California Gov. Gavin Newsom COVID-19 Press Conference Transcript December 15

Gov. Gavin Newsom: (04:42) Well, good morning, everybody. I want to jump right in, talk a little bit about the good news that all of us are talking about all across the United States and increasingly around the rest of the globe. That's the first vaccines that have arrived, not just here in the state of California, but all across America. Gov. Gavin Newsom: (04:59) Just yesterday, we received a word or rather we received word this weekend from our Western States Scientific Safety Review Workgroup of the efficacy and safety of the vaccine. I want to remind folks on October 19, the state of California established a formal working group, a scientific panel of experts, physicians, with particular focus on vaccinations, 11-member committee. We were joined by other Western states, Nevada, Washington state, and Oregon, a total of 17 individuals. Gov. Gavin Newsom: (05:37) They unanimously approved and supported not only the results that were coming from the FDA, but the assertions that were made by Pfizer. That led to series of events that ultimately allowed California to advance a formal notice that we put forward to multiple states. I just note here on this slide, you can see some of the qualifications the CDC and FDA vaccine committee members that also participated on our safety committee. Gov. Gavin Newsom: (06:11) Nonetheless, it led to a series of events that led to 33,000 doses of the vaccine arriving in the state of California yesterday 33,150 doses to be exact, four locations up St Joseph's and Eureka area, San Francisco General Hospital in San Francisco, San Diego. Of course yesterday, where I had the privilege of being in Los Angeles County at the large facility there, one of the larger hospitals in the region, working there with Greg Adams and Kaiser Permanente, 24 additional locations across the state are expecting doses to arrive today. Gov. Gavin Newsom: (06:48) We've already gotten word of Madera, Fresno, San Joaquin, Shasta, that those vaccines have indeed arrived, so four locations yesterday, 24 more locations today. We anticipate five tomorrow. If all 24 are delivered today, five additional sites receive vaccines tomorrow. It will represent roughly 60% of the original allotted commitment from Pfizer. Gov. Gavin Newsom: (07:18) I'll remind you, the original allotted commitment was 327,600 doses, 327,600 doses. The first distribution from Pfizer, all of those doses, beginning to arrive in the state of California, 33,000 yesterday, tens of thousands more as we speak into the evening, into the rest of the week. Gov. Gavin Newsom: (07:45) Here's some good news, just late last night, we received word from Pfizer that we will receive next week with orders being placed as early as this Friday, an additional 393, 900 doses. The original 327,000 doses, this is additive. This is on top of that, what were you receiving from Pfizer specifically another 393,900 doses as early as next week. Gov. Gavin Newsom: (08:17) This, in addition to what we have already socialized, and I'll just remind you briefly, and that's the anticipation when Moderna gets approval, that we will receive as part of their first contribution on the vaccinations, 672,000 doses. You start adding these up, 327, plus 393, plus the 672,000 doses. Getting closer to what we hope is the universe of doses that we can administer by the end of this year, by the end of the calendar month of a little over 2.1 million. Gov. Gavin Newsom: (08:55) That's an update specifically on where we are with the doses that we now have confirmed will be distributed, once again, Moderna gets the approval officially, and that can happen as early as this week as well, and those doses arriving next week. It's starting to take shape, a bit of a flywheel. Starts modestly, slowly, and we'll start to see these things build up. Gov. Gavin Newsom: (09:22) That's why we started this Vaccinate All 58 campaign, recognizing that all Californians need to be included in this vaccination process and that we can't leave folks behind. We talk in terms of equity. We talk in terms of inclusion. We often advance our values, but we have to make them real, and we have to also make them visible to people throughout our diverse communities. Gov. Gavin Newsom: (09:46) That's why in each and every county, we are providing resources and campaign assets that distinguish the unique characteristics and needs within each and every county in the state. You could see, vaccinate Shasta, vaccinate Riverside, vaccinate Los Angeles, each region of the state, each county in the state will be provided these campaign assets. Gov. Gavin Newsom: (10:11) We're putting over $30 million into the first, well, first tranche investment into this campaign. The campaign has guiding principles and not surprising in these principles have been well-described in the past, but these are important to remind you of today. It's a focus on diversity. It's a focus to acknowledge that cultural competency, as it relates to vaccinations, has not always been made visible, particularly in Native American communities, particularly in the African American community. That's why we want to be acknowledging of that fundamental lived experience. Gov. Gavin Newsom: (10:47) We also recognize we need to do a better job partnering with our diverse communities, our faith leaders, partnering in communities where we have well-established, community-based organizations, engage with trusted messengers, bottom up, not top down, and to provide as always a fact-based approach to making, well, making people aware of not only the access of this vaccine at no cost, but also to understand the efficacy and more importantly, the safety of this vaccine. So they can make an informed decision themselves on their own if they choose to take the vaccine. You're going to see a lot more about that campaign rolling out later this week. You're going to see more trusted messengers and PSAs coming out, more doctors and more folks in the community that will be part of that program. For what it's worth, and we have the richness of this recent experience. We're using our census campaign, building off the experience we had the census campaign, which truly was bottom up. Gov. Gavin Newsom: (11:58) The experience we had there during very challenging and difficult times, as it relates to working on that census in this COVID and pandemic-induced environment. We had success there. We had some areas that were stubborn, where we didn't see the success in terms of engagement, and so we're learning those lessons. We're taking that experience and bringing it right in to our efforts on the vaccines. Gov. Gavin Newsom: (12:23) I'll remind everybody that this state is the most diverse state in the world's most diverse democracy, 27% of our state is foreign born. It is incumbent upon us to meet people where they are, so we'll begin by connecting with Californians in 13 different languages, again, with a constant drum beat focus on efficacy and safety, cultural competency. Bottom up, again, not top down. Gov. Gavin Newsom: (12:52) Phase 1, let's talk more about phase 1. As you know, we not only put together a scientific advisory committee on October 19, but we also established two additional committees. We established a drafting guidelines work group, and we had established a community advisory work group, the guidelines work group and the community advisory work group are all about equity and distribution. The nuances, the details, the specificity of where these vaccines go, how they are distributed and how we can guarantee with the kind of transparency you should expect, that they truly are being delivered to those most in need with a prioritization. Gov. Gavin Newsom: (13:37) We put out those guidelines in public forums. They're available on our COVID19.ca.gov website, COVID19.ca.gov website. All of those details are up on that site. Phase 1 has been complete, meaning we have put out the guidelines for our phase 1A, which is a prioritization of roughly, and this is a rough number, but it'll give you a sense of the universe, of roughly a 3-million person universe, healthcare workers and residents and staff and long-term care facilities. Gov. Gavin Newsom: (14:12) That's the phase 1A, those are the details we put out and I'm going to show you those details in just a moment. The phase 1B is about an 8-million person universe, and this is the question many of you are asking and wondering yourself, am I included in phase 1B? Phase 1B is currently being discussed. A lot of work has already been done by the drafting guidelines work group. Gov. Gavin Newsom: (14:37) We're now socializing that in a very public forum and people can tune in tomorrow. I think, it's at three o'clock tomorrow. You can go to the COVID-19 site to learn about how you can tune in, watch their deliberations live. The drafting work group will submit their recommendations in this phase 1B, and the community advisory committee, 60 members, will adjudicate the veracity and the assertions and really make recommendations and determinations based upon these principles and the values that we've set forth of inclusion and equity. Gov. Gavin Newsom: (15:13) I encourage you to participate in that and engage and learn more about that by going to that website and learning when they are convening. That discussion, again, tomorrow, will be one of many different discussions in that 8-million plus or minus universe, which includes discussions around teachers, which includes discussions around farm workers, which includes discussions around grocery workers. You get the sense of that universe and those conversations, and so that's a broad strokes population, but remember, they're subpopulations and that's why we've created this tier status. Gov. Gavin Newsom: (15:52) I want to give you an example of what I mean by tiers. I've provided these slides last week. I want to give you a opportunity to take a look at them again. Again, they're on the website, but for the purposes of giving you a preview of subpopulation, sub-prioritizations. The phase that we're currently in with these Pfizer vaccines and the Moderna vaccines, this is tier 1 prioritization. You could see we were doing just this yesterday in those four facilities that received the vaccine, acute care, psychiatric, correctional facility hospitals. Gov. Gavin Newsom: (16:25) We talked about skilled nursing facilities in the next few weeks, in assisted living facilities, where we'll start distributing the vaccine, paramedics, EMT, dialysis centers, get all part of that broader healthcare workforce, skilled nursing workforce, as well as residential force, intermediate care facilities, home care workers. Gov. Gavin Newsom: (16:49) You get a sense here that tier 2 under phase 1A. Tier 3, specialty clinics, lab workers, dental, oral health clinics, and the like, as well as pharmacy staff, which will be, by the way, foundational, particularly as we move into our assisted living facilities, our residential care facilities, our skilled nursing facilities, pharmacy staff will be critical in that endeavor as well. Gov. Gavin Newsom: (17:18) You'll see something similar in our phase 1B. This will be the conversation they'll be having with their advisory committee, the drafting work group tomorrow, and in other public settings. You get a sense of our commitment to nuance and specificity, and to make sure that equity, again, is truly delivered, not just as a platitude, not just that's a platform, but it's manifested in real time. Gov. Gavin Newsom: (17:47) Speaking of manifesting, it goes without saying, there is light at the end of the tunnel. This has been a very, well, optimistic 48 hours, meaning we're finally seeing the vaccine be utilized. We're finally seeing those we value the most we've celebrated since the beginning of this pandemic, get that support, those emergency room docs and nurses, folks there on the front lines of this pandemic and have been from the beginning that are wary, that are worn out, worn thin. Gov. Gavin Newsom: (18:19) Now, they're able to not only get the vaccine to help their own health, but also, as we heard yesterday, just the five individuals that I had a chance to meet and dialogue with yesterday, just down in Los Angeles County. Two of them, the first thing they said is, "I'm just relieved for my family because I was taking a shower before I went home, took a shower when I got home, I was so worried. I had a separate entrance." Gov. Gavin Newsom: (18:43) One of the nurses said, "I've had a separate entrance since March into my home, because I didn't want to expose the rest of my family. Now, to know that at least the first shot of this two-shot regimen that I've gotten that vaccine, is such a relief to me because I can now relieve the stress on my family as well." It's why we put our heroes on the front lines as top in terms of the tier status. Gov. Gavin Newsom: (19:11) They're going to be able to come back to work without that stress, without that anxiety as well, that they were bringing home. These are the folks we're going to count on the most, because as I say, and I've said often, there is light at the tunnel, but we're still in the tunnel. That means we're going through perhaps the most intense and urgent moment since the beginning of this pandemic. Gov. Gavin Newsom: (19:34) Let me underscore why. You could see the case numbers here, running about, yesterday's numbers were about where we've been the last seven days. These are historically high case numbers, 32,326 new cases we reported yesterday, roughly equivalent to the seven-day average. If you take a look here at the 14 day positivity, just pulling it back a little beyond that seven day, the positivity rate in the state of California is now up past 10% to 10.7%. Gov. Gavin Newsom: (20:04) We haven't seen positivity rate that high since the very first few weeks of this pandemic, when few people were being tested and no asymptomatic members of the community were particularly being tested. That's why you had the high positivity rate at the beginning, but we obviously saw that settle out over the course of this last calendar year. Gov. Gavin Newsom: (20:26) Now, the 10.7% is roughly equivalent to the 10.6%, which is the seven-day positivity rate. One of the things that we are pleased with, increasingly proud of, is the fact that we're getting our average daily tests up. We've been seeing average daily tests north of 300,000 pretty consistently over the last number of days. You can see now just shy of 300,000 average tests every single day, 296,000 is the average number of daily tests that we are conducting in the state. Gov. Gavin Newsom: (20:59) We still want to see that number rise. We want to see more access to testing. We want to see those results come back even sooner, and we want to make sure that all members of our community throughout the state are availing themselves to these tests. But nonetheless, average number daily tests are starting to go up. Positivity rate though, as I said, it's gone up 10.7%, just consider where we were two weeks ago, at 6.9%. Gov. Gavin Newsom: (21:24) You could see that rate of growth, that trajectory represented in our hospitalizations, 68% increase in the growth of total number of patients in our healthcare delivery system, in our hospitals, 14,283. We were just at 8,500 beginning of this month, and that was alarming enough. Now, we're getting close to 15,000, 68% increase in just the last two weeks. ICU missions, not surprisingly, 2006 the beginning of this month, now over 3000, 3081 as we report yesterday. That's a 54% increase in ICUs, and I want to focus on ICUs as- Governor Newsom: (22:03) So that's a 54% increase in ICUs, and I want to focus on ICUs, as we have been, a little bit more in a moment and tell you why this issue is top of mind. This slide should sum it up very well. You could see these five regions in the state that we have identified. These are the large regions in this state where we have some mutual and proximate systems of engagement, meaning there is a healthcare delivery construct where there's mutual support, mutual aid, mutual agreements between hospitals and systems, bay Area largely defined, greater Sacramento, Northern California, the true northern part of the state, San Joaquin Valley. Look at that, 1.6% current ICU capacity. Over the weekend, they got to zero, zero, which means they were in a surge frame, and I'll talk about surge in a moment. That's about a 20% increase in ICU capacity. Governor Newsom: (23:01) So when you hear, "We're at 0%," that doesn't mean we have no ICU beds or staff available at all. It means we're now into a surge approach, surge staffing and surge management. So 1.6%, it goes up, it goes down by the hour, not just by the day. Southern California at 1.7% in the most populous region, populous region in the state. 5.7, 5.7% statewide. When the dust settles on all that, 5.7% is our current ICU capacity statewide. Light at the end of the tunnel, but we're still in the tunnel, going through the most challenging and difficult surge we've experienced since the beginning of this pandemic. Governor Newsom: (23:47) You can see here we have the new framework, these regional stay at home orders, not because we want to, not because we're enthusiastic about asking you to do even more after you've done so much over the course of the last nine months. It's because we are in a sprint, not a marathon now. Sprint. Next 45, next 60 days. It's not a permanent state by no stretch of the imagination. Light at the end of the tunnel. We're going to come out of this stronger than ever. Mark my words. We will come out of it stronger than ever. I just want to come out of it healthier than ever. I want you to be there to experience the resurgence, this recovery, California's comeback. Governor Newsom: (24:27) It's right in front of us, but it's also inside us. It's our decisions, again, not just conditions that will determine that fate and future. So we are encouraging that with the stay at home order, and we put that into place based on ICU capacity, San Joaquin Valley, Southern California. Greater Sacramento Bay Area, as you know, went in voluntarily a few weeks or a week or so ago, because they wanted to get ahead of the curve. So it's four out of five regions in the state currently under that regional stay at home order. I'll remind you again, see here, the San Joaquin Valley was at 0% over the weekend, and it goes without saying when you're at 5.7% of your ICUs available that they're filling up quickly, and many of them could be unavailable soon. Governor Newsom: (25:11) But here's the point we want to emphasize: that staffing is the biggest issue. It's not physical conditions, meaning it's not the rooms, per se. I say per se because that's not the case in every single hospital in every part of the state. But in the aggregate, staffing is our number one challenge. So I want to update you on some of the work that we're doing there. We just updated our new quarantine guidelines. But if you didn't read about this, you didn't hear about this, I want to make you familiar with these new quarantine guidelines. Governor Newsom: (25:47) It's 10 days instead of the 14 days for all asymptomatic individuals that are exposed. So from 14 to 10 days, but here's the critical point, and this is what connects the healthcare staffing dot, that during our critical staffing shortages, we now have looked to a 7, not a 10-day quarantine for healthcare workers and emergency response workers, social service workers that have been exposed, but as long as they test negative on day five or later. So there's a criteria based upon, again, health, safety, but also availability of critical care resources, and we continue based on the guidelines we put out in this executive order that all of us continue to do the important work of wearing masks and the physical distancing, self-monitoring of symptoms, all part and parcel of those quarantine guidelines, something I'm very familiar with after being 14 days in that similar construct. Governor Newsom: (26:48) Here's what we also did last week. We on Friday announced that we are adjusting our nurse to patient ratios in the state, and I just want to thank all our partners. I know how difficult nurse staffing ratio issues are. I want to just express deep empathy, deep admiration for the collaborative spirit, where we were working with our representative workforce and the California Nurses Association, others that were wonderful in terms of their understanding that it's a difficult time, that we need to be creative. We need to temporarily, very short-term temporarily look a little bit differently in terms of our staffing needs, ICUs, step-down units, telemetry units, as well as our emergency medical services and our medical and surgical units. Governor Newsom: (27:35) Here's what the staffing ratios fundamentally do, go from 1.2 nurse to ICU patient ratio to nurse to ICU patient ratio 1.3 under these emergency regs we have put out. So just stretching resources and, again, empathy and respect to those human beings, these frontline healthcare workers, these nurses in particular that are just doing heroic work every single day, asking yet again for a little bit more during these very challenging next few weeks, month, month and a half. Governor Newsom: (28:10) As it relates to staffing as well, we're looking more broadly at looking to be creative and flexible with our existing workforce. We're looking at getting additional staff contracted through agencies. 507 staff now have been deployed at 54 facilities in 20 counties. These are recent staff enhancements. 130 in our CalMet, individuals, CalMet program. I mentioned the contract staff. You can see 300 of the 507. Cal Guard, someone asked me today, "What about the California National Guard?" Well, we've included in our staff deployment those critical workers with unique expertise in the Cal Guard, 49 individuals, and then our Health Corps team, we have another cohort of Health Corps members that are also part of our recently deployed staff. I'm going to talk a little bit more about Health Corps in a moment. Governor Newsom: (29:05) We're asking as well for support from the federal government. We've received it through FEMA for 80 EMS personnel. That's 40 paramedics, 40 EMT. We have our DMAT, the disaster management. You're familiar with this, DMAT teams from the beginning of this pandemic, also wildfires and the like. We've got 35 folks that are currently supporting two hospitals. I think it's El Centro and Pioneer Hospital down near the border, and they've already been sent and deployed down there, Imperial County primarily. We also have a request. This is a request in for the Department of Defense for medical personnel. We're asking for 10 teams of 2,200 personnel. So we've been supported through DMAT, the FEMA requests. We have this outstanding request at the Department of Defense as well to help. Governor Newsom: (29:58) I mentioned Health Corps a moment ago. I want to mention it again. We have to date almost 3,000 shifts that have been covered, 143 facilities, primarily focused on skilled nursing facilities, our CalVet program, and you see Sleep Train up there. I'm going to talk more about Sleep Train in a moment. These are alternative care facilities that were beginning to open up and put on, as we've referred in the past and I'll refer to it in a moment again, our warm status. Governor Newsom: (30:25) I'll remind people, if you've just recently retired, your license has expired, or you have a unique expertise and you want to offer it to the State of California and you're a professional, we want to help support you getting back on track. If you live in a region that's primarily underserved and that would be significant to get your expertise and your support, go to the covid-19.ca.gov website, covid-19.ca.gov website, and avail us of the information, your expertise, your experience, your licenses, and what you are willing to offer. We'll provide supports in terms of hotel rooms and transportation and try to waive as many of the fees and related costs associated with getting you back into the workforce on a temporary basis to help us through this very difficult time. So encourage folks that know of folks that have recently retired and may be interested in really stepping up in the next 60 or so days to go to that COVID-19 website. Hundreds have, thousands. Tens of thousands have, hundreds already doing shifts, working in critical facilities, truly saving lives, and we're grateful, deeply grateful and humbled by that as well. Governor Newsom: (31:38) As it relates to those alternative care sites just briefly and quickly go through the rest of these remaining slides, and we're here, of course, to answer any questions with Dr. Ghaly, Here's where we are currently for non-ICU patients. I want to remind folks these alternative care facilities are not ICU facilities, but we have the Imperial Valley College that's open, just 30 beds for the moment. Sleep Train I mentioned a moment ago. We have 20 beds that are, quote unquote, "operationalized," 200 additional beds that are in this warm status. Later this week, you'll see the Fairview Development Center opens up on the 17th, just 10 beds to start. Porterville, 10 beds, which recently just became operationalized. So you can see the four sites that are moving now. Lights are on, staffing up. Governor Newsom: (32:32) As it relates to those additional sites, there's a total of 11. Here's the status on six that are in the warm status all across the state, Riverside, Contra Costa. You can see Fresno, San Diego, and, of course, San Francisco, the number of available beds. We're starting again just to get things situationally moved around and preparing if indeed we need to utilize these alternative care facilities for non-ICU patients. Governor Newsom: (33:01) We have as well, and this is a very sober part of the presentation, I have a PSA I want to share with you at the end, but I want to focus on the issue of how deadly this disease is. It's an interesting time, and we want to be optimistic. We want to share good news, and I hope we're doing that with the vaccinations, the additional 393,000 that Kaiser's moving in. So this thing's really starting to go, how we're more and more confident we get to two-plus million of you in the next number of weeks vaccinated. But let's deal with some sober realities. We lost 142 people in the last 24 hours to this virus. At least our reporting is 142 lives were lost to this deadly disease. Governor Newsom: (33:53) Again, I want to remind folks it's not the flu. This is not something to be trifled with. This is a deadly disease, a deadly pandemic, and we're in the middle of it right now. We're near the end, but we're in the middle of the most acute peak as it relates to what we refer to as the third wave, third and what we hope is the final wave of this disease. But we're in the middle of that peak, and you're seeing that reflected in the numbers. Governor Newsom: (34:25) So we have activated, and I pledge to you that the conversations I'm having with my wife, my family, that I'm going to make them public to you. I was having these conversations about some of the work we're doing on mutual aid for morgues and working with coroners just a couple days ago, and some hesitated to want to share that publicly. But I think I have an obligation to share with you publicly what we are doing on this issue. Governor Newsom: (34:53) Here's the numbers. 163 people we've lost on an average every single day, 142 yesterday, 163 on average over the last seven days. Compare the seven day average one month ago, 41. Think about if we continue down the path we're on what that January 14th number may look like if we do not do what we need to do, which is not just avail ourselves when we can to the vaccine, but to continue to wear these face coverings and to minimize mixing to the extent possible because of what's occurred in the last 30 days in particular. But we have to be mindful of how deadly this disease, this pandemic is. Governor Newsom: (35:39) Here's what we've just done. We have orders, and 60 53-foot refrigerated storage units are currently standing by now in counties and in hospitals. We just had to order 5,000 additional body bags they just purchased for this state, and we just distributed them down to San Diego, Los Angeles, Inyo Counties. That should be sobering. I don't say that. I don't want people to run with that. I don't want people to scare folks. But this is a deadly disease, and we need to be mindful of where we are in this current journey together to the vaccine. We are not at the finish line yet. So please, please, please be mindful, and forgive me. This is a very emotional PSA, but we're trying to raise awareness so others are mindful of the stakes. I hope you'll take a look at this PSA we're putting up. (silence) Speaker in PSA: (36:54) That was a phone call he never got to do. Sometimes I just close my eyes, and I'm like, " Dad, I wish I could hug you one last time." My dad ... Governor Newsom: (37:13) So wear a mask. Stay six feet apart. Do those basic things. Those are what we refer to as the non-pharmaceutical interventions that can truly save lives so we don't have to learn more about people that have been torn asunder, families who have lost a loved one, who can never do the things so many of us take for granted, and that's reach out and make a phone call and hear a loved one's voice. So this is sober, and this is the reality. This is the world we're currently living in. This is what we're doing everything in our power to mitigate. We want to eliminate, we will eliminate, ultimately eliminate this disease, but we have work to do. Again, in the tunnel, though there's light at the end of the tunnel. Governor Newsom: (38:04) In order as well to help with that, I want to bring back a slide I had last week. Last Thursday, we announced California Notify. This is, again, all about tools in the toolkit, and this is just another tool in the toolkit. Absolutely none of this is ... This is just additive. These are just the ability to use technology, use technology we're all familiar with, our smartphones. Some of you have the Android platform, Google. Some of you have the iPhone platform, and both Google and Apple have joined forces with the State of California in a program called California Notify. Governor Newsom: (38:42) Again, launched last Thursday. Six and a half million people have activated so far, which is not bad, though it would be nice if we can double that still. But six and a half million people, not bad, and I want to encourage you to, if you haven't, learned about it first. It's opt in, not opt out, privacy protected. It's not a contact tracing device. It's Bluetooth, and it uses these anonymous keys. I can get into all the technical points. I know we have a lot of trust-building to do on that point, but I encourage you to learn about those things. Six and a half million people have already availed themselves, Apple, iPhone. Governor Newsom: (39:22) You just go into the settings. You scroll down to the exposure notifications. You can do it right now as you're watching, listening. It's very easy to do. It's literally two or three prompts, and you've got it up and running. You can go to Google on the Android platform. You just go to Google Play, and you can download the app and learn more about what it is and what it isn't. But I encourage you to take advantage of this tool as, again, over six million Californians have just in the last few days. Governor Newsom: (39:53) So look, it's been an enlivening in few days in the context of the vaccines arriving. More and more to do on that front. Remind you just in closing before I open up to questions that the Pfizer vaccines are the ultra low cold storage, different than the Moderna vaccines, which are just more traditional cold storage, not arctic storage, just cold storage. Moderna has a different process for distribution. But, again, that process for distribution is based not on the whims of elected officials, not top-down, but a very comprehensive, equity- based lens that's been advanced by experts in their field, 16 members of the guidelines work group making recommendations to a community advisory committee made up of teachers, made up of nurses, made up people from every conceivable walk of life from all over the state of California, every race and ethnicity, mindful of the past as it relates to challenges around cultural competency and trusted messengers, but very, very committed to put out guidelines that are truly inclusive. Governor Newsom: (41:04) Again, tomorrow will be among many public meetings they have. Please go to the covid-19.ca.gov website to learn about their next public meeting time and learn more in real time about where the next round, roughly eight million Californians, where those priorities will stack in terms of exposure, in terms of risk, and in terms of priority. With that, we're happy to answer any questions. Moderator: (41:38) David Baker of Bloomberg News. David Baker: (41:41) Governor, thanks as always for having these sessions and taking our questions. I want to ask you three things regarding the vaccines that are being rolled out starting this week. First of all, do you know as of this morning how many of the vaccines have actually been administered in the state? Second, are you going to be updating the state's COVID dashboard to include that data on a day-to-day basis? Third, you mentioned last week that you wanted to make sure that people with means did not cut in the line and get ahead of more deserving folks. How exactly are you going to do that? Governor Newsom: (42:19) Yeah. Well, people of means that aren't otherwise at risk and not appropriately availing themselves to the protocols that we are establishing. So I'm going to ask Dr. Ghaly to come up and talk a little bit more specifically. But here, David, let me go back, and thank you for the questions. I want to go back to the slide here we began with. What we do know is we received four locations, and I laid out those details on the locations, the doses, 33,150. Not all of those doses were administered. We also know that 24 more locations across the state. Literally this morning, we had seven, eight, nine that we were able to confirm where the vaccines have been delivered, that information's coming in, even since the beginning of this presentation. So we'll update you to the extent possible in real time. Governor Newsom: (43:05) But I'm going to ask Dr. Ghaly to talk more specifically about what our expectations are, his expectations in terms of transparency, because it's a very good question in terms of when that information comes to us, how we get it to you and what platform do we do that in terms of the total number of doses that have been administered? We are very mindful, and forgive me for belaboring your question, and I'll pull this over to Dr. Ghaly, that just because we receive all the doses, there may be issues with administering the doses. Obviously, with ultra low cold storage, there's obvious concerns about the ability to administer all those doses within that prescribed five-day period, particularly for those that are no longer in the ultra low storage. So that opens a question. Is there going to be waste? Is there enough doses that we're ... Well, without getting into the details, I was just thinking yesterday, one of the- Governor Gavin Newsom: (44:03) Well, without getting into the details, I was just thinking yesterday, one of the doctors said, I actually think I can get an extra half a dose in each one of these vials a little bit more than they thought. So is there waste or they're actually in abundance? There's going to be all kinds of things that come forth is my point as it relates to distribution of the vaccine in real time. And so how we put all that up, how we make it available to you, Dr. Ghaly hopefully will have some greater insight in just a sec. Dr. Ghaly: (44:31) Thanks, Governor. And really picking up where the governor left off a few things to answer your questions directly. First, as of this morning, we've heard the locations that have received vaccine, but we have not been able to confirm, or we haven't confirmed whether those entities that received the vaccine have in fact started to administer them. I know a number of counties, a number of the locations that were scheduled for this morning. We're preparing as we saw at Kaiser yesterday, the governor and I and others, that it does take a little bit of time. Dr. Ghaly: (45:03) So as those doses arrive to the facilities, it takes a few hours to settle them into the storage, the vials that are going to be used immediately. And then of course, the process of getting people registered and lined up. To your second question about how quickly will we be able to identify the number of doses on a given day, and then be able to talk to and share with you and all Californians, the number of Californians who's who have received that first dose of Pfizer this week, moving forward Pfizer and Moderna starting hopefully next week, depending on the FDA process shipment, everything that we saw with the Pfizer vaccine. Dr. Ghaly: (45:42) So we'll be getting that information hopefully as soon as tonight and the next couple of days, and then being able to provide that in real time on our COVID website. In terms of really working to make sure the prioritizations are followed, this is an important question that we have been having conversation about. The governor has mentioned that we're laying out the prioritization around our equity principles around ensuring that those who are most vulnerable are really at the front of the line, our frontline healthcare workers. I'll just reiterate what the governor said, meeting some of those workers who were receiving the vaccine yesterday, although it was just five. Dr. Ghaly: (46:19) I think their stories are telling that the concern about bringing it home to their families, spreading it on their own units. I think it's important that we acknowledge how powerful this is as a tool to protect those healthcare workers, not just so that they can have peace of mind and come to work with confidence, but connected to our staffing challenges that we can ensure that more and more are available to work as we enter this surge. So we will be working and in fact are working with our local partners to assess how they themselves will make sure that they're upholding and putting forward our prioritization lists that we have already put out. Dr. Ghaly: (46:59) And then also using our own IT systems. You've heard about the California Immunization Registry as another tool not just to understand how many doses have been administered, track when that second dose will come, but also understand which settings those vaccines are being administered in so that we can track a bit where actually people are being vaccinated, which gives us some clue into who's getting vaccinated. I will tell you this 1A group, the group which is the three million that the governor mentioned, up to three million Californians, who are those frontline healthcare workers, as well as some residents in the residential care facilities, in particular skilled nursing facilities. Dr. Ghaly: (47:43) That frankly because those facilities directly are getting the vaccine, we have confidence that it will end up with the right people based on our prioritization list. It is really when we get into the future phases of the vaccine that we are building the systems to ensure that that list of priorities are followed and that we can track it and share that with you moving forward. Governor Gavin Newsom: (48:11) Dr. Ghaly's right. This care system, it's the immunization registry. We're also building on top of it, additional IT and implementation around referred to as CalVax, which will provide us more information, not just the end to end information and the components where we are well-established components with vaccinations. Remember we do about 19 million flu shots over probably a 90 day period, at least the bulk of it on an annual basis, millions and millions of other routine vaccinations each and every year. There's a registry, it's well-established, that connects our federal partners with our state partners, state partners with local partners. Governor Gavin Newsom: (48:47) We're adding on top of that reservation components and some other bells and whistles, the CalVax component that is as Dr. Ghaly said, part of the next phase, phase 1B and into subsequent phases where this vaccine will be more readily available and more prone to people prioritizing in ways that were not intended. And that's where we'll be most vigilant and prepared to be in terms of making sure that we hold folks to their hippocratic oath and higher level of accountability. Speaker 1: (49:24) Brittany Johnson, KCRA. Brittany Johnson: (49:28) Hi, this is Brittany with KCRA. Thank you for taking my question today. Earlier, Governor, you talked about a messaging campaign to reach communities of color hit hard by COVID-19, but many people will still be hesitant to take the COVID-19 vaccine due to valid and deep rooted mistrust in the medical system. So bottom line here, what if people, especially in these hard hit communities, simply don't trust the vaccine and choose not to get vaccinated? What impact could this have on California's fight against the COVID-19 pandemic? Governor Gavin Newsom: (50:03) Look, I appreciate the question and it allows me just to reinforce a fundamental and you see it described here in our Vaccinate All guiding principles. One has to acknowledge that past, not just in the black community, but also the Native American community. And that lived experience that's been passed down, some cases generationally, that mistrust as it relates to vaccinations, which is deeply understandable. And so we have a lot of work to do to overcome that. And so one is just acknowledging it. Thank you. Number two is really building partnerships and partnerships are peer to peer. Governor Gavin Newsom: (50:40) Partnership is around having trusted community leaders engage in conversations in a different way than we ever could from Sacramento selling those conversations down. So it's really about bottom up non-governmental organizations, trusted messengers, faith leaders, which are going to be foundational in terms of carrying this message. We know doctors and nurses, particularly doctors and nurses that look like the communities they serve, are profoundly significant messengers. That's why yesterday, I thought it was a wonderful thing that we were there vaccinating five individuals, the first cohort in the state of California, truly representing the diversity of this state. Governor Gavin Newsom: (51:21) And I think that's also part and parcel of advancing this effort of building back trust and addressing those lived experiences. And so that's fundamentally how we're approaching it. We're putting real resources in. As I said, this is backed up by the first commitment of $30 million. We're hoping to get more funding from the federal government that can not come too soon, and we're very hopeful. The last 48 hours seems like there's a little bit of break possibly with some movement out of Congress and a possibility of a deal that can help advance this cause. Governor Gavin Newsom: (51:54) There's national education efforts that have been delayed that need to be advanced to help substantively answer this question, but we are building off and I'll just close on this, because I mentioned a moment ago, but it really bears reinforcing. We're building on this very contemporary experience we just had reaching out on the census during extraordinarily challenging environment, not just the headwinds of COVID, but of all the conversations that were coming out of the White House and all of the very intentional actions that were rejected by court after court after court, not just the court of public opinion, to really politicize the census process, to scare diverse communities, particularly undocumented counties or mixed families, which is an overwhelming number of individuals that have a member of their extended or immediate family that may not be documented to push away from that centennial or rather that census experience. Governor Gavin Newsom: (52:58) So we're working with all of those lessons learned in the last year in that space and trying to also bring that to bear in terms of our fact-based messaging and our bottom up messaging to reach out to our diverse communities. Speaker 1: (53:15) AP. Speaker 2: (53:16) Governor, you said that we're in a sprint and you referenced the timeframe of 45 to 60 days. Does that mean that your expectation is it will take up to another two months for these cases to peak? And if that's the case, I mean, is it even possible for the hospital system to absorb two more months of increases? Or are you saying that that 60 days refers to an outer projection, that cases will already have peaked and that by mid February, some restrictions could be rolled back? Governor Gavin Newsom: (53:49) Yeah. No. Thank you. And by the way, truly thank you for the question and the opportunity. I'm going to ask Dr. Ghaly to come up and talk about our modeling. Here's what's interesting. Here's what's particularly powerful, not just interesting. Forgive the description there. Our modeling is becoming more and more accurate, alarmingly so. Some of the models we had just 10 days ago, particularly as relates to regions and ICU capacity, I hope we put this slide back up, look very, very real, meaning the projections are manifesting. So you continue to project out the next few weeks. Governor Gavin Newsom: (54:33) We're in that surge capacity in the ICUs almost in every part of the state. In the aggregate, we'll get there very soon. But in each and every part of states, it's different in Northern California, perhaps in greater Sacramento area and certainly San Joaquin Valley that already reached that over the weekend. Hospitals staffing is our principal issue and that's why we're being very aggressive and that's why I showed you updated for the second time in five days, some of those staffing efforts, and that can ameliorate a lot of the stress. Governor Gavin Newsom: (55:07) The alternative care sites also can ameliorate some of the stress in terms of decompressing our hospital system and getting non-acute patients out of that system, veiling more space and more opportunities of support within the existing hospital care system. So with that, that's broad strokes frame. I want to ask Dr. Ghaly to talk about why we're talking in terms of 45, 60 days in particular and working our way through scenarios, particularly in the middle of January. Dr. Ghaly: (55:46) Yeah. Governor, thank you. So I think about this in a rules of about using the number 12. If you look at cases about 12 days ago, really 14 days ago, but to keep this simple 12 days ago, 12% of those cases are going to be hospitalized. And 12 of the percent of those that have been hospitalized are going to end up in our ICUs. And when the governor says that our projections are becoming more accurate, we've been looking at this sort of system, a simple way of looking at what we expect to see in our hospital system. And it's tracking pretty closely over the last few weeks with some adjustments. Dr. Ghaly: (56:26) But with that in mind, if you look at where we were two weeks ago with cases more in the range of 15,000 per day on average, and you look at where we are now creeping towards even above 30,000 cases per day, that should tell you that in the next couple of weeks, what our hospitals will be facing, the amount of people knocking on the front door with COVID to the emergency departments that need an inpatient hospital bed that might need that ICU bed are going to increase. So even though we talk about today, ICU capacity being concerning, five or so percent statewide. Dr. Ghaly: (57:05) You see these numbers of where the different regions are. What we are really preparing for is two weeks from now. Now what turns the tide on that story? It is us following the regional stay-at-home orders, making the decision not just to be concerned about our own, whether we're infected by COVID, but really what the impact is with our family members. I'll remind you that some of our oldest Californians, they make up over 60 years of age, make up just under 14% of our total cases since the beginning, yet make up 80% of our deaths. Dr. Ghaly: (57:42) So this idea that we have an opportunity through our actions in the next many days, starting today I hope, to make a decision to stay at home as much as we can, to wear our mask as much as we can when we're not with others that we're not used to being around, making decisions about deferring some of our plans, whether their travel plans or even for my own kids talking about, even though there might be some conditioning exercises outside with the sports teams that they love to decide not to make that decision, to really stay home, to protect their grandma, their other family members. Dr. Ghaly: (58:21) And we each have that decision. So yeah, 45 to 60 days, we anticipate that it's going to be around that amount of time if we make some decisions today before our hospital system really sees the kind of relief in returning to something that is manageable and more normal, that is accurate. But I think the decision starts today for some of us. I really want to commend people who have been making this decision all along. But those who might consider how can they sort of lend a hand, pick up an oar today, I would say that here's an opportunity to make some decisions, especially as we move into the holiday season where the tendency and excitement to gather and come together in a way that we think, I can just do it once or it's no big deal. Dr. Ghaly: (59:06) There are people that I know and trust. The fact that 40% of people who are infected might be asymptomatic says a lot about just our lack of being able to understand whether those who are gathering with are going to be able to transmit the disease to us or a loved one who might be more vulnerable, who might have an underlying condition. So yeah, 45 to 60 days is an important marker, but I think it really is the message of starting now doing as much as we can with our own personal behaviors to contribute to what could be a real transformation, a real reduction in cases in just a few weeks. Dr. Ghaly: (59:47) Remember, we chose three weeks as the minimum period for the regional stay at home order because we believe that's the amount of time needed to see some of these actions manifest in the case numbers. And so we're watching that very closely. Thank you. Governor Gavin Newsom: (01:00:03) Without belaboring this any further, I think the point that Dr. Ghaly was just making is the critical point. Even if we start seeing the case numbers go down, you have the residual, which is the impact on the hospitals in the ICUs. And that's that long tail or medium term tail that we're concerned about in terms of our planning, in terms of our capacity and in terms of our staffing. And so again, just want folks to know, be vigilant this moment. I know there's a sense of relief that the vaccines and that's all, we're seeing 24/7, 24/7 vaccinations. We just don't want folks say, hey honey, we're great. Governor Gavin Newsom: (01:00:36) This thing, we got vaccinations. I'm good. I'm going back and going back into an environment that could put that person and loved one at higher risk. And so this is the call. It's sober, but it's also optimistic, light at the end of the tunnel, still in the tunnel. Speaker 1: (01:00:55) Elex Michaelson, Fox 11. Elex Michaelson: (01:01:01) To that point a little bit, congratulations on the vaccine. Clearly, there's a lot of reasons for hope, but you do talk about these rising case numbers, despite all of that. Clearly, there are still people that aren't wearing the masks, that are defying the orders, that aren't listening. How do you get them to listen? I know you released a new PSA today. But why do you think those people aren't listening to the message and what maybe can change so that they do? Speaker 1: (01:01:29) I think the majority of people are listening to it. I'm incredibly proud of this state. I was talking to a very close friend of mine, lives in Fresno and he was just commenting not only in the Fresno City Council that passed a resolution highlighting and encouraging more compliance and expressing concern about their case rates, but there was a recognition in the community, he was just saying just with folks he comes into contact with where they seem to be about somebody else or about them. All of a sudden, now, increasingly, someone knows somebody, someone cares about somebody that actually got really sick, that didn't just get tested positive that may end up in the hospital, God forbid, in the ICU, may have even lost their lives. Speaker 1: (01:02:15) So I think as this continues to impact more and more people in more and more parts of the state, that back to this frame lived experience, having it become now personal, it's not intellectual. It's not a political issue. It's not about whether I was with this person or that person on the November election. It's whether or not I actually care about this person or that person because of their personal experience with this deadly pandemic. But yes, I think it is important to remind people, and I appreciate your recognition of what we're trying to communicate with that PSA, of again how deadly this disease is and how people are not home this Christmas, even in the immediate household with a loved one because they've lost their lives to this disease. Speaker 1: (01:03:06) And so we're going to continue to raise those alarm bells not to make people feel badly, not to make people feel guilty, not to shame anybody, but to impress upon folks where we are in the midst of this third wave. Speaker 1: (01:03:24) [inaudible 00:01:03:24]. Speaker 3: (01:03:29) Good morning, Governor and Dr. Ghaly. If you could elaborate a little bit on the projections for ICU capacity, the dramatic draw down we've seen the past 10 days since you announced the regional plan. Southern California, for example, has lost 20% of its ICU capacity, the projection would seem to indicate that within two weeks, the staffing augmentations you discussed will not be adequate to keep up. What happens in two weeks? Are we in a place where we have to begin triaging who gets ICU care? Thank you. Governor Gavin Newsom: (01:04:04) It's a very thoughtful question and I appreciate it. Look, I'll bring back this slide just briefly as it relates to the current capacity, which really underscores your point. Look where Southern California is currently with our current ICU capacity. Again, this number changes on the hour, not just by the day. So this is a snapshot where we were late last night, 1.7%. Now every minute of every day, we are working, so are the local health officers and city leaders to augment capacity defined staffing that's done within the systems themselves, health plans themselves. Governor Gavin Newsom: (01:04:41) It's done with state support as well. I just highlighted on these slides coming up the work that we're doing to provide a different additional staff, but this is not all we're doing. And so I think the sophistication of your question is a presumption that even with everything you see on this slide, that we will drive past that you're correct. And that's why this is a very dynamic effort. We're continuing to get more and more people through our health corps. We'll continue to work with our federal partners to get more and more support, continue to work within the healthcare delivery system, work with our nurses, unions and others on the flexing and staffing strategies, work with different training strategies as well to bring more and more people online, particularly in the ICUs. Governor Gavin Newsom: (01:05:29) And that is a perfect segue a recent example of work we've done in the ICUs to get staff onboarded sooner, a proof point of Dr. Ghaly's ongoing efforts that he can illuminate you more further with. Dr. Ghaly: (01:05:48) Thanks again, Governor. And yes, two weeks from now, we are concerned about what our ability to provide the same level of high quality care will be. But rest assured, our hospitals have been planning for quite some time- Dr. Ghaly: (01:06:03) Rest assured, our hospitals have been planning for quite some time, our partnership with our local counties, our EMS agencies across the state, the state itself, all the Cal OES does and government operations here, another agency, they all have been working around the clock really, to anticipate what can we do when we are now at that surge level of care. We, of course, want to do all we can to avoid getting there, to make it as short a period as possible once we do get there, by doing all of the things that we've just talked about with the regional stay-at-home order, following all of the things we've been talking to you for many, many weeks, but anticipating really, some challenges in the next two weeks. Bringing on additional staff, that's goal number one. We are not as concerned as running out of space and supplies. Vents, as the Governor has discussed previously, we have plenty of ventilators. Dr. Ghaly: (01:07:01) We've moved them around to different parts of the state to make sure no area goes without them, working to make sure supplies of everything from oxygen to beds, are available. But that's not what we're concerned about, it is the staff, so working through different approaches to providing staffing. You've heard about, and you've seen on the slides, a number of requests, both federally and within the state, to bring on people who maybe just retired or just left a certain type of practice, asking them to come back, lend a hand. Figuring out some virtual opportunities for those individuals to provide support, we have a new tele-ICU project that this state is sponsoring, but frankly, other big systems have been doing this for quite some time to make sure that we augment and do all that we can. Dr. Ghaly: (01:07:52) The healthcare delivery system is well-known for being able to step up, for coming up with some innovative approaches at the time, to make sure that we can provide as high-quality care as possible, given the volume of patients. But still, our first go-to strategy is to try to keep the number of patients coming, as low as possible, not to discourage anyone who needs care to come, they should come. If you need care, you should call your providers, you should check in and determine if you're sick enough to be able to come, but making sure that you're getting tested and all of that clinical care before you need hospitalization, is key. But when you do, to come and the hospitals will do all they can to provide that care. To your question about this idea of rationing care, we have worked over the past many months with a number of our hospitals, our stakeholder groups, many, many Californians, to talk about what are called Crisis Care Guidelines. Dr. Ghaly: (01:08:50) If course, they are considered at different times, there isn't a facility in California that has implemented those because we've been able to step up and provide care. But if course is part of our preparation, we must look at that across the state, we must make sure that people are having those conversations now, in case we do need to implement some of those crisis care standards of care, that we are most ready, most prepared, and able to do that with the highest degree of integrity and thoughtfulness. Thanks. Gavin Newsom: (01:09:25) And just to reinforce the partnerships we've developed directly with the hospitals, the systems, with the leadership of Carmela Coyle and others who run the Hospital Association here in the state, working as well to look at the issues around well, scheduled surgeries, not just elected surgeries, looking at traditional and non-traditional ways of providing surge within the healthcare delivery system. These surge plans have been well-considered, many of them have been actualized, many of them are in the planning phases, many are also being considered in addition, all of it additive to some of the work the state is doing. There's a more abundance in terms of the staffing and protocols than it's been exposed on one or two slides. And by the way, to that end, I want to just remind you some of that abundance, because Dr. Ghaly referenced it briefly, but it's important to go back. The PPE inventory in this state, remember a few months back, that was the big issue, March, April, was PPE. We have currently over half a billion units just of the N95 and surgical/procedure mask. We've distributed some 600 million, but we currently still... This is the current status of just the state inventory. This is not the inventory that persistent exists at the local level or within the hospital system itself. Accordingly, Dr. Ghaly referenced ventilators, here's the actual accurate count today of where the state of California is in terms of accessing ventilators, which is foundational, staffing and vents, then you have an ICU unit. We have 14,021 available just in our state inventory, and the hospitals still have available over 6,500. Again, staffing, big issue, a lot of challenges, but also a lot of flexing opportunities, a lot of movement within the existing healthcare delivery system to manage staffing differently, in addition to the work we're doing as a state to provide additional supports and get federal support as well. Speaker 4: (01:11:35) Barbara Feder Ostrov, CalMatters. Barbara Feder Ostrov: (01:11:39) I thank you for taking our calls and questions. My question is about counties. I understand that counties have some flexibility in how they prioritize groups for the vaccine. What I'm wondering is, how much flexibility do you support, and would the state step in if Orange County, for example, decided to vaccinate Disneyland workers before teachers? Thank you. Gavin Newsom: (01:12:07) Well, that's a very interesting question, specifically as you pose it in that light. Look, I'll answer and then ask Dr. Ghaly to more granularly respond. But the bottom line is, the state sets the tone, the state sets the tenor, the state lays out the prioritization for the distribution of the vaccines. We do allow, within the partnerships that are well-established, as it relates to providers, clinics, hospitals, and the like, discretion within that frame and within those guidelines. As it relates to the specific example, the Orange County example, that would be Phase 1B, at least for teachers, and that is a discussion that we are having this week in more specific detail. Gavin Newsom: (01:13:02) And again, I encourage folks to tune in tomorrow when the Guidelines Advisory Group goes to the Community Advisory Group with more specifics on that universe of, plus or minus 8 million people, that would certainly include teachers in terms of the prioritization and the tiering of those subpopulations. But I'll ask Dr. Ghaly as it relates to his expectations in terms of enforcing that, which I think is fundamentally what you are questioning, and what his expectations are in terms of those partnerships that are well-established with our county and local health officers. Dr. Ghaly: (01:13:43) Yeah. Again, thank you for the question. And as the Governor just shared, this week, tomorrow in fact, the Drafting Guidelines work group will be coming together with our Community Vaccine Advisory group and discussing exactly this, what we call 1B, that first set of what some people call essential, others, critical infrastructure workers, and determining how we will roll out the vaccine to that group coming up. I don't want to get too far ahead of the work group. They will be sharing their advice, their guidance, their list of prioritization, tomorrow. And then we'll be able to unveil that to all of you. To the heart of the question, we're working with our counties, we always do, we always have, with really discussing what the priority groups are, getting buy-in, getting clear understanding, so that we really do hope that their ability to navigate and drive where vaccines are happening, follows exactly this set of priorities that's set by these groups that the Governor has described. Dr. Ghaly: (01:14:51) And we will be working to make sure that we track that from a data perspective, that we can share it in a very transparent way, and that if we do see clear deviations from that, that we have the tools to address it. We don't anticipate this being a concern, certainly not a major concern in Phase 1A, but all of this work is being prepared for 1B. Regarding your specific example, we hope that, based on these prioritizations, Orange County, just like every other of the 57 counties and all 61 health jurisdictions that are partners in this effort, that they will be lockstep with us in being able to move forward in this way. I think a lot of work on this to come, but we are working with all those counties today to make sure that we're moving in the same direction, that we're prioritizing those who we know are in higher-risk situations, or they themselves have additional high-risk of having a bad outcome, if they were to be infected by COVID. Gavin Newsom: (01:15:51) Thank you, next question. Speaker 4: (01:15:59) Nico Savage, [inaudible 00:01:16:01]. Nico Savage: (01:16:04) Hello, I wanted to switch gears somewhat, to some of the guidelines that came out recently about youth sports. The guidelines the state put out this week, would only allow some popular sports like football and basketball in areas that reach the orange and yellow tiers. How likely do you think that is to happen by the end of the school year, and what will determine whether that can happen? Gavin Newsom: (01:16:28) Well, the virus will make that determination. Our actions, each and every individual action, sum total of which will determine how quickly that will occur. Let me go to a slide here and I appreciate the opportunity to highlight the updated sports, youth sports and adult recreational guidelines. We did put out those new guidelines, they're on a COVID-19.ca.gov website, and they do differentiate activities at different levels of risk, indoor versus outdoor, obvious frame reference, outdoor versus indoor, contact sports versus sports like track and field where there are certainly less or no contact. We talked about resuming, with modifications, by 25th of January at the earliest. We have obvious guidelines related to that and they're based upon the tiered status that many of us become very familiar with, as it rates to purple, orange, yellow, and red status, and so different levels of risk, moving in different tiers, based upon those level of risk. Gavin Newsom: (01:17:32) I encourage... Look, I got four young kids. Soccer.... Two-thirds of my life is just logistics, not just in terms of PPE and addressing vaccinations, but trying to figure out how the kids move around safely, and sports have been a big part of their life, a huge part of my wife's life. She was on the Junior National Soccer team at Stanford, I was able to get into Santa Clara University, down in Silicon Valley, because of sports. And so I'm reverential in terms of my desire for kids' mental and physical health, from parents mental and physical health to get our kids playing sports again in a safe manner. We've been stubborn, we've been working on this, a lot of work behind the scenes on this, but you may have noted, and this is the stubborn reality, you may have noted up here just in my own backyard, Placer County, it's 77 individuals, we've been able to connect a multi-state outbreak because people were not applying the rules. Gavin Newsom: (01:18:33) They weren't modifying their activities. They were doing a multi-state tournament in the middle of this pandemic, and they quite literally put the lives of those that participated, at risk. And it's not an exaggeration at all. It wasn't just the kids that got tested positive, but some of the staff, coaches rather, and some of the parents. There's proof points that this is higher risk in certain activities, with certain activities, and we're just trying to do our best to encourage physical activity, address obvious issues of mental brain health, and get kids safely resuming, based upon differentiation of risk. And again, those guidelines are available and I appreciate you highlighting them and asking about them, and I encourage people to go to the COVID-19 website to learn more about them. Speaker 4: (01:19:29) Final question, Eric Westervelt, NPR. Eric Westervelt: (01:19:33) Hi Governor, a quick followup on hospital staffing challenges and specifically, California's requests. Has there been any discussion about requesting a return of the USNS Mercy Hospital ship and its 1,000 and some beds since Southern California is so hard-hit? And also, what requests, if any, has California made from neighboring states that may not be, right now anyway, as hard-hit and have some extra staff to spare? And finally, are you at all worried that the staffing crisis might hamper the state's ability to quickly and safely distribute and really implement the vaccine over the coming months? Gavin Newsom: (01:20:10) Let me take the latter part of your question first. At this moment, no. We are prioritizing those that are distributing and administering the vaccine, as well as those that are the most essential healthcare workers in the first traunch, the first distribution of the two-dose vaccine. The good news is, we're seeing hundreds and hundreds of thousands of additional vaccines now in the queue, and we expect a few million, as I said, by the end of the month. By the way, that will start having an impact, just the first dose, Pfizer, 21 days till the second dose, Moderna, 28 days till the second dose. But even after the first dose, 10 to 12 days later, we'll start to see some benefits beginning to accrue. Gavin Newsom: (01:20:54) There's some real sophistication as it relates to the distribution of the vaccine within cohorts, meaning it's not just an ICU nurse or doctor, it's an ICU nurse, a doctor, and environmental service worker that's also part of the prioritization, so we can create these pockets of support, also pockets of well, sanctity, so to speak, in terms of a mindset and a relief for the entire team that is critically attending to the needs of those most at risk. Regarding the, and I'll ask Dr. Ghaly to talk a little bit more about it, the staffing from other states, most other states are in a similar predicament. We are actually looking overseas, interestingly, to potentially recruit some staffing. We've done this in the past for many different issues in terms of our mutual aid, well-established most recently, of course, with our wildfires, but we're looking at health staff in addition. We also have, answer your question, and again, Dr. Ghaly will close this out, we have had, I've had, in fact, the last 48 hours, I've had multiple conversations about the USNS Mercy. Gavin Newsom: (01:22:10) Interestingly, one of the most significant resources in the USNS, is not the beds, as defined, but the extraordinary talent on board, meaning the human capital, the human resources, these remarkable military men and women, these personnel. We have had that conversation, it's not been formalized with our federal partners, we've had it internally in terms of potential need, but that's just to give you an update, full disclosure on some of those more recent conversations in that space. But no, again, formal request has gone in the administration. The request currently is for these 10 teams of 20, these Department of Defense medical personnel, and that request is outstanding. We've received, and we're very grateful, those paramedics and EMTs, the FEMA and the DMAT teams, those 35 that are down there, in Pioneer, in El Centro hospitals, down near Imperial County, near the border. That's been encouraging, again, the partnerships continue to be very, very positive, but let me now ask Dr. Ghaly to sort of fill in the blanks and close this all out. Dr. Ghaly: (01:23:27) Governor, not many blanks to fill in, but we'll say that, unlike in other mutual aid situations, really on the staffing side, we have these federal resources that, as the Governor laid out, we've been requesting primarily around staff. This also goes for the Mercy. I think the staff, the talent there, could really aid California. So of course, that is another potential resource, but then, much of healthcare depends on these registry companies, traveling nurses, that usually are available this time of year for California. And we're able to fulfill each hospital, doing it independently, state not needing as often to step in and help there, to identify staff to come help in the hospitals. But those registries are being used throughout the nation. We're only getting a small percentage, usually get to close to 100% of our requests, we're lucky to get two-thirds at the moment. Dr. Ghaly: (01:24:25) That underscores that each of the states around us is having their own set of challenges. I think in many ways, California is a little bit behind some of the other states' surge situations. We've been planning effectively, staying ahead on the planning, so we can anticipate in the next few weeks, the real need for these additional staff. All of that is definitely in the works, but again, a chance to say that the way we really keep this from swelling to the point where we have to make some hard decisions on who might receive care, making sure... And I just want to say, another big shout out to all of our nurses on the frontline. They are working day in and day out to really keep our families safe while they try to keep themselves safe and their own families, trying to provide the best care that they possibly can in so many hard situations. Dr. Ghaly: (01:25:21) And the way that we support them with our own actions, is to do the things that we know can reduce transmission. It doesn't happen overnight just because a community decides to really step up together. It's still going to be a little time before we see those case numbers come down, but they certainly will, and that is I think, going to be our best way to support the staffing issues that have been so primary in today's conversation, but really, over the last couple of weeks. Gavin Newsom: (01:25:52) Thanks again, everybody, for your attention. We'll continue to update you on a consistent basis over the next days and weeks, and just remind everybody we're in a sprint, no longer a marathon. There is light at the end of the tunnel, we're still in the tunnel. We'll get through this. We just need your indulgence the next few weeks to do what we can to eliminate to the extent possible, this virus, until we get this, well, at least the transmissions of this virus, until we get those vaccines. And good news on the vaccine front, and I hope you'll tune in as news is being made to the Community Advisory Process, 60-member Community Advisory Process. Tomorrow at 3:00, they'll be meeting, go to the COVID- 19.ca.gov website, learn more about what their priorities will look like before they're even made formal through a presentation like this. Take care everybody. Thank you.