California Gov. Gavin Newsom COVID-19 Press Conference Transcript December 7

Gavin Newsom: (00:00) ... December 7th, in a year where we have new members of the California legislature. So I'll just jump right in, try to be as brief as possible, get to a number of the issues of the day, particularly as it relates to some of the regional orders that now are in effect in the state of California. But also want just to provide some context and some information about some new technology that we're bringing to bear to slow the spread of COVID-19. There's been a lot of discussion around apps. There's been a lot of discussions about how technology can advance our efforts to notify individuals, mitigate the spread of COVID-19, and address this pandemic head-on. Gavin Newsom: (00:42) Two of California's best known headquartered technology companies, Google and Apple, have joined together in an effort to provide for exposure notification. Not contact tracing, but exposure notification. I want to provide you a little bit of information about what California is doing today to help support their efforts, a little bit about the work that we've been doing with Google and Apple over the course of the last number of months with a pilot program, particularly at our UCs. But you can see here that the CA Notify app we're putting out is about an opt-in opportunity for individuals to participate in a notification protocol, an opt-in. Not an opt-out, privacy protected. Gavin Newsom: (01:32) This is not contact tracing, this is notification technology. You can choose to participate in leveraging this technology to allow people that you have been in contact with or have been in contact with you to be notified of potential exposure related to the transmission of this disease. I remind you it's 100% private, 100% secure, 100% voluntary. You opt- in or you choose not to, and there is no tracking data, no location data that is shared as part and parcel of CA Notify whatsoever. These are foundational principles. The reason I'm reinforcing them is because they're important. Gavin Newsom: (02:15) We value privacy. California has long been a leader in terms of advancing the cause and we don't want to do anything to set that cause back. And that's why we've been, frankly, a little stubborn and kept our eyes wide open in terms of this technology. We didn't want to jump in ready, fire, aim. We wanted to really take time, reflect on this technology to be secure in our confidence that what we are promoting, what we're stating here today, is indeed accurate, and that's exactly what we have been doing. Now let's talk about the technology specifically. Technology will be available this Thursday. You have two platforms, you have the Apple and the Google Android platform. The Google Android platform requires that you download CA Notify from the Google Play Store. Gavin Newsom: (03:03) You open up the app, you turn on the COVID-19 exposure notification. It's a very, I don't want to say relatively, it is indeed a simple process. Go, if you have Google Android, download the notification app from Google Play, and you open the app and you turn on the notification. I'll tell you what it does in just one moment. But I'll remind you it's available this Thursday. The Apple iPhone, which I have right here, it's a simple thing, it's already in the phone. You open up settings, you scroll down to find the notification, you can see there on the slide specifically what is required in terms of the prompts. You just tap the turn on notification for exposures and you follow the prompts. It allows fundamentally Bluetooth access and you just have to, always is the case with these technologies, just accept the terms. Now you tap, "Turn on," and that's it. Your phone now is prepared for a notification. But let's talk about what this is. Gavin Newsom: (04:02) Here's how it works. So let's assume you are Alice and or Bob. You're chatting. You're very close. You're not socially distanced. You're not physically distance. You're chatting for a number of minutes and your cell phones, because you have opted into this technology, are automatically, because of Bluetooth, exchanging what we refer to in technological terms as anonymous keys. A few days later, you discover if you're Alice that you have tested positive for COVID and you receive a code via texts from the California Department of Public Health for the CA Notify. So what does this mean for Bob? Well, if Alice consents for CA Notify to anonymously alert other users that she has likely been exposed in the last 14 days, then Bob gets notified and is directed to information with an alert and it looks a little bit like the one you see up on the screen, "You've recently been exposed to someone who's tested positive for COVID-19. Tap this prompt for more information." Gavin Newsom: (05:13) That more information will lead you to information that's been provided by the California Department of Public Health on what you can do next. So fully automated opt in technology, not contact tracing, does not in any way, shape or form provide any of your personal information in any part of the process and protocol, and this is a pilot that now we're bringing to the state as a statewide opportunity that we've been engaged in since September. Specifically, the pilot began with the UCs and we officially started with the University of San Francisco, and then expanded to more California UC campuses. Now seven different UC campuses. We expanded them to those campuses in November, over a quarter of a million users now, and just in the last number of weeks, eight weeks, more than 60 positive test verification codes have been issued. Gavin Newsom: (06:16) Meaning 60 individuals have been notified of positive tests and been verified through the code process and been connected to their folks in their cloud, in their circle, people they may have come into contact with. If it's confusing, it really isn't that confusing. Just encourage you to go to the COVID19.ca.gov website, the COVID19.ca.gov website to learn more about CA Notify and whether or not it's something that you want to add to your just additional tool in the toolkit in terms of your safety protocols. That's why I started with that slide around physical distancing and wearing masks. This is just a technological opportunity for you to add to those tools. Again, it's available this Thursday, December 10th. Opt in, not opt out. You'll receive similar to what you see right here on the screen, an exposure notification. This will likely go out on Wednesday before the Thursday application of this new available technology. Gavin Newsom: (07:25) This will just prompt to remind you that you have the ability to utilize this technology if you choose. Washington State Governor Inslee just a few days ago, I think it was last week, offered a similar strategy. A number of other states have done the same, but here in California, the scale and scope, the number of individuals, obviously that could avail themselves to this technology, this holds a lot of promise. I don't want to over state it because you need to get to an adaptation level that is significant for it to have the kind of impact that would be profound. But nonetheless, as you've seen from the pilot at the UCs, it has been effective and even if we don't have tens of millions of people participating in this program, the more people that participate in it, the more than opt in, the more effective this program can be. Again, another tool in our toolkit in terms of impacting the spread and transmission rate of this virus. Gavin Newsom: (08:31) Now let's talk about new case numbers. 24,735 is what we're reporting over the last 24 hour period. You can see the seven day average now moving up just shy of 22,000 cases a day. This is substantially greater than what we have seen in the past. And just over the last three days, we've averaged roughly 25,000 cases, seven day just shy of 22,000 cases, just in the last 72 hours averaging about 25,000 new cases a day. You can see here on the 14 day test positivity rate at 8.4%, you can see that rate beginning to rise. Just looking at the last seven days of testing, you can also see our testing on a daily basis is also rising. 48 hours ago, we recorded almost 300,000 tests over a 24 hour period, testing now on a daily average, over seven days now just shy of 210,000 tests. We want to get those numbers up over 25 million, getting close to 26 million tests have been conducted in the state. Gavin Newsom: (09:42) I think that's the highest number of any state in the country, but not on a per capita basis, and that's why those daily test numbers continue to need to grow and that's why we committed ourselves to opening a state lab down in Southern California which is very timely, particularly now that you're seeing what we experienced a number of months ago, we're starting to see testing backlogs now across the country start to increase in terms of time to test results beginning to increase, number of days beginning to grow. We, of course, in anticipation of that open our own state lab. The goal is to get to 150,000 tests over a 24 hour period every day. That number continues to grow. Again, as I've said in the past, it's more of a flywheel. We don't ramp up overnight. A few thousand tests first week, to 10,000 plus a month, to getting up to 150,000 tests in the first quarter of next year. Gavin Newsom: (10:44) Positivity rate, and just put this in perspective that 8.4%, here's the 14 day trend line. You can see where we were just two weeks ago at 5.6% positivity, now 8.4%. You can see that rate of growth is very, very acute. Excited to provide, here's a 30 day look back where we were just a month ago, 3.4% positivity. You may recall that 5%, the magic number from a global perspective, where we want to see rates below 5% to create some semblance of stability. Of course, California, we want to see it below 1%. We want to see this virus eliminated. But nonetheless, we were at 3.4% just 30 days ago and how quickly, and that's what this chart represents, how quickly we can see these numbers climb. 10.5% is the seven day positivity rate. So that is an indication of where we're going. 14 days more modest at 8.4. Gavin Newsom: (11:47) That's the highest we've seen over a 14 day period since we started recording when we got into those summer months. Those early days, you may recall, and I'll just go back, you see that 40.8%. That was back in April, but that was on the basis of a very small number of average daily tests. You can see really the stability throughout the summer with a little peak in July, a little bit in August and we started to come down in September, October, and now here we go back up in November, 8.4% positivity rate now in the state of California. Hospitalizations, we're now over 10,000 patients in our hospitals. 72% increase over the last 14 days. You can see how quickly this grows. On 11/23, just a few weeks ago, we had shy of 6,000 COVID-19 positive patients in our hospital system. Now over 10,000 just like that, 72% increase in just 14 days. Gavin Newsom: (12:51) You carry that forward and you understand why we made the recommendations we did, made the announcement we did, rather, last week as it relates to further protocols in terms of movement and behavior in this state. But I want to put the hospital health care system and capacity overall into perspective. You can see here, this slide's very familiar for those that have watched these presentations. Close to 74,000 hospital beds in our hospital care system. This is the healthcare capacity, not our capacity outside the hospital system itself. You can see that 14% of our hospital beds, just 14% are COVID-19 positive. But 63% of all of the beds are being utilized for other purposes. As you recall, we've stated this on multiple occasions in the past, and these were the protocols that were well-established in the beginning of this pandemic, ability for the hospital system to surge to provide access and capacity above and beyond those 74,000 beds and also reduce by decompressing the existing hospital census of admitted patients by reducing elected surgeries and the like. You're seeing hospital by hospital, system by system, region by region doing just that. Gavin Newsom: (14:17) No mandate from above. We've been working very, very collaboratively with the Hospital Association, a true partnership with our system, and we have the ability in real time dashboard of sorts to monitor and engage to get a sense of where people are pulling back in terms of elective surgeries, where people's capacity is approaching a need and concern to surge either within the existing footprint of the hospital site or more regionally in terms of the mutual aid system that's well-defined in this state. So hospital bed capacity has always been of a concern. We've raised that as a legitimate concern, particularly region by region, hospital by hospital, system by system. But in the aggregate, we are currently in a position where we can absorb additional growth. Again, it's about ICUs and that's been our primary focus and that's why we highlighted ICU last week, we highlighted in the week before, and they were certainly highlighted in the last 24 hours where a number of new requirements went into effect in two regions in this state, and then the voluntary requirements that were put into place in a third region of the state, more on that in a moment. Gavin Newsom: (15:35) Let's take a look though, specifically at ICU admissions in the state, now over 2000. We were just at about 1400 two weeks ago. 2,360 individuals have been admitted to ICU. You've seen a 69% increase in ICU beds being utilized just in the last 14 days. Let's put this in perspective. I have a chart here that is very familiar, but I wanted to provide a different lens on this chart. What we've done here, as you can see in the blue portion of this pie, that's patients already in our ICU system. So here's our total capacity of the pie, the circle there of ICU beds, critical care capacity in the state of California. You can see now as a state, this is again in the aggregate, we don't live in the aggregate, but this is in the aggregate, ICU capacity. What's available in our ICU critical care capacity system is just 14.2% of beds. Gavin Newsom: (16:40) Good news is you can see on the lower right there, ventilators available is the highest number we've ever seen. We've been busily procuring more ventilators. I'll get to more specifics on that in a moment. And that's important because at the end of the day, the ventilators and staffing become foundational in terms of our ability to deliver critical care. But you get a sense of the why. If you're asking yourself, "Why did the state of California move forward with a trigger at 15% of ICU capacity? Why the focus on ICU disproportionately?" I hope this chart [inaudible 00:17:17] of any anxiety related to the why and substitutes, I hope with some more optimism, a frame that we are not only being proactive, but we're also preparing, and I want to talk about that in a second. But first let's update you on the regional stay at home order that went into effect after regions fell below 15% of the remaining ICU capacity. Gavin Newsom: (17:41) Remember, California size and scope of this state's the equivalent population of 21 States combined. So often is the case as we talk about other states, national media and others, California is just considered like another state. When in fact, California, in so many ways is unique and distinctive because of the scale and scope, the size. Not just the diversity, but the regional diversity of California in particular. And in each region are different resources, different capacity, and as a consequence, we've looked at five regions in not just one state, five regions where there is a connective tissue figuratively between the hospital system and the critical care system in terms of relationships and mutual aid protocols and a framework of proximity that advantages our critical care delivery. The regional stay at home order now because two regions, San Joaquin Valley and the Southern California region, the largest region, which in and of itself is a unique U of sorts, these two regions now have fallen under the 15% ICU capacity. Gavin Newsom: (18:54) Let's take a look under the hood what those look like specifically. Here's your current ICU capacity, at least as of late last night. Each region, again, reflected in the map that I just showed, and let me go back to that map. You could see Northern California, the area around Sacramento where I currently am, the Bay area, more concentrated, of course, larger population centers. San Joaquin Valley, central valley of California, Southern California. Again, Bay area, their current ICU capacity is about 25.7%. The Bay area voluntarily, and again, remember the way we framed our approach to California's response to this pandemic is to allow localism to ultimately be determinative in terms of their approach and their engagement. No one better positioned than local health officers, local leaders, to understand their conditions on the ground, trend lines that they can mitigate and address before they become headlines. Gavin Newsom: (19:52) So the Bay area moved, but not pursuant to state orders pursuant to their own local health orders. Greater Sacramento has not moved at 20.3%, but pursuant to the state orders, they're getting closer to that 15%. Northern California, a little bit better in terms of their current capacity based upon transmission rates and the community spread of COVID-19 at 28.2. But you can see, again, San Joaquin Valley down to 6.3% ICU capacity and Southern California, most populous part of the state, 10.9% current capacity. So that's where we are as of this moment, though we'll be updating these slides later this evening and early tomorrow, consistently updating this information. But the issue that remains paramount in terms of our focus and our attention is staffing. Fundamentally, staffing is going to be... Human resources are going to be the most challenging, well, most challenging for not just Californians, but for every state to address. Is how do we get enough people that are not fatigued- Gavin Newsom: (21:03) Dress is how we get enough people that are not fatigued that are not exhausted, that we haven't asked too much from, that are healthy and ready and available regionally in the right location with the right skill set, how we match those skillsets and we staff all of these beds. And so this is what we've been doing to prepare. And I want to just desocialize these highlights so folks get a sense. It's just a few examples of the work the state of California is doing. We have gone to a contract staffing agency. We have 100 or rather 815 medical providers that we've requested. Most will be here within a week, which is encouraging. 435 specifically to support our ICU strike teams. We have 150 LVNs, 150 CNAs to help with our skilled nursing or sniffs and alternative care, residential care facilities. And then 80 to staff, various needs, including brain health related behavioral health technicians, and issues related to the same. Gavin Newsom: (22:04) Of those 815 as I said, 566 are expected to be here and available by the 14th. So within literally a week, we'll be sending just to give you a sense of where we're prioritizing, sending down on Piero County and the 60 bed build-out I'll talk more about that in a moment. Some of the Northern California build-outs of beds that we are focused on and some other general acute congregate care facility needs, but 566 expected to be here in California. Many are already Californians. Some are coming from outside the state. Just depends. It's a mix with these contract staffing agencies, but we're confident in that 815 number and the 566, we are very confident will be here within a week and helping support staffing some of these important critical facilities, both in response to and anticipation of an increased surge. Gavin Newsom: (23:02) As it relates to additional requests just so folks know, I've had a number of people ask, have you requested of the federal government staffing? The answer's yes. 160 staff. We have requested also to support the ICU strike teams. Again, emphasis on our ICUs at the moment though, again, more broadly, always preparing for beds however one defines them within our healthcare delivery system and outside. And again, we'll get to what we're doing outside the healthcare delivery system in a moment, 80 EMS providers to assist the health care delivery and alternative care sites against sniffs and acute care hospitals. These combat teams, which those of you who followed us for the last number of months are very familiar with CAL-MAT. And these are these multidisciplinary staffs of doctors and nurses and experts and expertise that cross pollinates and these teams go out, strike teams together. They've been out there in Piero County in the past. They've been out in the Central Valley in the past. These combat teams are extraordinary and we have 90 folks that are already deployed currently in these CAL-MATS. We'll continue to push for more personnel, more medical response, what we refer to as force in the language of office of emergency services to advance this cause. Gavin Newsom: (24:16) As well, we have limited term state staff. And this is just something you may see a little bit more. I want to just provide you a little information on this, just these 100 individuals that will be limited in their staffing time, infection control, framework, clinical care, and the like. And so we're looking full-time, part-time but strike teams, multidisciplinary, federal state, local, private in terms of the contracting, but making sure that we avail ourselves to the broadest degree we possibly can to the human capital that's needed this moment. There's also things we're doing as well that I thought I'd highlight and we'll get to a few other topics here briefly, and we'll get to questions, but there's some interesting new protocols we've also put into effect, particularly Imperial County, also in Riverside, which is experiencing some rather significant rates of growth. In fact, Riverside specifically at a 16.5% positivity rate on Saturday San Bernardino, feeling the pressure in ICU capacity. Gavin Newsom: (25:21) So what we're trying to do is decompress and provide opportunities to get people at back at home with oxygen and paramedic support. That's the Home O2 Program, and we have capacity to pull 100 patients out within the system, get them back home into Imperial, the same in Riverside and San Bernardino. Again, more sort of creative approach as we've matured, as we've understood more of the nuances of this disease, more effective treatments, modalities, take care of people, and secure their health. These are examples of things we really weren't able to do or at least didn't have the confidence to do intentionally at least in the beginning of this pandemic. Now as an exercise of understanding, we're able to advance today. ICUs as well we're looking at training our ends, this two day, very effective focused training to speed up opportunities to bring nurses into the ICUs to help patients that's being rolled out immediately as well. Gavin Newsom: (26:24) And then we've got these expertise that we've developed, particularly with more of an accelerated pace that has been a part of a larger trend, but that's the issue around tele-health, but tele ICU consultants or you have on the ground physicians deal with some of the rural issues, deal with some of the proximity concerns. That program begins today. And that ICU expertise also should advantage us, not a substitute, none of these things, four foundational fundamental approaches with our core workforce, but nonetheless important to be supplementary. Accordingly, Health Corp. We've talked a lot about our Health Corp program in this state. Over the past, these are individuals that recently retired. Their licenses for whatever reason, have expired. People with particular expertise across the spectrum of needs in this state, we have an active group of roughly 900 members that are part of our active Health Corps. We're going to encourage. And that's why you see we need your help. We encourage people that are qualified healthcare professionals that have recently retired or for whatever reason haven't allowed their professional licenses to expire or look just to potentially provide a unique expertise that they may not be providing. Now that may be underutilized, but finding that they have other professional capacity that is available or rather they would avail themselves to. We want people to consider joining the Health Corps, go to covid19. ca.gov website. Covid19.ca.gov website. We want to actively onboard additional members for this program. And by the way, Health Corps has been incredibly effective, particularly at our skilled nursing facilities. I think we have 871 folks that have been actively deployed in some way, shape or form, or at least available to be actively deployed. Many that already have been, you could see the 109 facilities that they've been supporting in the last number of months. Here is the point I was previewing a moment ago is around additional preparedness outside of just human capital. Now here's the physical assets. We've talked a lot about the capacity that we have, roughly 2000 beds. I think it was 1,872 plus beds, but it's roughly 2000 beds outside our healthcare delivery system facilities that are in what we refer to as warm status. More on that on the next slide, but here you can see Imperial Valley College. Down in Imperial Valley, we already have some patients in the beds capacity to provide 100 beds in warm status down in Imperial Valley and Imperial County. ARCO Arena, sleep train arena up here in Sacramento, sort of gateway to Northern California. It's not the immediate needs of Sacramento per se, but it's the proximity of this facility. It's a wonderful facility. It has 224 beds in warm status on the ninth. Just in a couple of days, we're going to start to turn on the proverbial lights and get that facility prepared and up and running to the extent again that it's needed. Gavin Newsom: (29:37) So these are these pre located areas that we feel that there may need some gaps in the future, Orange County, Tulare, Riverside. You could see Contra Costa, San Diego, even in San Francisco, that's FMS, these field medical stations. These are the bed capacity that we can turn on as needed. Most of these will not be turned on in any immediate sense, but they're available. And we refer to this warm status because we're not just leaving everything in the corner. We're starting to sort of unpack things so to speak, but not necessarily turning on the proverbial lights. That's the warm status. Most of these can turn over and be available if appropriately staffed within worst case about 96 hours, most within 48 to 72 hours. So just keeping this slide up and providing you similar information the last week or two, just to make sure people have some comfort level in terms of the preparedness and the availability of resources. Gavin Newsom: (30:44) Speaking of availability of resources, here's our current inventory. I'll remind all of you that we've already distributed over 600 million units of PPP rather PPE. And that's just on surgical procedure masks as well as N95 masks, hundreds of millions more across the spectrum of gowns, gloves and face shields and the like, but you can see we still have over half a billion units of procedure masks/surgical masks and N95 masks in our inventory. We've been active not only procuring the masks and other PPE, but also ventilators. You saw that previous slide. I'll just bring it up again because I think it's important. You have the 7,000 ventilators and this is the current number of available ventilators today within the healthcare delivery system, 7,020, but the state has been active over the last number of months to procure, draw down more availability for ventilators and we have now over 14,000 in our state inventory. So you add those together. 21,000 ventilators. We are in a completely different place than we were in the beginning of this pandemic, both on PPE and on ventilators and our capacity to turn up the surge locations in a moment's notice at least within 96 hours and our sophistication in terms of accessing a limited scope, limited use staff as well as surging staff as part of our Health Corps. Gavin Newsom: (32:16) So again, all part and parcel of our strategy of preparedness to work our way through this winter, to work our way through looks to be a tough and challenging January into February. As we build that bridge to a vaccination, hope is on the horizon with the vaccination. We continue to accelerate our planning and preparedness for a safe and equitable vaccine distribution, emphasis, safe and equitable vaccine distribution. Gavin Newsom: (32:50) We have been highlighting over the course of the last number weeks, our progress on vaccinations. Let me update you on that progress. We again are working off a plan that assumes 327,000 doses that come from Pfizer directly will avail themselves as early as the 15th of this month. For planning purposes, we've added around the 12th to the 15th, but for the purposes of this slide, we're saying roughly around mid part of December. We have successfully had submitted from our partners, our first orders that was done last Friday. Some more orders coming in this week, but the bulk of it last Friday. We put up that plan, what we refer to as plan 1A. If you want to take a look at the vaccination plan, the details, the nuances, the prioritization, we focused on some slides last Friday that really laid out the subpopulations for prioritization, but go to that covid19.ca.gov website, covid19.ca.gov website to learn more about that. But that plan was submitted. The first orders were submitted and the first doses are going to be made available primarily for high-risk health care workers. Gavin Newsom: (34:08) We have the plans at the facility in place for the actual distribution, not just of what they refer to as in Pfizer lexicon, the pizza boxes, that looked like pizza boxes of the first traunch of vaccines, but how they can conduct and distribute those vaccines. Those plans are also in not just the state plans, but locals and their partners' plans. Here is the next planning process, deadlines, dates, and a little illumination on tential availability of additional doses. So phase 1A has been completed. We have this community vaccine advisory committee working with our distribution advisory committee. That phase 1A is complete. It's up on the website. Gavin Newsom: (35:01) Their next public meeting and these are public meetings. We want you to take a look at these meetings open to the public on Wednesday, encourage you to take a look. Go to that covid19.ca.gov website. Learn about when these meetings are conducted. You get real time information. It's quick and sooner as much as any of us get. They've been doing a magnificent job this advisory committee and our working groups. So that next meeting for the next phase, phase 1B allocation, so you can get a sense of where we're going is on Wednesday. FDA approval of Pfizer vaccine we expect this week as early as the 10th, and we expect the Moderna FDA approval, at least the discussion around that, to occur a week or so later. So it gives you a sense of now the cadence of the vaccination. We're getting into December now, first week of December, and I expect and I really believe this, we're going to start getting good news and numbers that continue to significantly increase over the weeks, not just months in terms of the vulnerability of vaccinations. Gavin Newsom: (36:09) Our planning assumption for the state, again 327,000 doses are our planning assumption for Pfizer's first distribution, but you have Pfizer and Moderna, and then all of the other subsequent distributors and manufacturers of vaccines that will stack behind them. We're working on a planning assumption of 2.16 million doses of the vaccine within the calendar month of December. So 327,000 next week or within the next week and then additional number that can get north of 2 million doses. Remember cut doses. You're going to get two. Both Moderna and Pfizer require two vaccination shots. Each dose is one shot. So cut that number in half in terms of how you allocate at least in your own minds number of individuals that can avail themselves if they choose to the vaccine. Gavin Newsom: (37:09) Just a reminder, we have six steps in the vaccine process. I don't need to review. For those of you who followed, you know what we've been doing in terms of enrolling the providers, in getting our prioritization guidance with these three work groups we've created including the Community Advisory Committee and how we allocate those doses in an equitable way. Again, that's all plan 1A. Gavin Newsom: (37:31) On this next slide, you can see that last icon on the right. What is the next step? Well, the next step that's currently happening as we speak is we're reviewing the local health department's orders. So again, those orders came in Friday, others coming in as we speak. We're reviewing those. The state is reviewing those orders and then we will submit them to the CDC. Third step, the CDC will receive and review those orders and then they'll submit those orders. Those orders then will be processed. They'll be shipped. Again, this is Pfizer in the first phase and Pfizer is doing their own distribution. Moderna is working not directly like Pfizer. It's a different process between Pfizer and Moderna. Gavin Newsom: (38:19) Moderna is working with McKesson, McKesson being a well-known California... It was a California-based company in San Francisco. They are well positioned as an intermediary in terms of their distribution protocols and planning and we are working directly with McKesson on the Modern vaccination. Again, two different types of vaccines, both require two doses. One is ultra cold storage. One is just cold storage. Both require different strategies, different approaches. Those orders have been processed for shipment. Pfizer does them directly. They ship to distribution centers throughout California based upon the protocols that everyone approved. Transportation of these is pretty easy and self-evident. Step five, traditional UPS, FedEx, DHL, and others transport from the factory directly to the providers, then go to the state, goes directly to the providers and maintained throughout this cold chain and the requirements for transportation. Gavin Newsom: (39:17) Once those vaccines are received, step six, this is it and I'll get to one other group of slides and we'll get to your questions, that vaccine is received by the provider. They have obvious storage on site that is required called chain requirements and then they start the administration. Based upon their first 327,000, we're very confident in our capacity with the cold chain requirements to be met by our providers. As you recall and I'll repeat it again today, we already have procured and we're expecting delivery at the end of this month in early January for a supplementary cache of ultra cold storage and cold storage that we will pre-position and distribute throughout the state of California just as a redundancy measure to provide for more confidence depending on where the vaccines go in our capacity to deliver them to supplement and augment what our providers already have. Gavin Newsom: (40:17) I'll remind you. There was some sense that providing vaccinations was unprecedented American history and there was a sense of overwhelm. I even heard some elected officials talking overwhelming terms. We haven't yet for no other reason than this, the scale and scope of the 19 million vaccines that we provide on an annual basis already and how sophisticated our provider network is, how culturally competent it is, though there's always gaps and how well distributed it is, though again, we have some regional gaps that we have to close. So that's the existing network, lot of existing resources in that network. And so far, no one's naive. This is not going to be perfect. And I imagine the next headlines people will be running is as we are administering vaccines, some actually pulled away from the cold chain requirements and maybe some vaccines weren't being able to be utilized. Gavin Newsom: (41:14) All those things we have to work through. No one's naive about the application of this process, but so far it has been a very effective process because relationships are well-established and the supplementary work on equity through our community advisory committees and through our safety advisory committee, I hope gives people a little bit more confidence that we're going to do things right and address concerns going in. So that's an update. Though, I wanted to close this on vaccines with a photo, so you can get a sense. These are the, we've shown in the past, some of the Pfizer vaccine pallet shippers. Here are some purchased on the Moderna side. These are just the cold storage, not the ultra cold storage. Just someone asked me earlier, "What do these units look like?" And I said, "Well-" Gavin Newsom: (42:03) So it's just someone asked me, "Hey, what do these units look like?" And I said, "Well, I'll put it up on a slide in the presentation on Monday." And there you have it. It just gives you a sense of what these look like. Not pizza boxes with Madonna, and forgive me for even bringing that up, I'd go down a rabbit hole in terms of the distinctions and how these things are distributed, but they also are distinctions that are important in terms of how we handle them and how we can avoid waste to the extent possible in terms of that cold chain connection. Gavin Newsom: (42:31) That said I wanted to connect more to the cause of education and I wanted to update you on some of that work. Over $80 million in kind and direct supports for new public education campaign, over $80 million. You're going to start seeing these billboards, over a thousand of these billboards are going up, you may have seen some of these already. These are the new iconic ads that we are putting up. You could see this is an actual a mock-up of two billboards that you physically will see not just on a slide, but are about six feet apart, six feet apart, keep your friends safer. Gavin Newsom: (43:11) And you can start to see where we're trying to build a more smash mouth, forgive that phrase, in terms of how we get your attention. So many billboards, so many advertising, and that's why we want to pull these physical bodies, these images out of the billboards themselves so people may pay a little bit more attention. So new public education campaign, you've already seen last few weeks, you'll see a lot more in the next few weeks. They include not just images like you just saw in the last slide but some more creative images and colorful images and you see dogs and fashion and we're just trying to get your attention and just thought I'd try to bring to your attention what we are working on and what you will start to see. A Thousand of those billboards and also a lot of creative done in Mong and Russian, any other languages, not least of which of course always is Spanish and English, et cetera. Gavin Newsom: (44:10) I want to compliment and I want to show you a quick PSA from California Firefighters Foundation, but I really want to thank them, California Fire Foundation. I want to thank the Grocers Association as well, in particular, they're providing a lot of in-kind support and a lot of in-store support as a grocery specifically to connect with people in a trusted way, in a very culturally-competent way. And I hope you'll enjoy just a brief example of at least what the Firefighter Foundation put out in terms of a brand new PSA. Speaker 1: (44:41) Every day we put our lives on the line. Speaker 2: (44:43) So many other workers are having to do the same. Speaker 1: (44:46) We can all do our part to protect each other, wear a mask, wash your hands and stay six feet apart. Join the fight. Speaker 2: (44:54) Slow the spread. Gavin Newsom: (44:58) And I say trusted messengers because no one is more trusted than our firefighters, our nurses, doctors, and I see others along that same vein but I want to just thank our firefighters and just remind you fire season into December, still battling fires down in Southern California. Thank you to our state partners, both mutual aid partnerships, local level, but also just our credible Cal Fire team, thank you to all the men and women at Cal Fire for working so hard and extending that work into December as well. And of course I can never say enough about our nurses and doctors and frontline health care professionals and we're going to be asking more from them than we ever have in the next six to eight weeks. Gavin Newsom: (45:45) And with that last slide, I wanted to introduce you to someone who is very familiar at least in Northern California, Tomas Aragon, who is the new public health director now in the State of California, just announced, or I'm just announcing his ascendancy. I hope ascendancy is from City and County of San Francisco, well-known to me and many others, my former role and capacity as mayor there and health department, that is an extraordinary health department. Gavin Newsom: (46:14) One of the most well-resourced both financially and from a human capital perspective and Tomas has been very active in the fight to eliminate this pandemic, to mitigate not just the spread of this virus but to mitigate number of deaths related to this virus and he's put out a lot of protocols that have been replicated all across the state. We're very, very enthusiastic to have him now on the team to continue to supplement our efforts as we move into this next and challenging phase. With that, of course we're happy now to answer any questions. Speaker 3: (46:57) Amy Taxin, AP. Amy Taxin: (46:59) Thank you for taking our question. We wanted to ask about the new technology that will be available via smartphone. Many other states are using similar technology but they have had relatively few people use it and that limits how effective it can be. Why do you think this will be any more effective in California? What is the state going to do to make sure people download it, especially those who are resistant and what's the plan to reach people who've been reluctant to comply with contact tracing? Gavin Newsom: (47:27) Now, those are wonderful questions and those are questions we've candidly been asking ourselves for a number of months and that's why as I noted in the beginning of this presentation, I wanted to advance a pilot. We advance that pilot with our UCs, we advance that pilot on a number of campuses as well. And we're very pleased with the results and the effectiveness, I showed you over a quarter million people participating in that pilot, went from one UC to seven UCs. But here's why we think it's a little different here in California. Gavin Newsom: (47:58) Also noted, you're absolutely right, in my initial remarks that this is only as good as people's adaptation and utilization. Opting in, it's not an opt-out, you make the decision. It's not a contact tracing app, it's a notification app. If you choose to use it we can leverage more and more utilization which will make us more effective and more meaningful. And I think the answer to your question is this is California, our adaptation, our innovative spirit, our willingness to be on the leading and cutting edge of new technology adaptation not just creation and discovery. And the fact that we have two California-based companies, Apple and Google that are partnering with us and also we'll be promoting this app in the state, in their state, in the state of California, the largest state in the United States I think gives us the capacity with the experience we've had in the knowledge now we have of the effectiveness of these apps that we can see some adaptation. Gavin Newsom: (49:04) But again I'm very, very sober about the adoption rates and I don't expect tens of millions of people, quite the contrary. And we're hoping that there'll be enough to make this meaningful but Apple and Google will be helping in that promotion and you can do the same and I appreciate your question and inquiry. Speaker 3: (49:27) Phil Coline, The FN. Phil Coline: (49:35) Hi there, thanks for your time governor. I wanted to ask and maybe this is a question for Dr. Ghaly if he's there about the timing of these new stay at home orders, given everything we've learned since March. Was there a discussion of putting in place a broader stay at home order say before Thanksgiving instead of a curfew? Can you give some sense of how those discussions went and can you talk about how much you think gathering during Thanksgiving is contributing to the surge now? Gavin Newsom: (50:01) Yeah, now, I appreciate and Dr. Ghaly is here and will come up just in a moment. Look, I mean, the vast majority, the overwhelming majority of Californians are now in this new stay at home order protocol. Let's disabuse ourselves that just because it's three out of five regions that somehow we are neglecting a significant number of individuals. We certainly have two other regions that are not in this order but the vast majority, the overwhelming majority of the population in the state is locked. As it relates to the conversations we had, I can assure you we've had many conversations and we've been gaming this out based upon the facts. The facts determined the when, the facts were ultimately determined on the basis of engagement with local health officers on the how. And with that I will happily stand aside and provide Dr. Ghaly to talk a little bit more about not just the how and the what but also the why we are here in the basis of the question you've asked specifically around concerns with Thanksgiving. Dr. Ghaly: (51:12) Thank you for the question and thank you, governor. Indeed since the beginning of our very first stay at home order we are constantly looking at the various actions not just regionally but statewide. And as we move through this current surge we've been asking the question about what are the right actions looking at the data as the governor mentioned throughout to determine what we would do. We know that these various restrictions are a hardship for people. It's not what we expected at this time of year but we know some of them are required to make sure we get through the surge as quickly as possible and saving as many lives and preventing as many infections as we possibly can. Dr. Ghaly: (52:01) Certainly through the months of October and November, discussing with our local partners the right actions to take, the timing of those actions, moving through in a state-wise way, adding various restrictions and then getting to the point very recently, looking at the ICU capacity, looking at our ability not just to care for COVID but to care for all emergencies and critical health issues in our hospital system, the decision to go with the regional stay at home order. Dr. Ghaly: (52:30) And your question is a very important one as it regards to Thanksgiving transmission. We know that those cases that occurred around people's potentially dinner tables or activities and plans to travel through Thanksgiving are going to show up right about now. Maybe the last couple of days we're seeing that but we know we'll be seeing that for many days to come. Not that this is just the beginning but we believe that the levels of transmission that we've been reporting so far will likely continue to go up so because of those activities around Thanksgiving. So all of these are coming together, these actions, these signals in our data to cause us to do the regional stay at home order the way that we did. Thank you. Gavin Newsom: (53:21) Thank you. Next question? Speaker 3: (53:24) Angela Hart, Kaiser Health News. Angela Hart: (53:28) Thank you, governor. I wanted to direct us to you governor as well as Secretary Ghaly if he wants to weigh in on the appointment of Attorney General Xavier Becerra to lead HHS potentially. I wanted to ask you specifically you've got some big healthcare plans some of which I think we'll be hearing about next month, but even even next year and beyond. I wanted you to speak, governor about the healthcare plans that California has, the ambitions and those that require federal approval and money, reforming Medicaid, I'm thinking about homelessness. Some want to go even bigger on healthcare expansions. What kind of healthcare shops do you think that the Attorney General Becerra brings up to federal level and how can California potentially accomplish more with him at the helm, potentially. Gavin Newsom: (54:16) Right, it's a game changer for us than the stale air of normalcy versus the fresh air progress, so I would describe it in terms of our relationship with the federal government with the new administration and now with our own attorney general ascending to this role. I had a wonderful conversation with the attorney general about all of the above. Every inquiry you are making we can assure you we've been assessing and we've been doing that previous to his announcement and hope and expectation that we would have a strong personal relationship with the new HHS Secretary. But the fact that it's our own Xavier Becerra is a game changer for the State of California and 1115 Waivers on 1332 Waivers on all of the issues related to Cali. And if I've lost most of you it's for good reason but probably not lost Angela on that, he's been following these things very, very closely. Gavin Newsom: (55:10) We're looking on the budget as we speak this afternoon. Again, every day I've been working on preparing the new budget. I make this point over and over and over again, government increasingly, local, state, and federal government is increasingly a healthcare budget and so you can't have a serious budget conversation unless you're talking about healthcare. And we have had our eye and you know well on some big reforms and we have been looking for a great partner and we have found a great administration and even better than hope for partner in our attorney general. And so I'm very enthusiastic about the pick, couldn't be more pleased not just for the attorney general but for this state and for our healthcare future as a state. Gavin Newsom: (55:58) And so we're going to hit the ground running, we're going to take advantage of this moment and these relationships not unfairly. Everybody needs to be treated equally and fairly but California is the largest state with more at stake. In terms of these reforms we want to make sure that we're right there in the beginning and doing everything we can to accelerate these reforms that you are well aware of and more of it will be made more aware of in the coming months as I release the January budget in just a number of weeks. Speaker 3: (56:39) Kevin [inaudible 00:56:41]. Speaker 4: (56:43) Hi governor, I have a couple of education questions. Wondering first, can you explain your thinking and allowing open schools to stay open during the surge after you shut them down in March? And second, as we all know you've emphasized equity as governor but the pandemic has exacerbated school in equity with low-income families having some of the worst access to education. A lot of people are wondering why you haven't done more to intervene directly. Gavin Newsom: (57:10) Well, I don't know, not to disabuse anyone of not intervening directly and we provided $5.4 billion of equity support and I just want to have the opportunity to repeat that. We took CARES Act money, money that could have been spent in any category. And we worked with the legislature to advance $5. 4 billion focused on learning supports. The overwhelming majority of that was money that is set aside specifically for equity. In fact, you may recall there was some dispute with the legislature, they didn't want to go as far as we did, I did in terms of that equity overlay. Gavin Newsom: (57:48) And we were stubborn about it and we maintained a firmness of focus and we were able to work with the legislature to land where we had hoped. We provided two months of PPE, we worked on establishing protocols, processes, and procedures based upon data, based upon facts, based upon epidemiology, and based upon the reality around the world looking at best practices. To look at cohorts, to look at ages, to look specifically at high-needs populations, special needs, and the like, and to look at strategies to cohort individuals and provided a process and protocol for waivers at the local level. Gavin Newsom: (58:28) We put up a tiered status, four tiers, and we made the point, you don't need to be in the orange or yellow tier, even the red tier, you could be in a purple tier and still access waivers. We've been working with our local directors, meaning a local, what we refer to as LEAs these are the local education administrators across the spectrum, and we continue to engage in a very proactive way to provide for support particularly on the issue of testing. One of the reasons we worked very aggressively and made a bold bet and did something no other state in America did in order to get a new testing facility in no small part was to help support our schools to reopen and to be in a position with PCR tests in particular where we can support the testing needs, not just as a state, but specifically for our public schools. Gavin Newsom: (59:23) One of the reasons we were bold and aggressive more than any other state in our country and going after PPE and procuring our own, in fact you may recall that we had at peak just a few weeks ago 40 million more and 95 masks than the entire national inventory just in our state was in no small part to provide supports for our schools and our districts. So we've been very proactive, we've been very focused, and we have been resolved as have I, as a father of four, as someone that believes in the social emotional side of learning to address the concerns and anxieties parents have. We can't have a conversation about equity unless you're talking about issues and struggles and challenges in distance learning. Gavin Newsom: (01:00:12) On multiple occasions, maybe a dozen occasions, we have communicated to you and others our philanthropic efforts. We've actually highlighted them in a report that I would encourage you to take a look at, over three and a half billion dollars of philanthropic support just in the last year and a half that we've been able to bring into the state. Many millions, tens of millions of dollars specifically for Chromebooks to address broadband, to address the digital divide, and to amplify the efforts and support the work that we did with the legislature in terms of that $5.4 billion in learning loss money being used more strategically to address the issue of equity. Gavin Newsom: (01:00:52) None of us are naive about the background rates and the community spread creating stress on the entire healthcare delivery system, school system, and our entire economy. And those stresses are real and they're certainly made very visible with the actions and with the announcement that was made just in the last 24 hours in LA Unified School District. So I hope you are disabused of that engagement and the state's approach in terms of addressing the issues of equity and supporting our districts, but I also hope that you are familiar with that work being an ongoing commitment. And that's why our budget which we'll be submitting just in a few weeks will lay out in more detail and more specificity more supports for our school system, substantially more support, including in the critical issue of testing of which we are fully resolved and committed to addressing head-on. Gavin Newsom: (01:01:51) I hope you'll look forward to more information in that space as I am fully engaged and resolved working with Tony Thurman and working with the incredible, credible leadership of Linda Darling-Hammond to advance the collective cause of safely, safely getting our kids back in school at the same time protecting teachers, paraprofessionals and support staff, and obviously making sure that our kids are safe in that entire experience. Speaker 3: (01:02:22) Phil Willon, L.A. Times. Phil Willon: (01:02:25) Governor, I just want to follow up on Kevin's question. You and your administration have not really hesitated to exercise your executive authority for statewide mandates and uniform restrictions on everything from shopping at a grocery store to getting a haircut, but you've abdicated that executive authority when it comes to school reopenings. You're allowing school district, local school districts to decide and I guess I want to know why that is. And what do you say to parents who feel that private schools for wealthy families get to stay open and that public schools do not? Phil Willon: (01:03:03) They open and that public schools do not in many cases. Gavin Newsom: (01:03:05) I don't know the frame abdicated executive orders, forgive me not understanding that fully, but as it relates to the issue of our default being in-person education, we've been crystal clear in that respect. But you are familiar Phil and I think most folks that covered the state of California familiar with a thousand plus school districts in this state, how we've constitutionally designed our public education system in this state that's unique and distinctive in many respects from perhaps other parts of the state and the globe, and how that is a real bottom up process, not a command and control structure. Localism, I often say is determinative perhaps nowhere more than as it relates to public education in the state of California. Gavin Newsom: (01:03:50) You know well, perhaps written a lot about the local control funding formula that Governor Brown had advanced to advance that cause more, meaning to focus on local decision-making, to focus on local conditions, to focus on English as second language, localize considerations and concerns and strategies and intervention so that we can avoid the top-down dictate when you're dealing with over 6 million public school children. So we had 21 counties, in the state of California there are 58 counties, 21 counties just a few weeks ago, we announced that had full or part time schools that were operating in-person, some hybrid, some just online, obviously number that receive waivers and others that were conducting in-person education. That was a few weeks ago. Gavin Newsom: (01:04:44) And I'll remind you of the slide just 30 days ago, 3.5% Positivity in this state, positivity rate is exploded. I don't know that one should be particularly critical when your positivity rate down, for example, in Riverside County was just at 16.5%. Seeing positivity rates, even North of that in other parts of the state, that there's some concern by teachers, there's concerns by parents. I'm a parent, I've got four young kids. The youngest is four. The oldest is 11 years old. As a parent, when you have background rates that are exploding, when you see ICU's and you see hospital rates that are putting tremendous strain and pressure, that it's not inappropriate for these parents and these professionals to express some concern and anxiety about the safety of their children and the in-person instruction. Gavin Newsom: (01:05:38) So we are working aggressively to get people back into school. I want to see them back into the classroom, but it must be done safely. And I can assure you that we are working to advance that cause. And you'll be hearing a lot more in the upcoming days specifically about our testing strategies, in particular, to address that very real issue in order to get our public schools back and operational as soon as possible. f/announcer: (01:06:09) Lori Weisberg, San Diego Union Tribune. Lori Weisberg: (01:06:13) Thank you, Governor. There's been a lot of confusion over the stay-at-home order as it relates to the lodging industry. And for that reason, you're seeing a lot of different press accounts on what it means. On your public hea- On your order that was signed by the [inaudible 01:06:28] public health officer said, except as otherwise required by law, no hotel and lodging entity in California shall accept out-of-state reservation. So you think, oh, so people from outside California can't stay in a hotel here, but people local can. But then on the website it says for the regional stay at home order, lodging can only offer accommodation for COVID 19 mitigation and containment measures, only for essential workers, et cetera. The State Lodging Association says they're not sure what the order really means because there's this contradictory information. I'm really hoping you can set the record straight. Nobody, no leisure guests can stay in a hotel right now, only essential workers, no matter whether you're from Arizona or from Newport Beach? It's just confusing. Gavin Newsom: (01:07:16) Well, not confusing in the context of the order that we just put out. In these five regions in the state, if you fall below the 15% capacity or you're in a region like the Bay area, where again, we support local decision-making based on the conditions on the ground, where they're now in to these new protocols, the protocols the state put out maintain that it's essential only, lodging could be open for essential workers only. Not for tourists, not for leisure, in those areas that have fallen in to those categories. Three specific regions now in the state, two regions that remain subject to preexisting rules. That said, [inaudible 01:07:58] Dr. Ghaly come up and he could perhaps amplify that a little bit more. And more importantly, because of the specificity of your question, you should expect my team to reach out directly to you and provide you more clarity so that you'll see that in more specific terms. Dr. Ghaly: (01:08:19) Thank you, Governor. And yeah, thank you for the question. We are working to be clear on that in some upcoming FAQ's that will be posted on exactly this question and some others as it relates to the regional stay-at-home order. But top-line point of the regional stay-at-home order is the focus at staying at home. We really do, in those areas where ICU capacity has dropped below a specific level, encourage, really require people, if it's not essential for you to leave your home, if you aren't doing one of the outdoor activities with your household with quite a bit of space between you and others, that the point is to stay at home during this critical time to bring transmission rates down, to help us get this under control so our hospitals can do what they have done for so long, which is provide high quality healthcare to all of those Californians who need it. Dr. Ghaly: (01:09:17) So as it relates to travel in specific, if you're in one of the two regions currently which are under the regional stay at home order, we ask you not to travel for leisure. If you need to travel and must stay overnight in a hotel in any of the regions in California as a result of your work, that is still permitted. And we know that it needs to continue to keep our infrastructure moving in California in these critical sectors operating. The other area is for quarantine or isolation. Some communities have brought on hotel rooms and we encourage that to allow people who can't easily isolate in their homes or their accommodations to have a hotel to be able to do that effectively so we can reduce transmission. So in those two cases, we know that hotels and the travel industry will be functioning as it has been. And then those other limitations will be clarified through some additional written, posted guidance around the regional stay-at-home order that will be up very soon. Thank you. f/announcer: (01:10:23) Final question. Elex Michaelson, Fox 11 News. Elex Michaelson: (01:10:28) Thank you Governor. An informational question and then a more broad question. First, the informational question. I'm wondering if you can give us some context on where ICU use would be normally at this time of year, and also any thoughts on trying to bring back the USS Mercy ship? And the broader question, we've heard from so many people whose businesses are being shut down by some of these orders who are really frustrated that they feel like they have not seen enough evidence that point to quote, " Outdoor restaurants spreading COVID in a major way, hair salons, nail salons, spreading COVID in a major way." And I'm wondering what you say to these people who say, "Look, I've done everything you've asked. I followed the rules. I spent a lot of money on PPE. My staff is on the brink of losing their jobs. We're on the brink of losing our business. It's the holiday season." What do you say to these people who are really desperate and confused and angry right now? Gavin Newsom: (01:11:28) Yeah, I said it Friday, I said it Monday, I'll say it again today. I'm deeply empathetic and deeply committed to advancing the cause of supporting our small businesses during this trying and challenging time. You saw just last week, the state of California put up half a billion dollars, $25,000 grants, not just to small businesses, but cultural institutions and nonprofits. Those dollars are now going out the door. Gavin Newsom: (01:11:56) If you're a small restaurateur, you're a barbershop, you're a nail salon, encourage you to go to the COVID-19.ca.gov website, COVID-19.ca.gov website to avail yourselves to information about those half a billion dollars in supports. And by the way, that's just interim support to get us to January where we are asking and working with the legislature to get early action to provide even further supports. We have a hundred million dollars of additional money that we put up in hiring tax credits for those that can hold the line, bring a few part-time employees or full-time employees back. Those dollars were just made available starting last week. We are waiving sales tax from being collected and distributed back to the state. We are allowing people that have collected sales tax in the past an additional 90 days without penalty and without any fees associated, to utilize those dollars as a float to help support their business operations. Gavin Newsom: (01:12:56) Those are three specific actions that have just been taken in the state. And those are just three among many subsequent actions, as it relates to small business loans for people that are falling through the cracks, that don't have traditional relationships with credit unions or banks that we are providing. We refer to it as first loss program. It's a novel program that Janet Yellen, now the new treasury secretary, working on behalf of our economic advisory task force. She created this program, supported by the legislature, hundred million dollars. We have put in to a program with leveraged resources, not just direct resources, hoping to get to 125 million all in, just in that first loss program. So those are among the supports. Gavin Newsom: (01:13:41) I am a small business owner. I started right out of college, put pen to paper, opened a small business with one part-time employee was the cause of my life. I deeply recognize people's pain and suffering this moment, their dreams being shattered because of this pandemic. So you asked me how I feel. It devastates me to know because I intimately understand what it means when you put everything on the line, you leverage everything, your family, your dreams are on the line and through no fault of your own something global, a pandemic hits and creates all of these constraints and all these constructs that are devastating to your life and your prospects for the future. And so we need the federal government to recognize that and to reconcile the fact they are not doing their job to provide additional supports at the scale that's required of this moment by extending the PPP program, by extending small business loans and grants to help support folks in this time of need. Gavin Newsom: (01:14:47) What California is doing is not unique in the nation. Quite the contrary. What is unique is we tend to be proactive, we tend to lead in many respects, and I recognize that comes with consequence and struggle. And all I'm asking folks is, know this, this is the third wave. We don't anticipate a fourth. Vaccines are on the way. Over 2.1 million doses of vaccine, we anticipate to distribute by the end of this calendar month, millions more in January and February. We're going to come out the other side, more resilient, more capable. We're going to provide more supports with the legislature on commercial evictions. We hope to do the same on rental evictions. We have a lot of work to do across the spectrum, including public schools. So people can go back to work, so people [inaudible 01:15:32] support they need, and to get these kids educated and address the learning loss that's self-evident and profound. Gavin Newsom: (01:15:39) So forgive me for being long-winded. And I know particularly, Elex for work you do, that's not anything you can use, but I hope you hear a congruence because this is not an intellectual thing for me, as someone literally who's here because of my entrepreneurial background that got me engaged in local government initially, that led me to be on a commission, the parking commission in San Francisco, led me to want to serve in a board of supervisor capacity, ultimately run for mayor. I have reverence, not just respect, reverence for small businesses, reverence for entrepreneurs, and it breaks my heart to see videos, it breaks my heart to see reports you and others of people's lives being torn asunder because of this pandemic. And we're just simply trying to do our best. And I recognize it's never good enough, but we're not going to give up and we're going to continue to do our best to provide more support during this very, very challenging time. As it relates to ICU capacity, let me ask Dr. Ghaly to answer that more specifically. Dr. Ghaly: (01:16:55) Thank you Governor. And yeah, right now we are, hospitals usually prepare for an upcoming flu season. They start to put together their plans on how they're going to moderate demand for ICU beds, because they anticipate that some additional patients, not just with flu, but with respiratory illnesses altogether, flu actually isn't an illness that always lands you in the ICU. Many people need an inpatient bed, but not an ICU bed necessarily. Just to give you some context, different facilities across the state, they might be half-full in their ICUs, some might be on the brink of being entirely full. That's why we look at this regionally as a set of beds that are available to treat people in this emergency for COVID. Another important point is at the peak of the summer, some of the regions dealing with COVID had roughly 35% of their ICU capacity filled with COVID positive patients. Dr. Ghaly: (01:17:52) We've seen that figure eclipsed. We think about that as new workload for the ICUs that wasn't there before. So even if you were running at 50 or 60% capacity before COVID, you might be running close to 90, 95%. And those facilities that were running higher are even more impacted. That's why with the great work and partnership with our hospital partners, they have made decisions about how to control demand for ICU beds, increasing their staffing as much as they can, working to cut down demand by delaying, for a period of time, some procedures and scheduled surgeries that could in fact be safely delayed. But there's limits to that. You can only staff up so much because the ICU staff are in such demand, not just here in California, but across the nation. Dr. Ghaly: (01:18:45) You can only wait to put in a new heart valve or a dialysis catheter or all of these procedures that are indeed scheduled, sometimes called elective procedures. But they're elective may be for a day or two, but not for months. We start to see morbidity and mortality from things other than COVID very quickly. And our state is committed to health broadly, not just around COVID health. We want that capacity to be there for you when there's a car accident, God forbid, or when a heart attack or a stroke happens. We talk about all of this together to assure you we're looking at this ICU issue as one, not just because we're worried about the demand, yes we are, but not only because of the COVID demand, but broad demand. Dr. Ghaly: (01:19:28) And the hope that the governor talked about with vaccines, indeed that 2.16 million doses that we see coming in December, those are first doses. That is not to be cut in half. That is not to say, we're going to give the first half out in the month of December and save the second half for January 2nd doses. We have a commitment to get the second doses to those doses three weeks afterwards, so that we have enough to give that second dose and we can continue to build up the number of people who get this additional tool, this additional benefit of a vaccine to protect them from COVID. Dr. Ghaly: (01:20:04) So all of this, these decisions are happening now today because we're at a certain point in our response. We're not sort of... I love sports, I think about half-time as an important moment. Many of us see us sort of crossing that half-time, coming to this important period where there is light on the end of the tunnel, there is some hope with vaccines, quite a bit of hope, and that we are actively working. And that's why the governor is so committed to sharing where we are with vaccinations, so that we can combine our efforts of today to really reduce transmission and take another set of hardships, personally, whether it's businesses or individuals or all of these aspects of our lives that are being impacted with that hope of vaccines coming to really get us through this third surge. Dr. Ghaly: (01:20:52) So really working together, the ICUs is a very important metric for us, preserving it is going to help us save lives. Preserving it's going to help us create the room that we need in our healthcare delivery system to serve all of you at home, if God forbid, you need that care in the days and weeks to come. Thank you. Gavin Newsom: (01:21:13) So a sprint, not a marathon to a vaccine, a few more months where we're just going to have to step up, meet this moment as we always do, as Californians, come out the other side more resilient, more capable than we ever could have imagined. We are resolved to do that. And we resolve to do our best to mitigate the spread of transmission of this virus, eliminate or rather, reduce the extent are possible, the deaths related to this pandemic, and do our best to help support our small businesses and our kids in terms of this very challenging and difficult moment. Gavin Newsom: (01:21:51) So with that, I want to thank everybody for the opportunity to update, and we'll be providing more updates over the course of this next week. Encourage everybody that wants more information about any of the issues and ideas came out from the app itself, to more information about the vaccines and more information about testing, whatever it may be, we encourage you to go to the COVID-19.ca.gov website. COVID-19.ca.gov. Take care, everybody.