrace and such I know Yesterday during one of his updates mayor murl Weinberger talked about how he had gone back and forth with you about getting more Information and more readily available information about the outbreak and When you take a look at you talking about the Rapid response team working with the facilities There's a lot of people out there who have their loved ones there who don't know what's going on So what are you doing or do you have plans in place now? to Really interact with the public? Better in real time Rather than having a delay in getting the information out you may be telling us today what happened Uh in these facilities But what about the family when it happened yesterday or the day before? How are you communicating with them? That's a great question. And i'm glad you're referring Your question to the families of loved ones that are there Who are the ones most concerned? Obviously um Is part of our rapid response is We are embedded and working with the facility And the facility has the responsibility quite often to communicate With their staff with their residents and with the families of those residents So we are doing our best to not only educate And intervene and implement as needed But we communicate with those in the facility so that they can provide the appropriate messaging Since we're not the caregivers for every individual who lives there So it's very important that we get those messages within the facility To be quite clear and so everyone understands the implications of what we're advising What we're recommending that they intervene with or implement All along the way so none of that Would come as a surprise and none of that was what the mayor was referring to I believe he was much more referring to His own knowledge and his office's knowledge of what was going on at that level But that shouldn't be construed to Convey any misconceptions about What the facility is doing and how they are constantly in the loop We actually can do nothing without the cooperation of the facility. So it would be very foolhardy for us to not be Advising educating communicating with them at every moment Does that answer your question?  This is occurring in but to other community leaders And to the media Yeah, so obviously hippo rules have to do with patient by patient naming patients There's really not a need to do that in public communication about these facilities We can use much more aggregate data about the facility talking about the number of residents who have an infection The number potentially of healthcare workers that have an infection Without naming anyone and breaking any hippo rules So it's it's easy to communicate in that way without worrying about Being inappropriate or interfering with confidentiality And are you working to speed up the process between Discovering an outbreak out of facility and letting Not only the family members know but the general public know that this has occurred Yes Short answer. Yes long answer that You're aware of one specific instance That does not mean that has been the practice all along Thank you Wilson ring ap Okay, great Finally came to be getting that the technology here I said another follow-up question for talk to me about advanced directives You've been talked about that quite a bit and was that stuff in burlington health and rehabilitation? and thinking beyond that Given that the statistic show you have some At least a percentage of the patients who are going to need Some sort of advanced care Are you able to calculate into your usage? estimates patients who might not need that care because They are under advanced directives of some sort and then the follow-up question to that is Um, is there more of an emphasis now in nursing homes and perhaps at hospitals? For any COVID patient who is presenting and needs to be hospitalized. Is there more of an emphasis on those advanced directives? so We're all looking at each other because various words came through well and various didn't so let me try to reinterpret your question And see if i'm on target. Okay What happens when i'm on a back? I understand Basically you're looking at Can we figure out the percentage of? Older vermonters who might be in a nursing home and might be under an advanced directive that would state No aggressive measures should be taken And factor that in as we begin to look at our modeling for surge and how many individuals who might not have that kind of advanced directive but the advanced directive might be do everything you can Short of a heroic measure perhaps And try to model our ventilator needs icu needs etc after that so You know what we do know in vermont And we're seeing a play out is we do have an older demographic And we are in the top three States for age And we have to respect that Doesn't mean though that there are 400 plus facilities that Older vermonters who aren't living at home can live in and they're not all Nursing homes and many of them are more independent senior living facilities And other types where? By implication the person is less medically frail and can succeed and survive on their own And presumably would have an advanced directive that said such so Have to be careful when we think about that because Many people would want to be brought to a hospital Would want to get The wonderful care the hospital can provide But would draw the line at having a ventilator And say if it came to that that's not what I perceive is the life I'd want to have And my family wouldn't want to see me go through that And that's very challenging for us to sort of pre calculate I think most of what we're doing is still Modeling in a way that we're not modeling the best case scenario, but we're modeling Something on the continuum towards worst case So I'd rather do that than assume that there were abundant vermonters who never wanted to see a hospital or ICU or ventilator And air on the side of making sure we can provide enough for the population Rather than on the other side The other part of that is that there are as the national and worldwide experience continues to expand If you say that most of the people who are going to be in the hospital are older because they're the ones that are most vulnerable to this virus in its most severe form It turns out that The larger the number of people that are getting the virus in your particular state There will be 20 of those that may be in a demographic you weren't anticipating. They may be Below age 50 even younger than that And if your state is large enough in terms of numbers 20 can be a large number absolutely of people So we have to again do our surge planning considering factors like that as well So without hearing every word you said did I answer enough? Pretty much the the only yes that was the first part of the question The other part is do you know has it changed or placed more of an emphasis On patients who are entering the hospital or a nursing home to make sure their advanced directives are in order that's been Forgetting about covet that's been a not I would I would call it even more than a trend That's been practice For quite some time now, and it's actually a performance quality indicator for patients who enter hospitals quite often and when outpatient care is assessed The percent of patients who are lacking an advanced directive is one of those metrics that We in the physician world have to report and adhere to and try to improve on So even without covet all of that was underway ongoing Okay, okay. Thank you My question is about Hospital beds and with the predictions that were put out yesterday Do we think vermont is going to have enough hospital beds or the hospital is about to be overwhelmed I'm going to let commissioner p check answer that question Thank you governor mike p check from the department of financial regulations. So britney As we talked about yesterday our modeling indicates that vermont Is on a better than our likely trajectory from just a week ago Under that likely trajectory. We were we did have enough hospital bed resources to care for all those Who would need a hospital bed It's important though to remember that those numbers can change and they can change for the worst or for the better And that's why it's so critical for people to continue to social distance to double down on it Because the worst is still ahead of us even though we have the glimmer of hope that we talked about yesterday Thank you Courtney landon seven days Hi governor, just a question about masks specifically Are you recommending that essential workers such as grocery store clerks wear masks at work? And then I'm doing a two for here. Do you also expect to extend orders on staying at home and closing bars and restaurants? Thank you. Yeah, I'm going to answer the second part of that first You can expect that there will be an extension of the Initial order and that'll be coming in the next two or three days. And yes, so we'll expand for a period of time And then update as necessary Based on the science the data that we receive and the advice of The experts and watching again The the modeling that we did and that we presented yesterday is so important to us to make sure that we're not exceeding our Our hospital capacity or health care capacity and staying underneath that line and then we'll manage our way out of this So the first part of with the mask. I'm going to let dr. Levine stress that again So If and when guidance comes out from The federal government or ourselves It's going to be much more of a blanket Policy recommended to all people So we won't have to single out a particular work group like a grocery store worker But I want to again emphasize what you've heard abundantly today about the social distancing is still the policy And what the governor said that You should view this as an altruistic policy So you may think that the grocery store worker is being protected by wearing the mask But it's actually you being protected from them And the reason for wearing the mask or the facial covering is to protect others around you In case you are in that pre-symptomatic infectious phase But would you personally recommend that they wear them anyway? Like and not just you know grocery clerks, but others I'm gonna I'll start and then I'll let dr. Levine finish again If this if this makes you feel more at ease more comfortable And you want to do something to protect others Please do so But don't use the n95 mask Don't take away from the frontline health care providers at this point in time And if you but just be aware that this isn't This isn't the answer in terms of of going out And and then integrating with others and and becoming social again We don't want people to to move around we want people to stay at home. So We don't want to give any false a sense of security in this way But for those who are comforted by that and again To protect others they should do so Thank you My question is um, I'm not you should answer it is whether the list of medical resources in vermont have included available to vermont has have included The facilities available at dart mess that's an almost 500 dead hospital. It's gonna it's got a lot of stuff It's got it has as much as or nearly as much as uvm has I just wonder about whether that those those The dart mess numbers are in the total numbers to get reported and the follow-up question would be Whether you can say Whether you can say that the pattern of pattern of hospitalization already Has it began to be has intended to focus on bigger hospitals or are you are we getting Hospitalization in community access Critical access hospitals of which there are aid in the state. They will only have 25 beds. They are much less resource medical resources Um, I think i'm going to maybe a secretary smith on the uh on the line I am governor and i'll take the first part of that question if you don't mind Ham the We have not included dart mess into those numbers office. Obviously dart mess is a resource That we can turn to if we have to the reason we haven't included dart mess is because new hampshire is probably doing the same exercise That we are doing right now and looking at available beds And we didn't want to double count given the fact that new hampshire is looking And doing the same same exercise as we are So dart mess isn't in that figure, but at the same time dart mess We're coordinating with dart mess in all of these exercises Just to make sure that they're aware of what we're doing And if if possible a resource for vermoner's as a plan I'll uh Dr. Levine, can you do the second part of that question because i'm not sure if i have an answer to that I'm going to let uh commissure p check answer some part of that and then if we have to we'll go to dr. Levine So ham um on the first part of your question as secretary smith alluded to 40 of those that get treatment at dart myth are vermonters So we are aware of those numbers, but as the secretary alluded to they're not included in our modeling numbers So those would be in addition to and above the numbers that we reported and are included in our modeling yesterday Right just to follow up that a little bit. I the I don't I don't I think I've missed the first thing that you said but 40 of dart myth traffic is is vermoners day in and day out And it's going to be an interesting political question whether um, if we if the surge puts a lot of pressure on the system We've come up close coming up from the south coming up close to that capacity line Whether the east side of the vermon is on the east side east of the green mountains So to the east coast of vermont whether they will be able to special and hard cases Really dangerously ill cases whether they'll be able to get a piece of that dart myth capacity So I think again my opinion sorry. Yeah, so I think again. No like I'll go ahead Mike No, like I said ham we are we recognize the capacity that is there But at the same time we want to be very cautious not to double count Beds when we're when we're doing our estimate on available beds. So We understand what you're saying. We understand the capacity that is there But at the same time we want to make darn sure that we are Are counting the beds that we know are available Thank you Yeah, I I just yeah, this just a suggestion one of the things I think that would help this But keep the public to be able to follow the track not just the overall track of this But the more detailed track and one way to do that would be to Simply list every day the number of patients that are hospitalized for covid in each hospital service area There's 14 of them and they they really much correspond to every county and the experience in In east and you know northeast in vermont is the density there is the half of what it is in chitin county So you would really be able to see I think a lot better if you just took the state map and you put the number of people in a hospital For covid my hospital service here. That's just an idea. Thank you And and we are currently Able on a daily basis to know who in vermont is hospitalized for covid and by hospital As you would imagine with the highest population density being in the northwestern part of the state That hospital would show more cases on a daily basis But there have been cases in some of the critical access hospitals you referred to All right, we're going to move to raymond torres channel seven Raymond. Hi, um Hi there Uh, I just had a question on whether if there was any plans in place in case the virus breaks out In main population across the state Can you just repeat that again in main populations? I think secretary smith has answered this question quite a bit Maybe secretary smith you want to answer that again? Give it again. Sure This has been a question that come up continually We've put preventive measures into place including quarantine for new Prisoners that new inmates that are coming into our correctional facility We also have limited visitation to video only All workers are screened for temperatures as we Move forward, but also if we do have a case Of uh of covid-19 within our prison system We do have negative pressure rooms in our in our in our couple of our facilities Where a person will be quarantined As a As they recover from this. Secondly, we have an overflow or surge capacity that we have Developed in the st. johnsbury work camp facility for those covid-19 Inmates that may not require hospitalization or a higher level of Care where they can recover as well So there has been quite a bit of planning that is going on more on the preventive side to make sure that We really are careful on who's coming into our facilities And and when they're coming into our facilities and then once they're in monitoring those those various Whether they're employees or Inmates in our facilities. So that's what's happening. So, uh, is the surge capacity places And in st. John's very is that for healthy inmates or is that plan for only healthy inmates or are there going to be preventive? at those That is surge capacity. So if there are inmates who are covid positive covid-19 positive Um, and they don't don't need hospitalization That's where they will be quarantined is in the st. John's very work camp facility Okay, chris roe newport d lea express Yes, good morning. Thank you. Um This is a little bit off thing But what is being done for the parents who have students who are home now who have an iep program? And it's the state doing anything to monitor the kids who might become who might come from a dysfunctional family Or come from a troubled family to make sure those individuals are safe French on today. No aoe's working on guidance on on these issues, which we could shoot over to you or connect secretary french to you Okay, i'd like that. Thank you Vermont standard Vermont standard right Dana from the caledonia record Dana star six to unmute Uh, good afternoon. This is uh, Dana Uh, just a question. I'm not sure who to direct it to but Among the identified locations to receive patients in the event of the surge of cases The closest to the northeast kingdom that's been identified is berry I'm just wondering if there are any sites In the kingdom that are being contemplated And then a follow-up question for secretary smith. You mentioned the st. John's very facility a search for inmates who may have tested positive for covet 19, uh, but do not need to be hospitalized. So my question there is Are there currently people uh in that condition at the st. J facility? Um, I'm going to ask uh, commissioner, let me To answer part of that but go ahead secretary smith You have to um as of this morning We have no confirmed positive cases of covet 19 within our prison population. We've had I believe uh, two, uh Back members that have tested positive but as of today. So no the answer is no There is no covet 19, uh Inmate at the st. John's very facility in terms of In terms of search capacity remember the first line of defense of search capacity is within Our current hospital Hospital system you have two hospitals up there in the northeast kingdom that are Now, um, I've asked them to surge their capacity to take more patients Especially icu and those types of uh, operations up into their hospitals, so We also have mobile units that michael shirling will probably talk about that we can deploy Depending on the need in in that area We're trying to stay as flexible as possible with our surge so that we can we can react Quickly in the case. We need uh mobility in that region michael Sure, secretary. I think you covered It pretty well, uh three Really four levels internal hospital surge capacity taking on additional patients internal to their walls Uh, a number of state Run surge sites that are hospital specific that have been set up in burlington barry and saint albin's already Two regional sites that are in progress and then the ability to pivot assets to deploy them as necessary using these mobile trailers as necessary Okay, thank you Thanks, joe barton chronicle Full star six to unmute From the bennington banner patricia. I believe you're unmuted patricia All right, leon from vpr Hi, uh, this is a question for uh, commissioner lozine. Um a week ago. You said the health department patricia, please stand by go ahead, leon Um, thanks. Yeah, a week ago. Commissioner said that the health department was expanding testing Part because it had enough test kits to do so And I was wondering what the state's supply of kits is right now if you've been able to sort of replenish them at all And how much longer you keep planning to do that expanded testing? Um, if you have the capacity for it sure so Depending on uh, what scenario we choose. It's kind of like modeling for surge um Depending on the level of testing on a given day We have varying degrees of sustaining this operation at this intensity but suffice it to say Well over 10 days if not double or triple that we've had a second analyzer come online at the health department laboratory which actually has a a larger capacity for testing then One that we've been using all along so we would be able to do both of those together We still have capacity at the mail clinic and The uvl medical center is in the process of validating its own test And trying to secure the reagents it would need for that test which would provide even further capacity So I have to be vague like any modeling Is and and telling you that we certainly have Well over a week or 10 days And maybe even double or triple that Depending on how much we need So we're going to continue this level of testing Into the foreseeable future because it's very very important As part of a containment strategy As well as for our surveillance and understanding How we're doing with all of the mitigation interventions like social distancing that have been put in the place I mean to that end commissioner Can you give me a specific example of how in the week or so that you have been doing this Famic testing that you shifted your strategy Of containment or surveillance in response to this higher number of tests that you're doing Yeah, so part of that strategy um allows you to Um Certainly advise those who test positive to isolate but then to do all of the appropriate contact tracing With the help of that individual So that you can appropriately recommend quarantine for those who are most likely to Be in contact and perhaps get infected So part of the strategy is to expand our workforce in contact tracing And we have abundant members of the department of public safety Local police departments, etc that we've been training all week In the science and art of contact tracing To augment our workforce So that if the increased level of testing produces an increased number of cases We can do the appropriate thing case by case because we we will have manpower to do that Is that clear? Yeah, uh, thanks. My sure It's all Patricia. Can you hear me? Yes. Can you hear me? Yes Oh gosh, but I can't hear you Are you there? We can We can hear you. Oh Okay, thank you. My phone volume was turned down again. Okay, sorry to take so long with that Um, I guess I have two but one of them is a yes or no question I'm hoping I might be able to squeeze by secretary more Should individuals wear a mask and outdoor recreation or only when they're in enclosed spaces with other individuals or anyone who's able to answer that question I think Excuse me. I think the question probably is best put to dr. Levine and they with the answer He's already offered which is we're awaiting the cdc guidance And again can't emphasize enough the importance of social distancing whether it's in an indoor or outdoor environment We've seen evidence that it's really tempting for folks to congregate outside. I think probably under the assumption There's a lot of air And a lot of room But the fact of the matter is if you're standing close to one another it really doesn't matter if you're inside or out You need to observe those minimum physical separations That makes sense and along with um, I know dr. Levine. Um, if you're still on you mentioned I believe it was yesterday. Um, that if I understand you correctly you do anticipate Second round of infections. I believe you said the intermediate kind of prediction was around three months after the peak If I understand that correctly there would be another wave And I'm wondering if in fact that's accurate. Um, governor or dr. Levine or anyone really How do you guys anticipate keeping the economy functioning here in vermont with that potential need? Or rather anticipated need to have to implement at least some social distancing measures again in the future after they're initially relaxed Yeah, again, you know, so much is going to be dependent on what's happens on a on a national level as well And in certainly worldwide or learning new this new um Treatment being contemplated every day. Um, there's even the possibility of of other measures being taken That will give us guidance as we get through this because this is so new. This is such a new virus That we don't have a playbook. So we don't know what to expect and And for us to say that once this wave is over That that will go back to normal would be disingenuous. We're going to have to be constantly Monitoring and making sure that we make corrections as as best we can Based on the science based on the information we're receiving. So Um, we may be in for a bit of a bumpy road over the next Year or two, but I I remember After 9 11 all the different things we learned from from that experience as well as after Irene And we uh, we took took things in and we did things differently and we'll be doing the same as we work our way out of this one. So Um, I haven't got a a good answer for you at this point other than to say This will be a long term. We're going to have to monitor this for quite some time Sure brief question here Have any enforcement actions been taken in regard to violating any of the governor's orders? So we know that you know state police did visit some lodging establishments things like that But have any, you know fines been issued have any penalties been put out that sort of thing Yeah, not that I am aware of but i'm going to ask commissioner schirling if he's aware of any No, not aware of any. Um, and I believe that with full visibility to what's going on on the ground Thanks guys. Um, I think this is for Dr. Levine. So, uh, hospitals have been working to increase their capacities But obviously they're not designed for the numbers that you're anticipating. So What are hospitals doing? What what are they? What are they giving up to accommodate larger numbers? In the short term according to the governor's order, they're giving up elective surgeries Things that would occur in a hospital in their routine way of doing business But that during this emergency aren't going to occur So that's in the short term in the long term Some of them will be adapting some of their facilities to a more intensively ill population And perhaps expanding the number of rooms they have that could be considered to deliver an intensive level of care But I think the ultimate part of the surge We are thinking that many of the sites that we've set up Will accommodate if you will The less ill or perhaps those who still have to be hospitalized, but they don't happen to have covid You know we've talked often about the fact People still get illnesses in the era of covid and The same kind of illnesses that would have hospitalized somebody with heart disease or diabetes or cancer are still going to hospitalize them So can some of those missions be diverted To these other facilities Enabling the hospital to still deliver that high level of intensive care that might be needed for the covid population So just a little follow-up Obviously You have surge units that are opening up in secondary locations, but hospitals are increasing the number of beds as well, correct? Many of them Um I'm not sure that secretary smith. Did you hear the question? It was our hospitals increasing as well as the surge site location. Yes Yeah, we're asking hospitals to increase their surge capacity. We're in we're asking them to uh back up to uh surge capacity that uh Uh will be the first line of defense the the other areas that we're talking about Are if we exceed that surge capacity of the hospitals. So right now they we have asked them to increase their surge capacity All right, that's everybody. Um For those of you and galloway and chris roy who I said I would follow up with afterwards. I've made note of that Okay, thank you all very much for tuning in and we'll see you back here on monday